Serum neopterin and orexin-A levels in different stages of diabetic retinopathy.

CLINICAL RELEVANCE: Retinopathy is one of the most common microvascular complications of diabetes mellitus and is the leading cause of vision loss in the working middle-aged population. BACKGROUND: This study aimed to investigate the value of neopterin and orexin-A levels in patients with diabetes mellitus with different stages of diabetic retinopathy and without diabetic retinopathy and to compare those findings with results from healthy individuals without diabetes mellitus. METHODS: In total, 65 patients with type 2 diabetes mellitus and 22 healthy individuals without diabetes mellitus were enrolled in this prospective study. The participants were separated into four subgroups. The first subgroup included 25 patients without diabetic retinopathy, the second subgroup included 20 patients non-proliferative diabetic retinopathy, the third subgroup included 20 patients with proliferative diabetic retinopathy, and the fourth subgroup included 22 healthy individuals without diabetes mellitus as controls. Serum neopterin and orexin-A levels were analysed and compared among the groups. RESULTS: The age and gender of the participants between the four subgroups were not statistically significantly different (p > 0.05). The mean neopterin levels were significantly higher in patients included in the diabetes mellitus subgroups compared with the controls (p < 0.001). Neopterin levels significantly increased as diabetic retinopathy progressed within the diabetes mellitus subgroups. Mean orexin-A levels were significantly lower in the diabetes mellitus subgroups compared with the controls (p < 0.001); however, orexin-A levels were not significantly different within the diabetes mellitus subgroups (p > 0.05). CONCLUSION: Patients with diabetes mellitus have higher serum neopterin and lower serum orexin-A levels compared with healthy individuals without diabetes mellitus. Moreover, serum neopterin levels increase with progression of diabetic retinopathy.

Long-Term Outcomes of Enucleation and Secondary Orbital Implantation Surgeries Using Polyester Mesh-Wrapped Acrylic Orbital Implants.

OBJECTIVE: To reveal the long-term outcomes of enucleation and secondary orbital implantation surgeries employing nonabsorbable surgical mesh-wrapped acrylic orbital implants for various reasons. METHODS: A retrospective interventional study of 48 eyes that underwent primary or late primary enucleation and secondary orbital implantation using polyester mesh-wrapped acrylic orbital implants, between 2012 and 2021. Patient demographics, diagnosis, prior ophthalmic surgery, implant size, follow-up periods, and implant-associated complications were evaluated. RESULTS: The records of 36 patients who underwent primary or late primary enucleation and 12 who underwent secondary orbital implantation due to sphere extrusion were evaluated. Patients' mean age was 38.7 (range: 2-75) and the mean follow-up period was 48.3 months (range: 24-72 mo). Major causes for surgeries were trauma and malignancies (54.1% and 33.3%, respectively). No complications, such as conjunctival dehiscence, implant exposure or extrusion, contracted socket, or fornix insufficiency were observed in any patient during the long-term follow-up period postsurgeries. CONCLUSION: Using polyester mesh-wrapped acrylic orbital implants in enucleation and secondary orbital implantation surgeries proves to be a successful, safe, and cost-effective option.

Biochemical and histopathological evaluation of systemic and ocular toxicity of favipiravir in rats.

Purpose: Favipiravir (FAV) used against COVID-19 is an antiviral drug that causes adverse reactions, such as hyperuricaemia, liver damage, and hematopoetic toxicity. The aim of the study was to investigate the systemic and ocular side-effects of FAV in rats, for the first time.Materials and methods: A total of 18 albino male Wistar rats were used in the study. The rats were divided into 3 groups as the healthy group (HG), the group given 50 mg/kg/day favipiravir (FAV50), and the group given 200 mg/kg/d favipiravir (FAV200). These doses were given to the experimental groups for one week. At the end of the experiment histopathological examinations were performed on the conjunctiva and sclera of the eye. In addition, malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), interleukin-1ß (IL-1ß), and tumor necrosis factor alpha (TNF-α) levels were measured in blood samples taken from rats. Results: Compared to HG, the MDA (1.37 ± 0.61 vs. 4.82 ± 1.40 µmol/mL), IL-1ß (2.52 ± 1.14 vs. 6.67 ± 1.99 pg/mL), and TNF-α levels (3.28 ± 1.42 vs. 8.53 ± 3.06 pg/mL) of the FAV200 group were higher. The levels of tGSH (7.58 ± 1.98 vs. 2.50 ± 0.98 nmol/mL) and SOD (13.63 ± 3.43 vs. 3.81 ± 1.43 U/mL) the FAV200 group were lower than the HG (p < 0.05, for all). The degree of damage to the cornea and sclera of the FAV200 group was quite high according to HG (p < 0.001). Conclusions: FAV can cause damage to rat conjunctiva and sclera by increasing oxidant stress and inflammation at high dose.

Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis.

PURPOSE: Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. METHODS: This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6 months, and signs scores were recorded at 1, 3 and 6 months. RESULTS: Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6 months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). CONCLUSIONS: Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.

Ozone-induced retinal vascular reactivity as assessed by optical coherence tomography angiography.

BACKGROUND: This study aimed to investigate the retinal vascular reactivity (RVR) of the macular and peripapillary capillary network in response to ozonated autohemotherapy (AHT) using optical coherence tomography angiography (OCTA). METHODS: This was a single-centre prospective study. All participants that were planned to have a combination of major and minor ozone AHT underwent a complete ocular examination and OCTA imaging before and after the ozone AHT. Foveal avascular zone (FAZ) metrics and vessel density (VD) of superficial (SCP), deep capillary plexus (DCP), and radial peripapillary capillary (RPC) plexus were assessed using the built-in software. RESULTS: A total of 40 right eyes of 40 individuals were included. No significant differences were observed for the mean values of the FAZ metrics and choriocapillaris flow area following ozone AHT compared with baseline values (p > 0.05). The mean whole VD of SCP and DCP was 47.80 ± 2.18% and 53.09 ± 3.00% before treatment, which decreased to 47.68 ± 2.7% and 52.38 ± 3.07% after treatment (p = 0.660 and p = 0.097, respectively). No significant differences were observed in the vascular densities of both SCP and DCP in any quadrant (p > 0.05). The RPC density did not show significant alterations compared with baseline values, except the inferior-hemi region. The VD in the inferior-hemi peripapillary quadrant was significantly increased after ozone AHT (p = 0.034). CONCLUSION: The ozone AHT did not cause evident RVR in the macular area, whereas the peripapillary area showed a partial response.

Retinochoroidal vascular plexuses in patients with iron deficiency anaemia.

CLINICAL RELEVANCE: Optical coherence tomography angiography (OCT-A) may enable the identification of alteration in the retinochoroidal microvasculature in patients with iron deficiency anaemia. BACKGROUND: To investigate the presence of macular microvascular alterations in females with IDA by using OCT-A. METHODS: This is a cross-sectional comparative study. Forty patients with IDA and 35 age-matched healthy women underwent a complete ophthalmologic examination and OCT-A imaging. Foveal avascular zone parameters and the vessel density in the superficial (SCP) and deep capillary plexus (DCP) were calculated using automated software. All measurements were compared between groups. Correlations between the OCT-A metrics and haematological laboratory parameters were evaluated. RESULTS: Compared to healthy subjects, IDA patients revealed significantly decreased vessel density of the SCP in all parafoveal quadrants (p < 0.05). In contrast, vessel density analysis in DCP has shown no statistically significant difference in all parafoveal quadrants (p > 0.05). Although foveal vessel density in both SCP and DCP were higher in the IDA group, only the foveal vessel density in DCP was significantly higher than controls (p = 0.001). The mean values of the foveal avascular zone area and perimeter and choriocapillaris flow area were significantly lower in the IDA group (p < 0.05). The parafoveal vessel density in SCP, foveal avascular zone area, and choriocapillaris flow area were positively correlated with haematological parameters including haemoglobin, haematocrit, mean corpuscular haemoglobin, and mean corpuscular volume (p < 0.01). CONCLUSION: Patients with IDA had decreased parafoveal vessel density in the SCP, but not the DCP. Foveal avascular zone metrics and choriocapillaris flow area measurements were significantly lower in IDA.

Optical Coherence Tomography Angiography for Evaluation of Retinal Vascular Changes in Patients with Psoriasis according to Disease Severity.

