cbd oil for central serous retinopathy

Articles

Blood is one of the main absorbers in the near-infrared spectrum and thus retinal vessels appear dark in near-infrared reflectance (NIR) images. Proliferative diabetic retinopathy (PDR) is characterized by abn.

Authors: Sara Vaz-Pereira, Manuel Monteiro-Grillo and Michael Engelbert

Citation: International Journal of Retina and Vitreous 2020 6 :59

Content type: Original article

Published on: 23 November 2020

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Safety and cost-effectiveness of single-use endolaser probe reprocessing in vitreoretinal surgery

Endolaser probes have been designed and sold for single-use only. However, in Brazil, they are not included in the list of single-use medical products that are prohibited from being reprocessed and could poten.

Authors: Leandro Cabral Zacharias, Lívia da Silva Conci, Bianca Partezani Megnis, Janaina Guerra Falabretti, Taurino dos Santos Rodrigues Neto, Epitácio Dias da Silva Neto, Rony Carlos Preti, Leonardo Proveti Cunha and Mário Luiz Ribeiro Monteiro

Citation: International Journal of Retina and Vitreous 2021 7 :22

Content type: Original article

Published on: 17 March 2021

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Smartphone fundus photography: a narrative review

The idea to use smartphone for fundus photography was put forward in 2010. Over the last decade, there has been a dramatic development in this field. This narrative review focuses on the principle of smartphon.

Authors: Usama Iqbal

Citation: International Journal of Retina and Vitreous 2021 7 :44

Content type: Review

Published on: 8 June 2021

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Safety and tolerability evaluation after repeated intravitreal injections of a humanized anti-VEGF-A monoclonal antibody (PRO-169) versus ranibizumab in New Zealand white rabbits

To evaluate the retinal toxicity after repeated intravitreal injections of a humanized anti-VEGF-A monoclonal antibody (PRO-169) versus ranibizumab in New Zealand white (NZW) rabbit eyes.

Authors: Leopoldo Baiza-Durán, Alejandra Sánchez-Ríos, Joel González-Barón, Oscar Olvera-Montaño, Elba Correa-Gallegos, Andrea Navarro-Sánchez and Patricia Muñoz-Villegas

Citation: International Journal of Retina and Vitreous 2020 6 :32

Content type: Original article

Published on: 28 July 2020

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Intravitreal aflibercept following treat and extend protocol versus fixed protocol for treatment of neovascular age-related macular degeneration

To assess the morphological and functional outcome of intravitreal aflibercept following the treat and extend protocol compared to the fixed protocol for treatment of eyes with neovascular age-related macular .

Authors: Alaa Din Abdin, Asem Mohamed, Cristian Munteanu, Isabel Weinstein, Achim Langenbucher, Berthold Seitz and Shady Suffo

Citation: International Journal of Retina and Vitreous 2021 7 :74

Content type: Original article

Published on: 7 December 2021

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Choroidal thickness in relation to urinary albumin excretion rate in type 2 diabetes mellitus without retinopathy

To evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) in relation to the urinary albumin excretion rate (UAER).

Authors: Doaa Maamoun Ashour, Amany Abd El-Fattah El-Shazly, Randa Hesham Ali Abdelgawad and Mohamed Ibrahim Saleh

Citation: International Journal of Retina and Vitreous 2021 7 :61

Content type: Original article

Published on: 16 October 2021

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Retinal and choroidal thickness in pediatric patients with sickle cell disease: a cross-sectional cohort study

To measure the retinal/choroidal thicknesses in the macular area of asymptomatic pediatric patients with sickle cell disease (SCD).

Authors: Juliana Prazeres, Luiz Filipe Lucatto, Adriano Ferreira, Nilva Moraes, Josefina A. P. Braga, Luiz H. Lima, Caio Regatieri and Maurício Maia

Citation: International Journal of Retina and Vitreous 2022 8 :15

Content type: Original article

Published on: 4 March 2022

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25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes.

Authors: Gordon T. Brown, Sangeethabalasri Pugazhendhi, Robert M. Beardsley, John W. Karth, Peter A. Karth and Allan A. Hunter

Citation: International Journal of Retina and Vitreous 2020 6 :56

Content type: Original article

Published on: 16 November 2020

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Relation between lipid profile, blood pressure and retinopathy in diabetic patients in King Abdulaziz University hospital: a retrospective record review study

Diabetic retinopathy (DR) is a major cause of blindness worldwide, threatening the vision of approximately 10% of patients with diabetes. Many studies have demonstrated that intensive control of the risk facto.

Authors: Khadijah Alattas, Dania W. Alsulami, Rahaf H. Alem, Felwa S. Alotaibi, Bayan A. Alghamdi and Layan S. Baeesa

Citation: International Journal of Retina and Vitreous 2022 8 :20

Content type: Original article

Published on: 9 March 2022

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Preoperative imaging optimized for epiretinal membrane surgery

To compare imaging modalities for visualizing primary epiretinal membrane (ERM) with each other and with intraoperative digital images (IDI) after blue staining.

