Extraretinal Fibrovascular Proliferation in a Neonate Possibly Associated with an ESAM Gene Variant

A female infant born with a gestational age of 35 weeks and birth weight of 2500 g was referred for ophthalmic examination on the second postnatal day. Bilateral venous dilatation and arterial tortuosity, severe extraretinal fibrovascular proliferation, and peripheral ischemia were detected. Fluorescein angiography showed profoundly delayed arteriovenous transit and peripheral avascularity. Both eyes were treated with diode laser photocoagulation and bevacizumab injection. Cranial magnetic resonance imaging (MRI) revealed hydrocephalus, ventricular dilatation, and cerebral atrophy. Her family history revealed that the patient's brother presented to the ophthalmology outpatient clinic at postnatal 3 months with inoperable total retinal detachment and similar cranial MRI findings. No systemic or ocular findings were detected in the parents. A recent study showed that in 13 cases, including our patients, bi-allelic variants in the ESAM gene lead to a new neurodevelopmental disease whose main clinical features include impaired speech and language development, seizures, varying degrees of spasticity, ventriculomegaly, intracranial hemorrhage, and developmental delay/mental disability. Newborn siblings of children with serious pathological retinal findings should undergo a detailed ophthalmic examination as soon as possible after birth to prevent total retinal detachment, even without a diagnosis of specific inherited retinal vascular diseases. Further investigations performed in collaboration with an international network may reveal more candidate gene variants possibly related to retinopathy of prematurity-like ophthalmological findings such as extraretinal fibrovascular proliferation.

Based on the Real-Life Data of Türkiye; Comparison of Anatomical and Functional Outcomes of Phakic and Pseudophakic Patients in Wet Type Age-Related Macular Degeneration.

Objectives: The aim of the study was comparison of wet-type age-related macular degeneration in phakic and pseudophakic patients in terms of anatomical and functional success based on the real-life data of Türkiye. Methods: The multicenter retrospective real-life study data of the. retinal study group were used in this study. Among 867 eyes of 867 patients were included in the study. Patients were divided into two groups according to the status of the lens; phakic group and pseudophakic group. The follow-up period of the two groups, the number of injections at the 1st, 2nd, and 3rd years, and changes in the central macular thickness (CMT, µ) and visual acuity (VA, logMAR) of the patients at the beginning, 6th, 12th, 24th, and 36th months were examined. Results: In our study, the number of injections in the 1st, 2nd, and 3rd years, respectively, was 4.2±2.0, 1.8±1.9, and 1.0±1.7 in the phakic group, and 3.9±2.0, 1.7±1.9, and 0.8±1.4 in the pseudophakic group. When the two groups were compared in terms of the number of injections, there was a statistically significant difference in the 1st year, but there was no significant difference in the 2nd and 3rd years (p=0.001, p=0.350, and p=0.288, respectively). There was no statistically significant difference between the groups in terms of CMT in the baseline, 6th, 12th, 24th, and 36th months (p=0.991, p=0.327, p=0.652, p=0.599, and p=0.873, respectively). Although there was no difference in VA between groups at the beginning (p=0.052), the phakic group showed statistically better VA in controls at 3rd, 6th, 12th, 24th, and 36th months (p=0.001, p=0.001, p=0.000, p=0.000, and p=0.003, respectively). Conclusion: Differences in the number of injections and visual results between phakic and pseudophakic patients in wet type AMD may necessitate the creation of different treatment and follow-up protocols.

Quantitative Evaluation of Progression of Retinal Vascularization After 60 Weeks Postmenstrual Age in Infants Treated With Bevacizumab.