OBJECTIVES: To investigate foveal avascular zone (FAZ) area and retinal vascular density (VD) in patients with psoriasis according to disease severity using optical coherence tomography angiography (OCTA). METHODS: Twenty-seven patients with mild psoriasis (Group 1), 28 with moderate to severe psoriasis (Group 2) and 30 healthy controls (Group 3) were evaluated with OCTA. Foveal and parafoveal VD and FAZ area were measured and compared. RESULTS: FAZ values were significantly higher in Group 2 (0.20 ± 0.1, 0.31 ± 0.07, 0.20 ± 0.09; P < .001, respectively.). The mean VD value were significantly lower in the deep capillary plexus in parafoveal area in Group 2 (35.5 ± 8.7, 28.7 ± 4.6, 35.0 ± 3.5; P < .001, respectively.). These changes showed significant correlation with Psoriasis Area and Severity Index (PASI) scores of patients. CONCLUSIONS: Our results suggest that OCTA may have a future role as alert of potentially more severe disease in cases clinically classified as mild disease.

Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy.

AIM AND OBJECTIVE: To evaluate the efficacy and safety of XEN stent implantation in the inferonasal quadrant after prior failed trabeculectomy. MATERIALS AND METHODS: Fourteen open-angle glaucoma patients with prior failed trabeculectomy were recruited to this retrospective study. Implantation of the stent was performed as a stand-alone procedure. The mean follow-up duration was 14.2 months. Best-corrected visual acuity, intraocular pressure (IOP), number of medications, complications, and the requirement for additional procedures were among the outcome measures recorded. RESULTS: Mean IOP reduced by 49.3% from 24.14 ± 2.74 mm Hg preoperatively to 12.23 ± 2.89 mm Hg at month 12 (p < 0.001). Medication usage reduced from 3.71 ± 0.47 medications preoperatively to 1.31 ± 1.55 at month 12 (p = 0.003). Adverse events included transient slight intracameral hemorrhage (5 eyes, 35.7%), second trabeculectomy required (2 eyes, 14.3%), and numerical hypotony (IOP <5 mm Hg, in 3 cases, 21.4%), all of which resolved spontaneously. Six eyes (42.8%) required postoperative bleb needling to further reduce IOP. There were no cases of vision loss, stent exposure, hypotony, lower eyelid malposition, bleb dysesthesia, or bleb-related infection. CONCLUSION: XEN gel stent implantation in the inferonasal quadrant can be considered a viable surgical option for patients with a history of previously failed trabeculectomy requiring further IOP lowering. CLINICAL SIGNIFICANCE: To the best of our knowledge, this is the first case series describing the outcome of inferonasal implantation of XEN gel stent following failed trabeculectomy. HOW TO CITE THIS ARTICLE: Düzgün E, Olgun A, Karapapak M, et al. Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy. J Curr Glaucoma Pract 2021;15(2):64-69.

Retinal Vascular Changes in Patients with Chronic Obstructive Pulmonary Disease: An Optical Coherence Tomography Angiography Study.

OBJECTIVES: In the current study, we aimed to investigate retinal vascular density and blood flow changes in patients with chronic obstructive pulmonary disease (COPD) using optical coherence tomography angiography (OCTA) (AngioVue Avanti, Optovue). METHODS: Thirty eyes of 30 patients with COPD and 30 eyes of 30 healthy controls were evaluated with OCTA. Foveal and parafoveal vessel density, inner retinal and choriocapillary flow area, and foveal avascular zone (FAZ) area were measured and compared between the groups. RESULTS: No statistically significant differences were observed in the outer retinal flow area and choriocapillary flow area measurements between the groups (p=0.609 and p=0.162, respectively). There was no statistically significant difference in FAZ and FAZ perimeter values between the groups (p=0.725 and p=0.820, respectively). Vascular density measurements in the superficial foveal and parafoveal areas were not statistically significantly different between the groups (p>0.05, for all). Deep parafoveal vascular density values of the COPD group were statistically significantly lower than the control group in all investigated areas except the superior and inferior quadrants. CONCLUSION: The results of our study demonstrated for the first time that vascular density decreased in the parafoveal area due to COPD-related hypoxemia and endothelial dysfunction.

Microvascular and functional changes according to the fundus location of the affected arteriovenous crossing in patients with branch retinal vein occlusion.

