Aplication of <i>in Vivo</i>Confocal Microscopy in Ophtalmology—Overview

Confocal microscopy is a method which has been increasingly used over the last decade in the study of the anterior ocular surface. The method allows testing and in vivo high resolution imaging of the structures of the anterior eye segment, at a cellular level, which is close to the histological examination of tissues. The data provided by this method allow for a better understanding of both the functional and pathological processes occurring in the anterior ocular surface not only for scientific purposes but also in clinical practice. The aim of the present work is to summarize the current knowledge and applications of confocal microscopy of the anterior ocular surface.

Ischemic Retinal Vasculitis after Previous Toxoplasma Chorioretinitis

Introduction: Ischemic retinal vasculitis is an inflammatory disease affecting the retinal vessels. Visual acuity decreases due to macular ischemia, macular edema, neovascularization leading to vitreous hemorrhage, fibrovascular proliferation or tractional retinal detachment. Purpose: To present the case of a patient with ischemic retinal vasculitis. Material and Methods: The case involves a 34-year-old woman. The following tests were performed: complete blood count, biochemistry, coagulogram, rheumatological tests, serum calcium level, angiotensin-converting enzyme, CT of the lungs, MRI of the brain and spine, serological tests for: cytomegalovirus, herpes simplex virus (type 1 and 2), varicella-zoster virus, toxoplasmosis, tuberculosis, syphilis, as well as fluorescein angiography and optical coherence tomography. Results and Discussion: The patient was admitted to the hospital with visual acuity of the right eye, 0.8/0.9, and of the left eye, 1.0. The intraocular pressure in both eyes was normal: 14 mmHg in the right eye and 15 mmHg in the left eye. The following pathological finding was detected in the right eye fundus: an old chorioretinal cicatrix under the inferior temporal vascular arch with an ischemic exudate next to it, occlusion of the inferior temporal retinal arterial and venous branches, neovascularization and a preretinal hemorrhage. Fluorescein angiography showed delayed filling of the affected vessels, neovascularization, and major ischemia in the lower temporal part of the retina. The results of the serological tests for varicella zoster virus, herpes simplex virus type 1 and toxoplasmosis were outside the reference ranges. The patient was treated with Clindamycin and Acyclovir. Emergency laser therapy was performed in the ischemic retina area. Previous toxoplasma chorioretinitis was diagnosed, which had led to ischemic retinal vasculitis with sectoral involvement of the retinal vessels. The patient has been monitored over 3 - 4 month periods, showing high visual acuity and stable ocular condition. Conclusion: Patients with ischemic retinal vasculitis are a challenge when it comes to clarifying the etiological diagnosis. Treatment on time prevents severe and irreversible loss of vision. Occlusive vasculitis is a rare complication of ocular toxoplasmosis, but must be taken into consideration when young patients are involved.

Hertel Exophthalmometry and Computed Tomography for the Evaluation of Exophthalmos in Patients with Thyroid-Associated Ophthalmopathy

Objective: To compare the values of exophthalmos measured by computed tomography (CT) and Hertel exophthalmometry (HE) in patients with thyroid-associated ophthalmopathy (TAO). Material and Methods: One hundred and seventy eyes were examined in 85 patients with TAO. Each patient underwent a complete ophthalmic examination, Hertel exophthalmometry, and CT of the orbits through a 16-slice CT scanner (Bright Speed, General Electric), measuring the extraocular muscles, the total muscle thickness sum (MTS), and proptosis. The patients were divided into two groups-with activity and without TAO activity, the activity being assessed by means of the Clinical Activity Score (CAS) and the severity-according to the EUGOGO classification. Results: TAO activity was detected in 45 patients (90 eyes, 53%) with MTS of 23.54 ± 5.73 mm, IOP of 19.78 ± 4.49 mm Hg, Hertel exophthalmos of 23.08 ± 4.19 mm and measured by CT-23.32 ± 4.33 mm. Forty patients (80 eyes, 47%) were without TAO activity, with MTS of 19.28 ± 4.03, IOP of 16.6 ± 4.51 mm Hg, Hertel exophthalmos of 20.03 ± 3.84 mm and measured by CT-19.84 ± 4.47 mm. A correlation was detected between exophthalmos and: MTS, IOP, the activity and severity of TАО. High congruence was established between the two methods of measuring exophthalmos-CT and HE (Pearson correlation, r = 0.690, p = 0.000). Conclusion: Our results showed a high degree of consistency between Hertel exophthalmometry and multidetector CT for the evaluation of exophthalmos in patients with TAO. Exophthalmos is an important clinical feature and its measurement and monitoring over time assess the clinical course and outcome of treatment.