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A comparison between the amblyopic eye and normal fellow eye ocular architecture in children with hyperopic anisometropic amblyopia

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... A.O. Khan и соавт. сравнили структуру переднего и заднего отрезка амблиопичных и парных глаз у 14 пациентов с гиперметропической анизометропической амблиопией [46]. Пациентов обследовали с использованием двух методов: определения топографии роговицы для измерения кривизны передней и задней части, толщины и объема роговицы, объема и глубины передней камеры и проведения OКТ для измерения слоя нервных волокон, центральной толщины и объема макулы. ...
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Child health is a global health priority. Anomalies of refraction, complicated by amblyopia and squint, occupy one of the leading places in the pathology of the visual system of children. According to data obtained from 26 regions of Russia, the leading place in the ocular morbidity of children and adolescents is occupied by ametropia and strabismus with amblyopia. They account for up to 90 % of all cases of visual impairment in childhood. The term amblyopia is understood to mean a decrease in the maximum corrected visual acuity that occurred at an early age, which is caused by disorders of the functions of the visual analyzer, without changes in the fundus and organic lesions of the visual pathways and centers. Despite the outstanding achievements of 21st century medicine, today the questions of the pathophysiological essence of this condition remain open, which is the subject of discussions among pediatric ophthalmologists around the world. In this regard, the literature review presents the results of domestic and foreign authors who studied the morphological (optical coherence tomography) and functional (electroretinography, microperimetry) features of the retina in dysbinocular and anisometropic amblyopia. Some authors have demonstrated the presence of differences in the thickness of the central region and the layer of nerve fibers in patients with amblyopia compared with paired and healthy eyes, their correlation with functional parameters, as well as changes in the thickness of the choroid and microvasculature of the retina. Recently, there have been works devoted to the study of the photosensitivity of the retina in patients with amblyopia and visual rehabilitation using this equipment. A number of authors have shown that with amblyopia, the retinal photosensitivity parameters in the central region are reduced, and there is a correlation between these changes and morphological changes in the posterior pole. The microperimeter also makes it possible to carry out visual rehabilitation, in particular in pediatric patients, and isolated results have been published on the use of this method in patients with amblyopia. The literature data are quite contradictory, and more research remains to be done to determine whether these changes in the retina are primary in relation to this disease, or whether they can be the result of retrograde changes that are obscured by defocusing of visual images from birth.
... To detect RNFL-T changes in different ocular and systemic conditions is crucial because OCT measurements are widely used in various macular (central serous chorioretinopathy, macular hole, epiretinal membrane, wet age-related macular degeneration), retinal vascular (branch retinal vein occlusion, central retinal vein occlusion, diabetic macular edema) diseases, glaucoma [27], in the differentiation between true edema and pseudoedema of the optic disc [28], optic neuritis [29], and systemic diseases such as multiple sclerosis, neuromyelitis optica [30], systemic lupus erythematosus [5], obstructive sleep apnea syndrome [31], pituitary adenomas [32], scleroderma [33], Alzheimer's disease [34], bipolar disorder [35], iron or vitamine B 12 deficiency anemia [36], metabolic syndrome [37], Wolfram syndrome [38], amyotrophic lateral sclerosis [39], psoriasis vulgaris [40], Parkinson disease [41], HIV-positive patients [42], systemic arterial hypertension [43], major depressive disorder [44], chronic obstructive pulmonary disease [45], end-stage renal disease [46], asthma [47], and drugs such as inhaler corticosteroid [47], ethambutol [48], and cocaine [49]. Because of such a widespread area of use in daily practice, we should not ignore factors which could affect RNFL-T. ...