Authors: Elise Philippakis, Raphaël Thouvenin, Sarra Gattoussi, Aude Couturier and Ramin Tadayoni

Citation: International Journal of Retina and Vitreous 2021 7 :32

Content type: Original article

Published on: 13 April 2021

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Macular and choroidal thicknesses in a healthy Hispanic population evaluated by high-definition spectral-domain optical coherence tomography (SD-OCT)

To report normal values of macular and choroidal thickness obtained from a healthy Hispanic population using Optovue (Optovue Inc, Freemont CA, USA) spectral domain optical coherence tomography (SD-OCT).

Authors: Diana A. Cortés, Daniela Roca, Pedro Iván Navarro and Francisco J. Rodríguez

Citation: International Journal of Retina and Vitreous 2020 6 :66

Content type: Original article

Published on: 7 December 2020

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Efficacy of nanosecond laser treatment in central serous chorioretinopathy with and without atrophy of retinal pigment epithelium

To evaluate the outcomes of subthreshold nanosecond laser treatment of chronic central serous chorioretinopathy (CSC) as a function of the severity of concomitant of retinal pigment epithelium (RPE) defects.

Authors: Hakan Kaymak, Saskia Funk, Andreas Fricke, Roxana Fulga, Karsten Klabe, Berthold Seitz, Achim Langenbucher and Hartmut Schwahn

Citation: International Journal of Retina and Vitreous 2020 6 :11

Content type: Original article

Published on: 4 June 2020

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Fingerprint sign in Vogt-Koyanagi-Harada disease: a case series

The tomographic finding, which has been called the “fingerprint sign” in en face reconstructions, seems to be the result of a variety of processes that cause distension of the outer plexiform layer (OPL) and the .

Authors: Ruy Felippe Brito Gonçalves Missaka, Mauro Goldbaum, Cleide Guimarães Machado, Emmett T. Cunningham Jr, Fernanda Maria Silveira Souto, Marcelo Mendes Lavezzo, Priscilla Figueiredo Campos da Nóbrega, Viviane Mayumi Sakata, Maria Kiyoko Oyamada, Carlos Eduardo Hirata and Joyce Hisae Yamamoto

Citation: International Journal of Retina and Vitreous 2022 8 :7

Content type: Original article

Published on: 10 January 2022

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Epidemiology of uveal melanoma in Brazil

To report the prevalence of uveal melanoma in a Hospital database in Brazil over the period of 16 years (2000 to 2016).

Authors: Evandro Lucena, Daniel Cohen Goldemberg, Luiz Claudio Santos Thuler and Andreia Cristina de Melo

Citation: International Journal of Retina and Vitreous 2020 6 :51

Content type: Original article

Published on: 11 November 2020

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Supine positioning after vitrectomy for rhegmatogenous retinal detachments with inferior retinal breaks

To evaluate the effectiveness of face up position (FUP) following pars plana vitrectomy (PPV) and silicone oil injection in cases of rhegmatogenous retinal detachment (RRD) with multiple peripheral and inferio.

Authors: Amr Mohammed Elsayed Abdelkader and Hossam Youssef Abouelkheir

Citation: International Journal of Retina and Vitreous 2020 6 :41

Content type: Original article

Published on: 14 September 2020

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Autologous full-thickness retinal transplant for refractory large macular holes

Despite the constant refinement of techniques and surgical aids, extremely large and refractory macular holes continue to have poor surgical outcomes with the current standard of care. The objective of the pre.

Authors: Sergio Rojas-Juárez, Javier Cisneros-Cortés, Abel Ramirez-Estudillo and Raul Velez-Montoya

Citation: International Journal of Retina and Vitreous 2020 6 :60

Content type: Original article

Published on: 23 November 2020

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New Frontiers in Retina: highlights of the 2020 angiogenesis, exudation and degeneration symposium

We summarize the most important findings presented at the 2020 angiogenesis, exudation and degeneration symposium in five topic areas: (1) epidemiology of retinal vascular disease and macular degeneration; (2).

Authors: Carmen A. Puliafito and Charles C. Wykoff

Citation: International Journal of Retina and Vitreous 2020 6 :18

Content type: Commentary

Published on: 22 May 2020

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Safety of various parameter sets with navigated microsecond pulsing laser in central serous chorioretinopathy

Subthreshold microsecond pulsing laser is an increasingly common treatment approach for central serous chorioretinopathy. However, there is no literature available on the safety of microsecond laser using diff.

Authors: Jay Chhablani, Gagan Kalra, Lubna Alkwatli, Bernd Fassbender, Francesca Amoroso, Khushboo Chandra, Samantha Ankireddy, Dmitrii Maltsev, Nina-Antonia Striebe and Eric Souied

Citation: International Journal of Retina and Vitreous 2021 7 :62

Content type: Original article

Published on: 16 October 2021

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Eales’ disease: epidemiology, diagnostic and therapeutic concepts

To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease.