BACKGROUND AND OBJECTIVE: To investigate the progression of retinal vascularization after 60 weeks postmenstrual age (PMA) in eyes treated with intravitreal bevacizumab (IVB). PATIENTS AND METHODS: Twenty-seven eyes that were treated with IVB and underwent two consecutive fluorescein angiographies (FA) after 60 weeks PMA. Horizontal disc diameter (DD), disc-to-fovea (DF) distance, and length of temporal retinal vascularization (LTRV) were measured in pixels on the two consecutive angiograms. RESULTS: Mean age at first and final FA sessions were 77.7 ± 15.7 and 168.0 ± 49.0 weeks PMA, respectively. The DF/DD ratio was 3.30 ± 0.46 and 3.16 ± 0.46 in the first and final FAs (P = 0.001), respectively. The LTRV/DD ratio was 13.38 ± 2.12 and 13.15 ± 2.13 in the first and final FAs (P = 0.027), respectively. The LTRV/DF ratio was 4.06 ± 0.39 and 4.17 ± 0.42, respectively (P = 0.032). CONCLUSION: Temporal retinal vascularization did not progress despite an average follow-up of 90 weeks in pixel units and DD. [Ophthalmic Surg Lasers Imaging Retina 2023;54:417-424.].

Results of anti-VEGF treatment for neovascular AMD in eyes with different baseline visual acuity in Turkish population-based on real life data-Bosphorus retina study group.

BACKGROUND: To investigate the anatomical and visual outcomes of the patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF), according to the baseline best-corrected visual acuity (BCVA) based on the multicenter real-life data. METHODS: Five-hundred-ninety patients who had taken the Pro Re Nata (PRN) treatment regimen with three loading doses and at least one year of follow-up were included. The patients were divided into three groups according to the baseline BCVA: Group 1 (BCVA ≥ 1.3 Logmar), Group 2 (1.3 Logmar > BCVA ≥ 0.3 Logmar), and Group 3 (BCVA ≤ 0.2 Logmar). BCVA, central macular thickness (CMT), and the number of injections and visits were evaluated. RESULTS: There were 175, 322, and 93 patients in Group 1, Group 2, and Group 3, respectively. The number of visits and injections in the 1st year was not different between the groups (p = 0.58 and p = 0.08) and was 7.09 and 4.41 (Group 1), 6.59 and 5.58 (Group 2), 6.77 and 4.08 (Group 3). There was a significant difference in CMT between the baseline and 12th month in Group 1 and Group 2 (p < 0.001, p < 0.001, respectively) but not in Group 3 (p = 0.84). BCVA was significantly better in the 12th month in Group 1 (p < 0.001), slightly worse in Group 2 (p = 0.79), and significantly worse in Group 3 (p < 0.001). CONCLUSION: This study provides evidence that an inadequate number of injections cannot protect vision. Moreover, it can cause vision loss, especially in the eyes with good vision.

Subconjunctival hemorrhage in the newborn: Experience of a tertiary care hospital.

OBJECTIVE: The aim of this study is to determine the incidence and characteristics of newborns with subconjunctival hemorrhage (SCH). METHODS: In our study, patient files of term infants referred to the study hospital's ophthalmology clinic in 2018-19 were analyzed. Demographic data of infants including gestational week, birth weight, gender, and head circumference were all recorded. The frequency of SCH detection was evaluated depending on delivery type. Demographic data of infants with and without retinal hemorrhage (RH) were compared. RESULTS: A total of 172 eyes of 86 infants were included in study. Forty-two (48.8%) of 86 neonates were male, and 44 (51.2%) were female. Mean gestational week was 38.62±1.1. SCH was detected in 31.4% (27) in the right eye, 36% (31) in the left eye, and 32.6% (28) in both eyes. The diagnosis was made at the mean of 3.74 days (range 1-20). Mean birth weight was found as 3621.1±453.3 g, head circumference as 35.4±1.3 cm, height as 50.7±2 cm, and chest circumference as 33.6±1.4 cm. Mean Apgar score in 1st min was 7.1±0.4; 5th min was 9. About 11.6% (10) of the mothers were nulliparous, and 88.4% (76) were multiparous. It was found that 79 of the deliveries were vaginal and seven with cesarean section. RH was not detected in any of the infants born with cesarean section. CONCLUSION: SCH and RH were more common in infants born vaginally. If SCH is detected, a fundus examination should be performed to not miss possible RH.

Bi-allelic variants in the ESAM tight-junction gene cause a neurodevelopmental disorder associated with fetal intracranial hemorrhage.