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Objective To detect retinal nerve fiber layer thickness differences of ambylopic and fellow eyes and ambylopic and control eyes. Methods The study comprised a total of 152 eyes recruited from Erzurum Region Training and Research Hospital, Turkey, between January 2018 and May 2018. Anisometropic amblyopia was the only cause of disability (visual acuity ≤ 6/12 and a difference in best-corrected visual acuity (BCVA) between the two eyes of 0.20 logMAR (2 lines on an acuity chart) in amblyopic eyes (n, 74) whereas normal eyes had a best-corrected visual acuity of 6/6 and no morbidities (n, 78). Anisometropic patients were divided into three groups as hyperopic, myopic, and cylindiric. All amblyopic eyes were compared with fellow eye and control group. Retinal nerve fiber layer thickness was analyzed using optic coherence tomography (OCT) (RTVue 100-2, Optovue, Inc. Fremont, CA). Results The mean age of the patients was 28.64 ± 8.23 years in amblyopia group and 32.23 ± 8.14 years in control group (p, 0.008). Mean best-corrected visual acuity (BCVA) was 0.36 ± 0.23 in amblyopic eyes, 0.96 ± 0.15 in fellow eyes, and 1.00 ± 0 in control group. Mean refractive error was 2.76 ± 7.84 in amblyopic eyes, 0.42 ± 1.34 in fellow eyes, and 0.12 ± 0.27 in control group. Temporal retinal nerve fiber layer thickness (RNFL-T) was 77.27 ± 10.38 μ, 79.31 ± 9.53 μ, and 81.46 ± 9.86 μ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.036). Superior RNFL-T was 136.23 ± 18.52 μ, 131.91 ± 13.80 μ, and 135.56 ± 14.94 μ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.204). Nasal RNFL-T was 87.99 ± 13.05 μ, 82.16 ± 12.33 μ, and 85.50 ± 10.62 μ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.014). Inferior RNFL-T was 144.85 ± 18.39 μ, 140.55 ± 16.92 μ, and 143.47 ± 17.75 μ respectively in ambylopic group, fellow eyes, and control eyes (p, 0.322). There was statistically significant difference in temporal and nasal quadrants and no statistical difference in superior and inferior quadrants. Discussion The presence of amblyopia seems not to be related with RNFL-T so we could ignore anisometropic amblyopia in patients with disease that could be detected and followed via RNFL thickness. Further and larger scaled studies are needed for certain results.
Chapter
Purpose: To analyze the advantages of optical coherence tomography (OCT) or OCT angiography to detect retinal nerve fiber layer (RNFL) thickness abnormalities, changes in the macula and in the choroidal thickness in amblyopic patients.
Book
This book reviews recent important advances in the use of optical coherence tomography (OCT) in order to analyze neurodegeneration within the retina through the quantification of axonal loss. Detailed information is provided on the role of OCT as a promising tool for the evaluation of disease progression in numerous neurodegenerative disorders and as a biological marker of neuroaxonal injury. The disorders considered include multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, intracranial hypertension, Friedreich’s ataxia, schizophrenia, hereditary optic neuropathies, glaucoma, and amblyopia. Individual chapters are also devoted to OCT technique, new OCT technology in neuro-ophthalmology, OCT and pharmacological treatment, and the use of OCT in animal models. By documenting the ability of OCT to provide key information on CNS diseases, this book illustrates convincingly that the eye is indeed the "window to the brain".
Chapter
The purpose of the study is to analyze the advantages of optical coherence tomography (OCT) to detect retinal nerve fiber layer (RNFL) thickness abnormalities and changes in the macula in amblyopic patients. Studies were selected through an electronic search on PUBMED, EMBASE and GOOGLE SCHOLAR using the following terms: “Optical coherence tomography in amblyopia”, “OCT and amblyopia”, “Optical coherence tomography and anisometropic amblyopia”, “Optical coherence tomography and strabismic amblyopia”. We found that optical coherence tomography is a rapid, non-invasive imaging technique allowing objective quantification of retinal structures with high resolution; it can be successfully applied to young children, even those who are neurologically disabled or less cooperative. New generations devices, such as spectral domain OCT, have led to a dramatic increase in sensitivity that enables high-speed imaging. OCT technology could be also an useful biomarker for evaluating progressive thinning of RNFL over time and changes in the macula in amblyopia. Evidence for direct retinal changes in eyes with amblyopia has been controversial, so that further studies with large sample are required.