Authors: Sergio Murillo López, Silvia Medina Medina and Fernando Murillo López

Citation: International Journal of Retina and Vitreous 2022 8 :3

Content type: Original article

Published on: 4 January 2022

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Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept

This study explores the long term anatomic and functional results of patients who were switched to intravitreal aflibercept injections (IAI) after being initially managed with other anti-VEGF agents for neovas.

Authors: Sean D. Adrean, Darren Knight, Siyang Chaili, Hema L. Ramkumar, Ash Pirouz and Scott Grant

Citation: International Journal of Retina and Vitreous 2022 8 :11

Content type: Original article

Published on: 10 February 2022

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Macular vessel density before and after panretinal photocoagulation in patients with proliferative diabetic retinopathy

Diabetic retinopathy (DR) is microangiopathy causing ischemia leading to proliferative diabetic retinopathy and macular edema. Panretinal photocoagulation (PRP) reverses the ischemia leading to regression of n.

Authors: Ahmed Shawkat Abdelhalim, Mohamed Farouk Sayed Othman Abdelkader, Mohamed Salah El-Din Mahmoud and Asmaa Anwar Mohamed Mohamed

Citation: International Journal of Retina and Vitreous 2022 8 :21

Content type: Original article

Published on: 14 March 2022

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Multimodal imaging for paracentral acute maculopathy; the diagnostic role of en face OCT

To describe the features of multimodal imaging and the diagnostic role of en face OCT in the paracentral acute middle maculopathy (PAMM) spectrum.

Authors: Hamid Riazi-Esfahani, Elias Khalili Pour, Kaveh Fadakar, Nazanin Ebrahimiadib, Fariba Ghassemi, Ramin Nourinia, Hassan Khojasteh, Behnoosh Attarian, Hooshang Faghihi and Hamid Ahmadieh

Citation: International Journal of Retina and Vitreous 2021 7 :13

Content type: Original article

Published on: 16 February 2021

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Proposed algorithm during COVID-19 pandemic for patient management in medical retina clinic

Authors: Paolo Corazza, Francesco Maria D’Alterio and Saad Younis

Citation: International Journal of Retina and Vitreous 2020 6 :20

Content type: Original article

Published on: 3 June 2020

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Test–retest variability of microperimetry in geographic atrophy

Microperimetry (MP) allows for measurement of retinal sensitivity at precise locations and is now commonly employed as a clinical trial endpoint. Test–retest reliability is important when evaluating treatment .

Authors: A. Yasin Alibhai, Nihaal Mehta, Sheila Hickson-Curran, Carlos Moreira-Neto, Emily S. Levine, Elias Reichel, Jay S. Duker and Nadia K. Waheed

Citation: International Journal of Retina and Vitreous 2020 6 :16

Content type: Original article

Published on: 30 April 2020

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Internal limiting membrane detachment in acute central retinal artery occlusion: a novel prognostic sign seen on OCT

To present a series of acute central retinal artery occlusion (CRAO) cases showing internal limiting membrane detachment (ILMD) on optical coherence tomography (OCT) and to describe the possible etiopathogenes.

Authors: Ramesh Venkatesh, Chaitra Jayadev, Akhila Sridharan, Arpitha Pereira, Nikitha Gurram Reddy, Jophy Philip Cherry, Naresh Kumar Yadav and Jay Chhablani

Citation: International Journal of Retina and Vitreous 2021 7 :51

Content type: Original article

Published on: 3 September 2021

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Posterior segment inflammatory outcomes assessed using fluorescein angiography in the STOP-UVEITIS study

Although fluorescein angiography (FA) is a frequently used imaging modality in patients with non-infectious uveitis (NIU), it has not been reliably used for objective assessment of posterior segment inflammato.

Authors: Mohammad Ali Sadiq, Muhammad Hassan, Rubbia Afridi, Muhammad Sohail Halim, Diana V. Do, Yasir J. Sepah and Quan Dong Nguyen

Citation: International Journal of Retina and Vitreous 2020 6 :47

Content type: Original article

Published on: 6 October 2020

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Influence of vitreomacular interface score on treatment outcomes of anti-VEGF therapy for neovascular age-related macular degeneration

To quantitatively evaluate the vitreomacular interface of eyes with neovascular age-related macular degeneration (AMD) and to investigate its association with the 1-year treatment outcome following intravitrea.

Authors: Manabu Miyata, Sotaro Ooto, Kenji Yamashiro, Hiroshi Tamura, Akihito Uji, Masahiro Miyake, Yuki Muraoka, Ayako Takahashi and Akitaka Tsujikawa

Citation: International Journal of Retina and Vitreous 2021 7 :77

Content type: Original article

Published on: 20 December 2021

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Intravitreal sirolimus for persistent, exudative age-related macular degeneration: a Pilot Study

To evaluate the safety and efficacy of intravitreal sirolimus for persistent, exudative age-related macular degeneration (AMD).