Purpose: The aim of this study was to evaluate the structural and functional changes occurring in patients with branch retinal vein occlusion (BRVO) according to the distance of the affected arteriovenous (AV) crossing to the centers of the fovea and optic disc by optic coherence tomography angiography (OCTA). Methods: Forty-five patients with unilateral BRVO and 45 age- and sex-matched healthy controls were included in this retrospective observational study. Images of the macula (3 mm × 3 mm) and affected AV crossing sites were obtained by OCTA. The fovea-AV crossing distance (FAVD), optic disc-AV crossing distance (DAVD), and optic disc-fovea distance (DFD) were measured. Results: The FAVD/DFD ratio was positively correlated with the vessel density in the superficial and deep affected hemifields (r = 0.430, P < 0.05 and r = 0.308, P < 0.05, respectively) and negatively correlated with the superficial foveal avascular zone and logarithm of the minimum angle of resolution (logMAR) visual acuity (r = -0.412, P < 0.05 and r = -0.356, P < 0.05, respectively). The DAVD/DFD ratio was not correlated with the logMAR visual acuity, superficial FAZ area or vessel densities in the affected hemifield (all P > 0.05). Conclusion: The affected AV crossing site that was further away from the fovea had better visual acuity and quantitative microvascular parameters in the affected hemifields. However, this correlation was not observed for the distance between the affected AV crossing site and the optic disc.

Peripapillary vascular density and retinal nerve fibre layer changes in patients with chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a systemic disease which may cause end organ damage. OBJECTIVES: In this study, we aimed to investigate the radial peripapillary capillary (RPC) density and retinal nerve fibre layer (RNFL) thickness changes in patients with COPD. METHODS: The right eyes of 35 patients with COPD and 35 healthy controls were evaluated with optical coherence tomography angiography (OCTA). RPC density values and RNFL thicknesses were measured and compared. RESULTS: The mean inside disc vascular density and the mean peripapillary vascular density values were lower in the COPD group (p = 0.002, p < 0.001, respectively). When the peripapillary area was evaluated independently as eight different quadrants, the RPC density values were lower in the COPD group in all of the quadrants except superotemporal and temporal superior quadrants. RNFL was thinner in all quadrants in the COPD group compared to the control group. But this difference was significant only in the nasal superior and inferonasal quadrants (p = 0.03, p = 0.04, respectively). Although, there was no correlation between the mean RPC density and the mean peripapillary RNFL thickness of the patients, FEV1 values for all patients were found to be correlated with the mean peripapillary RPC density (r = 0.406, p = 0.015). CONCLUSION: OCTA may have a potential to be used in the follow-up of COPD patients.

Short term effects of intravitreal anti-vascular endothelial growth factor agents on cornea, anterior chamber, and intraocular pressure.

Objective: To evaluate short term changes in anterior chamber depth (ACD), central corneal thickness (CCT), intraocular pressure (IOP), and corneal endothelial cell density (ECD) after intravitreal anti-vascular endothelial growth factor (VEGF) injections. Materials and methods: A total of 100 eyes from 100 patients, who were naive for intravitreal injection treatment, were included in this retrospective study. Patients who received only a single type of intravitreal anti-VEGF injections (bevacizumab, ranibizumab, or aflibercept) for two consecutive months were examined. ACD, CCT, IOP, and ECD measurements were taken at pre-injection and one month after the first and second injections and were compared. Results: The mean corneal ECD for all eyes and phakic eyes was significantly lower one month after the first (p = 0.041 and p = 0.047, respectively) and second injections (p = 0.013 and p = 0.034, respectively) compared to the values at pre-injection levels. Similarly, the mean ACD of all eyes and phakic eyes was significantly lower one month after the first (p < 0.001 and p < 0.001, respectively) and second injections (p < 0.001 and p < 0.001, respectively) compared to the values at pre-injection levels. However, there was no significant difference in pseudophakic eyes one month after the first and second injections (ECD, p = 0.28 and p = 0.23; ACD, p = 0.75 and p = 0.71, respectively). There was no significant change in IOP and CCT values at pre-injection and one month after the first and second injections for all eyes and for both the phakic and pseudophakic eyes. Discussion: After the anti-VEGF injections, IOP and CCT values were not significantly changed and were similar in all eyes and phakic eyes; however, in these groups, there was a small but statistically significant decrease in ACD and ECD. On the contrary, there was no significant difference in pseudophakic eyes. Clinicians performing intravitreal injections must be aware of these associations for a better understanding of ACD and ECD changes in phakic eyes.