Article
An 8-year-old girl was seen for evaluation of recently recognized glaucoma. The history was given of her swollen knees at 18 months followed by recognition of bilateral iritis at 4 years of age, controlled with remittent topical steroids. At 7½ years of age, her parents noticed dilation of the right pupil followed in 1 month by initial intraocular pressure measurements of 33 mm Hg in both eyes. On initial examination at 8 years, the elevated intraocular pressures were 42 mm Hg in both eyes associated with advanced cupping in both eyes, greater in the right eye than in the left eye, and poorly reactive pupils with a relative afferent pupillary defect in the right eye. The lenses were clear. Gonioscopy revealed open angles with no synechial abnormalities. Goniosurgery was performed consisting of goniotomy X2 in the right eye and X1 in the left eye. On examination 6 months following surgery, her intraocular pressures were 14 mm Hg in both eyes. Inspection of the iris showed circumferential pupillary sphincter atrophy in the right eye greater than in the left eye. Anisocoria was present secondary to a larger right pupil. The right pupil constricted minimally and a relative afferent pupillary defect was still evident in the right eye. Slit-lamp examination of the right lens showed multiple anterior cortical irregular white opacities that continued into the equatorial region (Figure 1). The left lens was clear. Persistent advanced cupping was present with minimal vascularization of the right disc versus the more normal disc in the left eye. The correct answer to What’s Your Diagnosis? is glaukomflecken (cataracta glaukomatosa) associated with ischemic iris atrophy.…
Article
To compare the anterior and posterior ocular architecture of amblyopic and normal fellow eyes in children with hyperopic anisometropic amblyopia. Fourteen subjects with hyperopic anisometropic amblyopia were examined using the Pentacam and optical coherence tomography. For each participant, the amblyopic eye was compared to the fellow non-amblyopic eye. There were no significant differences (P > 0.05) in the anterior corneal curvature, posterior corneal curvature, central corneal thickness, corneal volume, anterior chamber depth, anterior chamber volume, peripapillary retinal nerve fiber layer, central macular thickness, and macular volume between the amblyopic eye and fellow eye of the study participants. The Pentacam and optical coherence tomography revealed no differences in the anterior and posterior ocular architecture between the amblyopic eye and fellow eye in children with hyperopic anisometropic amblyopia.
Article
Urrets-Zavalia syndrome is a surgical complication in which the pupil remains fixed and dilated after a procedure. It is believed to be caused by brief periods of high intraocular pressure. Although the syndrome was originally associated with penetrating keratoplasty, it has subsequently been associated with other procedures. We report the case of a 13-year-old boy with congenital glaucoma who developed Urrets-Zavalia syndrome after goniotomy. After 2 years of follow-up, the pupil remained fixed and dilated in that eye. To our knowledge this is the first case of Urrets-Zavalia syndrome to be reported following goniotomy and the first to occur in a child.
Article
In nonamblyopic eyes of hyperopic children, axial length has a consistent mathematical relationship to cycloplegic refraction and keratometry such that estimated axial length = ([-0.04 × refraction] + 2.98) × (corneal radius)]. The purpose of this study is to determine whether the pathophysiology of amblyopia affects this relationship. This a prospective case series of children 5 to 16 years of age diagnosed with esotropia related to uncorrected hyperopia who underwent keratometry and optical biometry by the IOLMaster in addition to cycloplegic refraction. The equation was assessed in affected eyes of consecutive children with unilateral amblyopia (at least 2 lines interocular difference with refractive correction). Of the 23 identified children (16 males, 7 females, 5-14 years of age), all had a cycloplegic spherical equivalent of ≥+2.75 D in at least one eye, 14 were anisometropic (by >1.00 D), and none had myopia. Estimated and measured axial lengths of amblyopic eyes were strongly correlated (Pearson coefficient 0.9; 95% confidence interval, 0.79-0.96) and did not differ significantly by the 2-sided paired t test (P = 0.3; difference between means, 0.1). The two values differed by ≤ 0.5 mm for most eyes (20/23) and were within 0.9 mm for all eyes, similar to what has been described for nonamblyopic eyes. The intraocular relationship of axial length to cycloplegic refraction and keratometry in hyperopic nonamblyopic eyes is maintained in hyperopic amblyopic eyes. Thus, the pathophysiology of amblyopia in this setting does not involve a mismatch among these biometric variables.