Authors: Robert J. Minturn, Peter Bracha, Margaret J. Klein, Jay Chhablani, Ashley M. Harless and Raj K. Maturi

Citation: International Journal of Retina and Vitreous 2021 7 :11

Content type: Original article

Published on: 16 February 2021

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Vitreomacular interface after anti-VEGF injections in diabetic macular edema

The purpose of this study was to evaluate the incidence of vitreomacular adhesion (VMA) release after anti-VEGF therapy for the treatment of diabetic macular edema (DME) and to evaluate further changes in outc.

Authors: Carlos E. Veloso, Daniel N. Brocchi, Rishi P. Singh and Márcio B. Nehemy

Citation: International Journal of Retina and Vitreous 2021 7 :23

Content type: Original article

Published on: 19 March 2021

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Vogt-Koyanagi-Harada Syndrome following COVID-19 and ChAdOx1 nCoV-19 (AZD1222) vaccine

The challenge of COVID-19 has rapidly changed medical management worldwide. The relatively small time from pandemic to vaccines regulatory approval triggered a race toward vaccines development. However, import.

Authors: Janaína Jamile Ferreira Saraceno, Guilherme Macedo Souza, Luciana Peixoto dos Santos Finamor, Heloisa Moraes Nascimento and Rubens Belfort Jr

Citation: International Journal of Retina and Vitreous 2021 7 :49

Content type: Letter to the Editor

Published on: 30 August 2021

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Mechanisms of sterile inflammation after intravitreal injection of antiangiogenic drugs: a narrative review

Intraocular inflammation is an uncommon but potentially vision-threatening adverse event related to anti-VEGF therapy. This is of increasing importance given both the volume of injections performed, as well as.

Authors: William J. Anderson, Natasha Ferreira Santos da Cruz, Luiz Henrique Lima, Geoffrey G. Emerson, Eduardo Büchele Rodrigues and Gustavo Barreto Melo

Citation: International Journal of Retina and Vitreous 2021 7 :37

Content type: Review

Published on: 7 May 2021

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New findings useful for clinical practice using swept-source optical coherence tomography angiography in the follow-up of active ocular toxoplasmosis

Ocular toxoplasmosis is one of the most common causes of intraocular inflammation and posterior uveitis in immunocompetent patients. This paper aims to investigate swept-source optical coherence tomography ang.

Authors: João Rafael de Oliveira Dias, Camila Campelo, Eduardo Amorim Novais, Gabriel Costa de Andrade, Paula Marinho, Yusláy Fernández Zamora, Luciana Finamor Peixoto, Maurício Maia, Heloísa Nascimento and Rubens Belfort Jr.

Citation: International Journal of Retina and Vitreous 2020 6 :30

Content type: Original article

Published on: 8 July 2020

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Safety and efficacy of Razumab™ (world’s first biosimilar ranibizumab) in wet age-related macular degeneration: a post-marketing, prospective ASSET study

Razumab™ (world’s first biosimilar ranibizumab) is approved for several macular disorders including wet age-related macular degeneration (AMD). We evaluated the safety and efficacy of biosimilar ranibizumab in.

Authors: Shashikant Sharma, Vishali Gupta, Aniruddha Maiti, Sribhargava Natesh, Sandeep Saxena, Vivek Dave, Vimal Parmar, Raju Sampangi, Hemanth Murthy, Sandhya Dharwadkar, Naresh Kumar Yadav, Shrinivas Joshi, Rahul Mayor, Dhanashree Ratra, Soumyava Basu, Neha Goel…

Citation: International Journal of Retina and Vitreous 2021 7 :24

Content type: Original article

Published on: 24 March 2021

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Lasting effects of prenatal exposure to Cannabis in the retina of the offspring: an experimental study in mice

Prenatal exposure to Cannabis is a worldwide growing problem. Although retina is part of the central nervous system, the impact of maternal Cannabis use on the retinal development and its postnatal consequence.

Authors: Paulo Roberto Arruda Zantut, Mariana Matera Veras, Sarah Gomes Menezes Benevenutto, Angélica Mendonça Vaz Safatle, Ricardo Augusto Pecora, Victor Yuji Yariwake, Janaina Iannicelli Torres, Gustavo Sakuno, Marco Antonio Garcia Martins, Aline Adriana Bolzan, Walter Yukihiko Takahashi, Paulo Hilario Nascimento Saldiva and Francisco Max Damico

Citation: International Journal of Retina and Vitreous 2021 7 :45

Content type: Original article

Published on: 30 June 2021

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Factors associated with 1-year visual response following intravitreal bevacizumab treatment for diabetic macular edema: a retrospective single center study

To explore the association of clinical characteristics and retinal microstructural features on optical coherence tomography in predicting 1-year visual response following intravitreal bevacizumab injections in.

