A pilot cross sectional study was conducted to investigate the role of red blood cells (RBC) deformability in type 2 diabetes mellitus (T2DM) without and with diabetic retinopathy (DR) using a dual optical tweezers stretching technique. A dual optical tweezers was made by splitting and recombining a single Nd:YAG laser beam. RBCs were trapped directly (i.e., without microbead handles) in the dual optical tweezers where they were observed to adopt a “side-on” orientation. RBC initial and final lengths after stretching were measured by digital video microscopy, and a Deformability index (DI) calculated. Blood from 8 healthy controls, 5 T2DM and 7 DR patients with respective mean age of 52.4yrs, 51.6 yrs and 52 yrs was analysed. Initial average length of RBCs for control group was 8.45 ± 0.25 μm, 8.68 ± 0.49 μm for DM RBCs and 8.82 ± 0.32 μm for DR RBCs (p < 0.001). The DI for control group was 0.0698 ± 0.0224, and that for DM RBCs was 0.0645 ± 0.03 and 0.0635 ± 0.028 (p < 0.001) for DR group. DI was inversely related to basal length of RBCs (p = 0.02). DI of RBC from DM and DR patients was significantly lower in comparison with normal healthy controls. A dual optical tweezers method can hence be reliably used to assess RBC deformability.

Citation: Bradley PD, Sim DA, Keane PA, et al. The evaluation of diabetic macular ischemia using optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2016;57:626-631. DOI:10.1167/iovs.15-18034 PURPOSE. The purpose of this study was to compare optical coherence tomography (OCT) angiography to standard fluorescein angiography (FA) in the grading of diabetic macular ischemia.METHODS. In our study, OCT angiography and traditional FA images were acquired from 24 diabetic patients. The level of diabetic macular ischemia in the superficial capillary plexus was graded with standard Early Treatment Diabetic Retinopathy Study (ETDRS) protocols and a comparison between conventional FA and OCT angiography was performed. The deep vascular plexus and choriocapillaris were also graded for macular ischemia. Additionally, flow indices were analyzed for all OCT angiography images. RESULTS.We identified moderate agreement between diabetic macular ischemia grades for conventional FA and OCT angiography (weighted j of 0.53 and 0.41). In addition, the intergrader agreement for the superficial, deep, and choriocapillaris scores was substantial (weighted j of 0.65, 0.61, and 0.65, respectively). Finally, the parafoveal flow indices were shown to have a statistically significant relationship with diabetic macular ischemia grades for the superficial capillary plexus (P ¼ 0.04) and choriocapillaris (P ¼ 0.036), with a trend toward significance for the deep capillary plexus (P ¼ 0.13).CONCLUSIONS. We demonstrated moderate agreement between diabetic macular ischemia grading results for OCT angiography and conventional FA using standard ETDRS protocols. We also showed that OCT angiography images could be graded for diabetic macular ischemia with substantial intergrader agreement.Keywords: diabetic macular ischemia, optical coherence tomography, fluorescein angiography D iabetic macular ischemia (DMI) is an important clinical feature of diabetic retinopathy (DR). It has been postulated that the selective loss of pericytes and thickening of the basement membrane in retinal capillaries occurs as a result of exposure to elevated blood glucose over an extended period of time.1 Clinically, DMI is defined by an enlargement of the foveal avascular zone (FAZ) and paramacular areas of capillary nonperfusion.2 In a previous paper, we have demonstrated that a large proportion (approximately 41%) of patients with DR in a tertiary hospital setting have some evidence of macular ischemia. 2 Of note, this study demonstrated that visual function was affected only in those with moderate to severe macular ischemia. 2 More recently, an analysis of the RIDE and RISE trials showed that patients with DMI at baseline progressed earlier to neovascular complications of DR during intravitreal ranibizumab treatment than those with normal perfusion at baseline. Therefore, baseline assessment of DMI when initiating ranibizumab therapy for diabetic macular edema (DME) has clinical implications and may be of practical importance to patients and physicians...

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The superficial retinal capillary plexus is present in cases with foveal hypoplasia, while the deep retinal capillary plexus is absent to varying degrees. Our findings support the hypothesis that an intact foveal avascular zone of the deep capillary plexus allows for outer retinal photoreceptor specialisation to occur unimpeded, resulting in preserved visual acuity, while this process may be inhibited by an absent deep capillary foveal avascular zone with resultant poor vision.

Purpose: To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. Design: Retrospective case-control study. Methods: This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. Results: The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model ( p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group ( p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group ( p < 0.001). The reported dysphotopsia was not significantly different between both groups ( p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. Conclusion: Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

This effect persisted even after adjusting for potential confounding factors. Conclusions:Patients with higher values of QFT (>1.5) are more likely to be associated with treatment success with ATT. In our model, steroid sparing immunosuppressive agents reduced the chances of success, in both ATT and 3 non ATT treated patients. It is unclear whether this effect reflects the intrinsic underlying severity of disease (i.e. study bias), or whether steroid sparing immmunosuppresive agents mitigate against successful ATT therapy.4

Intraocular TB can be associated with significant ocular morbidity. Early recognition, treatment, and regular follow-up of this complex disease may help to reduce visual morbidity and ocular complications.

Scedosporium apiospermum, the anamorphic form of Pseudallescheria boydii, is a filamentous fungus with low inherent virulence. Increasing numbers of cases of this infection have been reported probably related to the rising number of immunosuppressed persons. Apart from mycetoma, cutaneous and subcutaneous infection is rarely encountered in clinical practice. We describe a case of cutaneous infection caused by Scedosporium apiospermum in a subject with rheumatoid arthritis and diabetes mellitus who was submitted to long-term therapy with cyclosporin and corticosteroids. Histopathologic examination of a skin biopsy showed a granulomatous infiltrate with hyaline septate hyphae. Culture of two skin biopsies taken at two different observations of the woman, 3 weeks apart, allowed isolation of Scedosporium apiospermum. Therapy with itraconazole, 400 mg/day, for 3 months was effective in curing the infection.