Article
To explore the relationships among cycloplegic refraction, keratometry, and axial length in children with refractive accommodative esotropia and to evaluate the feasibility of axial length estimation from the other 2 parameters. This is a prospective case series of children ages 4-12 years who were diagnosed with refractive accommodative esotropia, cooperative for keratometry and optical biometry by the IOLMaster, and without amblyopia in the right eye. The right eyes of the first group of patients were used to generate a linear regression formula from cycloplegic refraction, keratometry, and axial length. This formula was used in the second group of patients to estimate axial length from cycloplegic refraction and keratometry. A total of 100 children were enrolled. Cycloplegic refraction ranged from +2.25 D to +8.25 D, keratometry ranged from 38.34 D to 48.37 D, and measured axial length ranged from 19.34 mm to 23.66 mm. Estimated and measured axial lengths were strongly correlated (Pearson coefficient = 0.9; 95% CI, 0.83-0.94) with the former values having a greater mean by the paired t test (2-sided P < 0.0001; difference between means, 0.27 mm). Estimated and measured values differed by <0.5 mm for most eyes (33/50, 66%) and were within 1 mm for all eyes. In children with refractive accommodative esotropia, there exists a constant mathematical relationship among cycloplegic refraction, keratometry, and axial length. This relationship allows reasonable estimation of axial length from the other 2 parameters.
Article
The aim of this study was to investigate the ocular parameters and their contribution to total axial length, and any inter-ocular differences when compared to the fellow non-amblyopic eye, in a population of paediatric amblyopes. Inter-ocular differences in visual acuity, refractive error, corneal curvature, anterior chamber depth and their contribution to total axial length were analysed in four populations: adult controls (n=26), paediatric controls (n=24), paediatric strabismic amblyopes (n=18) and paediatric anisometropic amblyopes (n=27). In the two control groups, there were small inter-ocular differences between the components, none of which were statistically or clinically significant. Anisometropic amblyopic eyes were found to have statistically and clinically significant differences in refractive error, crystalline lens power, vitreous chamber depth and total axial length when compared to the fellow eye. Anterior and vitreous chamber depths, when expressed as a percentage of the anterior and vitreous chambers in the non-amblyopic fellow eye, were approximately 95% of the size. When parameters were normalised by expressing as a percentage of total axial length, the contribution of the anterior chamber, crystalline lens and vitreous chamber to total axial length in both eyes were comparable, suggesting that all components of the anisometropic amblyopic eye are proportionately reduced in size. The strabismic amblyopic eyes were in the main isometropic. There were however statistically significant differences in anterior chamber depth, crystalline lens power, vitreous chamber depth and total axial length, but not in crystalline lens thickness. When the components were expressed as a percentage of the component in the non-amblyopic fellow eye, the anterior and vitreous chambers were approximately 90% of the size of the fellow non-amblyopic eye and made a significantly smaller contribution to total axial length when normalised. Crystalline lens thickness contributed significantly more to the total axial length in a strabismic eye. This suggests that, unlike control eyes or anisometropic amblyopic eyes, the strabismic eye is physically, though not proportionately, reduced in size.
Urrets-Zavalia A. Fixed, dilated pupil, iris atrophy, and secondary glaucoma
Urrets-Zavalia A. Fixed, dilated pupil, iris atrophy, and secondary glaucoma. Am J Ophthalmol 1963;56:257-65.