Authors: Janejit Choovuthayakorn, Apichat Tantraworasin, Phichayut Phinyo, Jayanton Patumanond, Paradee Kunavisarut, Titipol Srisomboon, Pawara Winaikosol, Direk Patikulsila, Voraporn Chaikitmongkol, Nawat Watanachai and Kessara Pathanapitoon

Citation: International Journal of Retina and Vitreous 2021 7 :17

Content type: Original article

Published on: 4 March 2021

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The Tie2 signaling pathway in retinal vascular diseases: a novel therapeutic target in the eye

Retinal vascular diseases such as neovascular age-related macular degeneration, diabetic retinopathy and/or diabetic macular edema, and retinal vein occlusion with macular edema—share several key pathophysiolo.

Authors: Quan Dong Nguyen, Jeffrey S. Heier, Diana V. Do, Adam C. Mirando, Niranjan B. Pandey, Huan Sheng and Theresa Heah

Citation: International Journal of Retina and Vitreous 2020 6 :48

Content type: Review

Published on: 13 October 2020

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Effects of phosphodiesterase type 5 inhibitors on choroid and ocular vasculature: a literature review

To provide information on the effects of phosphodiesterase type 5 (PDE5) inhibitors on choroidal vessels and central serous chorioretinopathy (CSC) and possible implications for development of exudative age-re.

Authors: Natasha Ferreira Santos da Cruz, Murilo Ubukata Polizelli, Laís Maia Cezar, Emmerson B. Cardoso, Fernando Penha, Michel Eid Farah, Eduardo B. Rodrigues and Eduardo A. Novais

Citation: International Journal of Retina and Vitreous 2020 6 :38

Content type: Review

Published on: 6 August 2020

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Endophthalmitis after pars plana vitrectomy with reused single-use devices: a 13-year retrospective study

To describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well .

Authors: Sukhum Silpa-archa, Kwanchanoke Kumsiang and Janine M. Preble

Citation: International Journal of Retina and Vitreous 2021 7 :2

Content type: Original article

Published on: 6 January 2021

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Large-cube 30° × 25° optical coherence tomography in diabetic macular edema

To evaluate the contribution of large-cube 30° × 25° optical coherence tomography (OCT) in the characterization of diabetic macular edema (DME) by assessing its extent and the presence of additional retinal ed.

Authors: Amir Mahdjoubi, Youcef Bousnina, Fatma-Samia Bendib, Faiza Bensmaine, Wafa Idlefqih, Sadri Chahed and Amina Ghezzaz

Citation: International Journal of Retina and Vitreous 2021 7 :19

Content type: Original article

Published on: 6 March 2021

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Future of anti-VEGF: biosimilars and biobetters

The advent of Anti- VEGFs like Lucentis (Ranibizumab), Eylea (Aflibercept) and off-label Avastin (Bevacizumab) have radically improved visual outcomes in patients of neovascular Age Related Macular Degeneratio.

Authors: Monika Kapur, Suvansh Nirula and Mayuresh P. Naik

Citation: International Journal of Retina and Vitreous 2022 8 :2

Content type: Review

Published on: 4 January 2022

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A practical guide to optical coherence tomography angiography interpretation

Optical coherence tomography angiography (OCTA) can image the retinal vasculature in vivo, without the need for contrast dye. This technology has been commercially available since 2014, however, much of its us.

Authors: Eugenia Custo Greig, Jay S. Duker and Nadia K. Waheed

Citation: International Journal of Retina and Vitreous 2020 6 :55

Content type: Review

Published on: 13 November 2020

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The effect of silicone oil tamponade on retinal layers and choroidal thickness in patients with rhegmatogenous retinal detachment: a systematic review and meta-analysis

To evaluate the effects of intravitreal silicone oil (SO) on the retinal and choroidal thickness in eyes with rhegmatogenous retinal detachment (RRD).

Authors: Heshmatollah Ghanbari, Farzan Kianersi, Alireza Jamshidi Madad, Alireza Dehghani, Alireza Rahimi, Awat Feizi and Afsaneh Naderi Beni

Citation: International Journal of Retina and Vitreous 2021 7 :76

Content type: Review

Published on: 20 December 2021

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Update on surgical management of complex macular holes: a review

Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling.

Authors: Mohd-Asyraaf Abdul-Kadir and Lik Thai Lim

Citation: International Journal of Retina and Vitreous 2021 7 :75

Content type: Review

Published on: 20 December 2021

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Optical coherence tomography in diagnosing polypoidal choroidal vasculopathy. Looking into the future: a systematic review and meta-analysis

Polypoidal choroidal vasculopathy (PCV) is an exudative maculopathy with features similar to wet age macular degeneration. The incidence of PCV is known to be higher in the Asian population compared to Caucasi.

