The Impact of Multifocal Intraocular Lens in Retinal Imaging with Optical Coherence Tomography

Multifocal intraocular lenses (MF IOLs) have concentric optical zones with different dioptric power, enabling patients to have good visual acuity at multiple focal points. However, several optical limitations have been attributed to this particular design. The purpose of this study is to access the effect of MF IOLs design on the accuracy of retinal optical coherence tomography (OCT). Cross-sectional study conducted at the Refractive Surgery Department of Central Lisbon Hospital Center. Twenty-three eyes of 15 patients with a diffractive MF IOL and 27 eyes of 15 patients with an aspheric monofocal IOL were included in this study. All patients underwent OCT macular scans using Heidelberg Spectralis®. Macular thickness and volume values and image quality (Q factor) were compared between the two groups. There were no statistically significant differences between both groups regarding macular thickness or volume measurements. Retinal OCT image quality was significantly lower in the MF IOL group (p < 0.01). MF IOLs are associated with a significant decrease in OCT image quality. However, this fact does not seem to compromise the accuracy of spectral domain OCT retinal measurements.

Progressive Multifocal Leukoencephalopathy and Systemic Lupus Erythematosus: Focus on Etiology

Progressive multifocal leukoencephalopathy (PML) caused by reactivation of the JC virus (JCV), a human polyomavirus, occurs in autoimmune disorders, most frequently in systemic lupus erythematosus (SLE). We describe a HIV-negative 34-year-old female with SLE who had been treated with immunosuppressant therapy (IST; steroids and azathioprine) since 2004. In 2011, she developed decreased sensation and weakness of the right hand, followed by vertigo and gait instability. The diagnosis of PML was made on the basis of brain MRI findings (posterior fossa lesions) and JCV isolation from the cerebrospinal fluid (700 copies/ml). IST was immediately discontinued. Cidofovir, mirtazapine, mefloquine and cycles of cytarabine were sequentially added, but there was progressive deterioration with a fatal outcome 1 year after disease onset. This report discusses current therapeutic choices for PML and the importance of early infection screening when SLE patients present with neurological symptoms. In the light of recent reports of PML in SLE patients treated with rituximab or belimumab, we highlight that other IST may just as well be implicated. We conclude that severe lymphopenia was most likely responsible for JCV reactivation in this patient and discuss how effective management of lymphopenia in SLE and PML therapy remains an unmet need.

Formas Imagiológicas Atípicas de “PRES” em Idade Pediátrica – Envolvimento Bulbo-Medular e Múltiplas Hemorragias – Nada Posterior e Pouco Reversível!

Introdução: Osíndrome de encefalopatia posterior reversível, ou PRES, é uma entidade clinico-radiológica associada a uma grande variedade de contextos clínicos, nomeadamente em idade pediátrica, com padrões imagiológicos mais típicos com envolvimento dos lobos parietais e occipitais mas também com outras formas imagiológicas, mais ou menos frequentes dependendo dos locais envolvidos (frontais e temporais, tronco cerebral, ganglios da base, cerebelo...). Objectivos: Apresentar formas de PRES em idade pediátrica com características imagiológicas infrequentes. Casos Clínicos: Apresentam-se os casos em duas jovens de sexo feminino, ambas com HTA grave e insuficiência renal, que se apresentaram com cefaleias intensas e uma delas com crises convulsivas, alteração do estado consciência e hemiparésia esquerda. Num dos casos a RM demonstrou um envolvimento extenso da medula e bulbo, apenas com uma pequena lesão parietal direita, com total reversão destas alterações em estudos de controle. No outro caso, a TC e a RM evidenciaram inúmeras lesões de edema com envolvimento multifocal de todos os lobos cerebrais e com múltiplas áreas hemorrágicas igualmente dispersas, desde micro-hemorragias a um hematoma mais volumoso, tendo-se constatado nos estudos de controle uma regressão parcial destas alterações. Conclusão: Apesar do envolvimento mais típico das regiões parietais e occipitais no PRES por lesões de edema vasogénico, padrões atípicos e infrequentes estão documentados e devem ser reconhecidos, incluindo-se nestes padrões o envolvimento predominantemente medular e a presença de múltiplas hemorragias.

The Shading Sign: Is It Exclusive of Endometriomas?

OBJECTIVES: To investigate if the shading sign is an exclusive MRI feature of endometriomas or endometrioid tumors, and to analyze its different patterns. METHODS: Three hundred and fourty six women with adnexal masses who underwent 1.5/3-T MRI were included in this retrospective, board-approved study. The shading sign was found in 56 patients, but five cases were excluded due to lack of imaging follow-up or histological correlation. The final sample included 51 women. The type of tumor and the pattern of shading were recorded for each case. RESULTS: Thirty endometriomas and five endometrioid carcinomas were found. The remaining 16 cases corresponded to other benign and malignant tumors. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 73%, 93%, 59%, and 96%, respectively. Restricting the analysis to cystic lesions without solid or fat component, sensitivity, specificity, positive predictive value, and negative predictive value were 73%, 96%, 94%, and 80%. Five shading patterns were identified: layering (15.7%), liquid-liquid level (11.8%), homogenous (45.1%), heterogeneous (11.8%), and focal/multifocal shading within a complex mass (19.6%). No significant correlation was found between these patterns and the type of tumor. CONCLUSIONS: The shading sign is not exclusive of endometriomas or endometrioid tumors. Homogenous shading was the most prevalent pattern in endometriomas and half of the cases with focal/multifocal shading within a complex mass were endometrioid carcinomas.