Authors: Annisa C. Permadi, Ari Djatikusumo and Gitalisa Andayani Adriono

Citation: International Journal of Retina and Vitreous 2022 8 :14

Content type: Review

Published on: 28 February 2022

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Morphology of partial-thickness macular defects: presumed roles of Müller cells and tissue layer interfaces of low mechanical stability

The pathogenesis of partial-thickness macular defects and the role of Müller glial cells in the development of such defects are not well understood. We document the morphological characteristics of various typ.

Authors: Andreas Bringmann, Jan Darius Unterlauft, Renate Wiedemann, Matus Rehak and Peter Wiedemann

Citation: International Journal of Retina and Vitreous 2020 6 :28

Content type: Original article

Published on: 6 July 2020

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Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab

Despite the good outcomes achieved with intravitreal angiogenic therapy, a subset of neovascular age-related macular degeneration (AMD) patients experience resistance to therapy after repeated injections. Swit.

Authors: Mohamed A. Hamid, Nizar S. Abdelfattah, Jamshid Salamzadeh, Sahar T. A. Abdelaziz, Ahmed M. Sabry, Khaled M. Mourad, Azza A. Shehab and Baruch D. Kuppermann

Citation: International Journal of Retina and Vitreous 2021 7 :26

Content type: Original article

Published on: 1 April 2021

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Intraoperative optical coherence tomographic findings in patients undergoing subretinal gene therapy surgery

To analyze intraoperative OCT (iOCT) findings during subretinal gene therapy.

Authors: Huber M. Vasconcelos Jr., Brandon J. Lujan, Mark E. Pennesi, Paul Yang and Andreas K. Lauer

Citation: International Journal of Retina and Vitreous 2020 6 :13

Content type: Original article

Published on: 1 May 2020

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Morphological alternation and influence of aqueous flare in idiopathic epiretinal membrane

Idiopathic epiretinal membrane (iERM) is a common retinal disease in the elderly population. The exact pathogenesis of iERM is unknown. The present study aimed to evaluate the relationship between aqueous flar.

Authors: Yasuko Ikegami, Jiro Numaga, Saori Ue and Tomohiro Sano

Citation: International Journal of Retina and Vitreous 2021 7 :40

Content type: Original article

Published on: 17 May 2021

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Fluorescein angiographic findings and Behcet’s disease ocular attack score 24 (BOS24) as prognostic factors for visual outcome in patients with ocular Behcet’s disease

To determine the application of fluorescein angiographic (FA) findings and Behcet’s disease ocular attack score 24 (BOS24) scoring system in predicting poor visual outcome in patients with ocular Behcet’s dise.

Authors: Narumon Keorochana, Nathamon Homchampa, Sritatath Vongkulsiri and Raveewan Choontanom

Citation: International Journal of Retina and Vitreous 2021 7 :48

Content type: Original article

Published on: 28 August 2021

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Fluid dynamics between injections in incomplete anti-VEGF responders within neovascular age-related macular degeneration: a prospective observational study

The purpose of the study was to investigate the short-term response profile after an intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in patients with neovascular age-related macu.

Authors: Anthony Gigon, Antonio Iskandar, Chiara Maria Eandi and Irmela Mantel

Citation: International Journal of Retina and Vitreous 2022 8 :19

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StatPearls [Internet].

Hyperopia

Soumyadeep Majumdar ; Koushik Tripathy .

Authors
Affiliations

Last Update: February 21, 2022 .

Continuing Education Activity

Hyperopia is a very common refractive condition of childhood and adults. Proper assessment and treatment can prevent multiple complications in the future. Adult hyperopia is associated with some complications which must be assessed at regular interval. This activity reviews the evaluation and management of hyperopia with the prevention of long term complications.

Introduction

The most common refractive error in childhood is hyperopia.[1] The term hyperopia refers to the refractive condition of the eye where parallel light rays coming from the infinity are focussed behind the neurosensory retina (after refraction through the ocular media ) when accommodation is at rest. The spontaneous accommodative effort of the human eye, by increasing the anterior curvature and converging power of the crystalline lens, usually tries to overcome this situation. So, accommodative rest is mandatory to elicit total hyperopia, specifically in young individuals.[2] 

By birth, human beings are predominantly hyperopic, and as the age progresses, hyperopic eyeballs grow to become emmetropic or even myopic.[3][4] Positive family history plays a crucial role in the development of hyperopia in the next generations.[5] If left untreated after diagnosis, sequelae such as amblyopia and tropia may develop.[6][7][6] 

Etiology

Conventionally the hyperopia is etiologically classified into:

Axial hyperopia (most common - simple hyperopia): It is due to anterior-posterior axial shortening of the eyeball. Genetic predisposition plays an important role. Retinal edema can cause a hyperopic shift. 1 mm decrease in axial length leads to 3 diopters of hyperopia.[8]

Curvature hyperopia: It is due to flattening of the cornea or the lens or both. A radius of curvature increase in 1 mm leads to 6 diopters of hyperopia.

Index hyperopia: It is due to the change in the refractive index of the crystalline lens, which occurs in old age or diabetics. The refractory index gradually increases from the center to the periphery.

Positional hyperopia or absence of the lens (aphakia) or ocular pathologic conditions: This condition occurs due to malposition or absence of the crystalline lens (congenital or acquired) or intraocular lens owing to the creation of an aphakic zone in refractive media. Post-traumatic or post-surgical aphakia is not an uncommon cause of hyperopia.

Few ocular pathologies, e.g., nanophthalmos, microphthalmos, aniridia, may cause hyperopia. 

No unanimous causative factor is identified to date. Though sporadic, few genetic factors have been identified in association with hyperopia. Apart from genetic and environmental factors, few acquired conditions are also responsible, specifically in aged persons.[9] The following are a few identified conditions leading to hyperopia:

Epidemiology

Axial hyperopia, being the commonest, is usually present from birth.[3] The prevalence of moderate hyperopia, i.e., ≥ +2 diopter at 6 and 12 years of age, is 13.2% and 5.0%, respectively, and it is more in White race individuals than in other ethnic groups.[24] The prevalence of hyperopia ≥+4 diopter was 3.2% in the worse eye, with both eyes involved in 64.4% of cases in a study.[12] For United States participants, non-Hispanic, and Hispanic White races have a significantly higher risk of hyperopia in 6 to 72 months of age group.[12] 

In 15 years or less age group, and ≥30 years age group, hyperopia prevalence was higher in females.[25] A systematic review of refractive error revealed that the prevalence of hyperopia is 4% (less than myopia) in the population with more prevalence in school going boys than girls.[26] In the United States, for the ≥20 years age group, hyperopia is the least common refractive error while it was the most common refractive error with astigmatism in the ≥60 years age group.[27] In Polish immigrants in Chicago, a study found that hyperopia is a more common refractive error overall and in the >45 years age group.[28] 

In the 6 to 15 years age group in Cameroon, hyperopia is the most common refractive error.[29] Hyperopia is unrelated to posterior subcapsular cataracts but is related to incident nuclear and cortical cataract.[30] The intelligence quotient score in hyperopic patients was lower than that of myopic in a study conducted in the United Kingdom.[31] A higher prevalence of hyperopia is seen in people living in rural areas compared to urban areas.[32] Hyperopia is more prevalent in families with a history of accommodative esotropia and hyperopia, and 20% of the hyperopic individuals in infancy develop strabismus.[5] 

Pathophysiology

The axial shortening of the eyeball or decreased converging potential of the cornea or crystalline lens due to flattening are common responsible factors for simple hyperopia. Congenital or acquired absence of the crystalline lens resulting in loss of converging capacity leads to the pathological hyperopia. Senile changes in cortical lens fibers lead to change in the refractive index causing index hyperopia. Paralysis of accommodation (by cycloplegic drugs) and loss of accommodation due to complete third nerve palsy or internal ophthalmoplegia cause functional hyperopia.[22][21]

Accommodation is a dynamic factor in controlling the state of refraction, specifically in hyperopia. Depending on the accommodation, manifest hyperopia may subdivide into:

The manifest hyperopia is the sum of absolute and facultative hyperopia. Clinically, it is measured by the strongest plus (or convex) lens with which the patient can still maintain the maximum vision (20/20).

Latent hyperopia is due to the inherent ciliary muscle tone. Usually, the magnitude of latent hyperopia is 1D, but it is higher at an early age and gradually decreases as age progresses. Cycloplegic agents like atropine unmask this condition. This latent hyperopia causes asthenopic symptoms without dimness of distant vision. Cycloplegia is a must to elicit the amount of latent hyperopia in children.    

History and Physical

Depending on the age of presentation and the degree of hyperopia, clinical presentation varies from no symptom to a wide range of complaints. Age is an important factor not only due to the ability to express but also the accommodative effort of the patient.

Asymptomatic: The patient’s inherent ciliary muscle tone and accommodative effort can overcome some degree of hyperopia without creating any difficulty.

Symptomatic:

Deviation of eyes (noted by the parents)[33][34]: Parents sometimes note deviation of either or both eyes (simultaneous or alternative) in very young children with hyperopia. The commonest type is an inward deviation (esotropia).  

Asthenopia: With total accommodative effort, the patient’s hyperopia is corrected here. In these cases, asthenopia (i.e., varied amount of tiredness of eyes with localized frontal/frontotemporal headache) is a very common symptom due to prolonged accommodative effort. Sometimes it may be associated with photophobia and watering. Usually, asthenopia increases after near activity of long-duration.

Dimness of vision: There will be dimness of vision if existing hyperopia is not corrected with total accommodative effort. In hyperopia, infinity focuses beyond the neurosensory retina. So, nearer objects focus behind the retina. Characteristically the defective vision affects near vision more than distant vision. Thus, the objects appear more blurred as they come closer. This dimness may (small amount of hyperopia) or may not (a large amount of hyperopia or after 40 years of age when accommodation is lost) be associated with asthenopia. A significant difference in uncorrected hyperopia may predispose the worse eye to develop amblyopia. Uncorrected hyperopia of both the eyes may develop ametropic amblyopia bilaterally.   

Sudden blurring of vision (intermittent)[35]: Due to prolonged accommodative effort (e.g., during reading), there may be an episode of accommodative spasm leading to a sudden blurring of vision, often termed as pseudomyopia. It is commonly found in teenagers with uncorrected hyperopia. 

Recurrent Internal/External Hordeolum or Conjunctivitis: The exact mechanism of the recurrent eyelid or conjunctival inflammation is unrevealed. The proposed theory is the frequent rubbing of the eyes with unhygienic hands, which leads to recurrent inflammatory episodes. Proper treatment of recurrent inflammation helps to get good best-corrected visual acuity in the future and vice-versa.[36]    

A sensation of Crossed Eye: Prolonged sustained accommodation is sometimes felt as a crossed eye. The patient may complain that the eyes are crossing each other (due to convergence) without any diplopia. Ignorance towards this symptom in the pre-school age group may lead to amblyopia in the future.[37]   

Premature Presbyopia: As the age progresses, obvious receding of the near point becomes apparent. It occurs earlier (earlier than the 40s) in hyperope than emmetrope. The progressive accommodation loss with age is more frustrating to the patient as the near vision was already compromised earlier due to hyperopia.

Evaluation

A thorough clinical evaluation not only helps to diagnose hyperopia but also points out significant related events. 

Visual Acuity: It depends on the age at presentation, degree of accommodation, and status of the crystalline lens and posterior segment. In children, the vision may not be affected due to a full accommodative effort to focus the image on the retina. As the status of the eye is usually not complicated by cataract and retinal diseases in children, distant vision may be affected with high hyperopia, which can not be corrected by the full range of accommodation. There may be a gross reduction of vision if amblyopia develops in unilateral or bilateral high hyperopia cases. Near vision may also be diminished in children with high hyperopia or in aged where accommodation is partially or fully lost. An age-related hyperopic shift can make near vision more difficult.

Diffuse light examination: Eyeball and cornea may appear smaller, especially in high hyperopia and in unilateral cases. Sometimes it may simulate enophthalmos. Anterior chamber (both central and peripheral) appears shallow, and the angle of the anterior chamber may appear narrow with a small pupil. Gonioscopy is indicated in all cases to rule out possible angle closure. Cortical cataracts may also be present in aged persons or young individuals with diabetes.

Fundoscopy: Fundoscopy reveals a small optic disc with a very small cup. Disc margins become blurred with overcrowding of blood vessels, sometimes termed as “pseudopapillitis” or “pseudo-papilledema” if bilateral. Choroidal folds may be present.[38][39] An increased reflex of retina named as “shot-silk appearance” is seen along with crowding of the nerve fiber layer.[40]

Examination of Latent / Manifest strabismus: In children having uncorrected hyperopia for a long duration, strabismus may be present: latent (-phoria) or manifest (-tropia). Extraocular movement is usually full in all directions of gazes. 

Breaking the fusion by Alternate Cover-Uncover test with occluder and asking the patient to focus at a point light source may reveal latent strabismus, mainly in children and young. Alternate and sequential shifting of the occluder to cover either eye is done. The presence of latent strabismus is confirmed if the covered eye deviates, which is noted during refixation when uncovered.

In manifest strabismus, the deviated eye takes fixation after occlusion of the fellow orthophoric eye. Manifest strabismus must be examined by Hirschberg corneal reflex test (HCRT) and with a prism bar to note the degree of deviation. HCRT reveals the approximate degree of deviation i.e., corneal light reflex on the pupillary border and the corneal border corresponds to approximately 15 degrees and 45 degrees of deviation, respectively. Prisms can also serve to keep the apex towards the deviation to bring the corneal light reflex at the center and note that deviation in prism-diopter. 

Retinoscopy/Refraction: In the modern era of automated refraction, retinoscopy has its importance while examining young children and bed-ridden patients. It’s a good practice to evaluate a child with suspected any refractive error with cycloplegic retinoscopy[41] from a 1-meter distance as routine. Cycloplegia abolishes ciliary muscle tone and accommodation to reveal the actual status of refraction. With a streak retinoscope, under cycloplegia, different powered-spherical lenses are used to reach a neutralization point (full illumination of the fundus with no movement)  both in the horizontal and vertical axis. 

Existing refractive error (in horizontal/vertical axis) = Retinoscopic findings (in both axis) – the value of distance in meter (1 for 1 meter, 1.5 for 2/3rd meter) – tonus allowance for the particular cycloplegic drug (For atropine ointment 1% it is 1, cyclopentolate drops 1% it is 0.75, and for homatropine drops 2% it is 0.5) 

If both the axis and the power (after deduction) are equal, then that is considered as the spherical refractive power of the eye. If it is unequal, then the extra power (in one axis) is denoted as the astigmatic power in the other axis.