The blood-brain barrier (BBB) is an essential gatekeeper for the central nervous system and incidence of neurodevelopmental disorders (NDDs) is higher in infants with a history of intracerebral hemorrhage (ICH). We discovered a rare disease trait in thirteen individuals, including four fetuses, from eight unrelated families associated with homozygous loss-of-function variant alleles of ESAM which encodes an endothelial cell adhesion molecule. The c.115del (p.Arg39Glyfs∗33) variant, identified in six individuals from four independent families of Southeastern Anatolia, severely impaired the in vitro tubulogenic process of endothelial colony-forming cells, recapitulating previous evidence in null mice, and caused lack of ESAM expression in the capillary endothelial cells of damaged brain. Affected individuals with bi-allelic ESAM variants showed profound global developmental delay/unspecified intellectual disability, epilepsy, absent or severely delayed speech, varying degrees of spasticity, ventriculomegaly, and ICH/cerebral calcifications, the latter being also observed in the fetuses. Phenotypic traits observed in individuals with bi-allelic ESAM variants overlap very closely with other known conditions characterized by endothelial dysfunction due to mutation of genes encoding tight junction molecules. Our findings emphasize the role of brain endothelial dysfunction in NDDs and contribute to the expansion of an emerging group of diseases that we propose to rename as "tightjunctionopathies."

Relationship between refractive outcomes and quantitative retinal vascularization and severity of plus disease in eyes treated with intravitreal bevacizumab.

Purpose: The study aimed to investigate the relationship between refractive outcomes with the extent of retinal vascularization and severity of the plus disease in infants treated with intravitreal bevacizumab (IVB). Methods: Pre-IVB fundus images (PFIs), final fundus images (FFIs), and refractive outcomes of the 93 infants who underwent IVB monotherapy for type 1 and aggressive retinopathy of prematurity (A-ROP) were retrospectively evaluated. Quantitative measurements were performed on PFIs and FFIs. Pre-IVB plus severity was scored on a five-leveled scale. Correlation between spherical equivalent (SE) with pre-treatment and final extent of the temporal retinal vascularization and pre-treatment severity of plus disease was analyzed. Results: There was a linear and low positive correlation between the extent of pre-IVB and final temporal retinal vascularization with final SE (p = 0.000, r = 0.267; P = 0.002, r = 0.274, respectively). There was a low negative correlation between the pre-IVB plus severity score with final SE (p = 0.012, r = -0.192). Gestational age (GA), birth weight (BW), IVB dose, presence of additional IVB, or laser treatments were not correlated with refractive outcome. Out of 171 eyes, 38 eyes had >1 D myopia. In the univariate logistic analyses, pre-IVB retinal zone and pre-IVB and final extent of the temporal retinal vascularization were found to be related to the development of >1 D myopia (p = 0.002, odds ratio (OR) = 0.298; P = 0.000, OR = 0.281; P = 0.001, OR = 0.317; respectively). Conclusion: Our study indicates that the pre-treatment and final extent of retinal vascularization were the main parameters that were related to final refractive outcomes in IVB-treated eyes for type 1 and A-ROP.

Quantitative vascular outgrowth and anatomic and refractive outcomes of eyes treated with bevacizumab in posterior zone â .

PURPOSE: To report the anatomic and refractive outcomes and retinal vascular outgrowth in eyes with posterior zone Ⅰ retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB). METHODS: Thirty-eight eyes of 21 infants treated with IVB for type 1 and aggressive-ROP, and whose posterior border of retinal vascularization was shorter than the optic disc-to-fovea distance were defined as posterior zone Ⅰ and included in the study. RESULTS: Nine eyes of five infants whose follow-up time was lower than four months were accepted as insufficient for clinical outcomes. Additional treatment(s) had been performed up to 60 weeks postmenstrual age (PMA) in 10 of 29 eyes whose follow-up were higher than four months. Macula was attached at the final examination in all eyes with > 4 months follow-up. Anatomical outcome of two eyes of one infant was accepted as unfavorable whose routine follow-up was interrupted after successful initial treatment and who was presented with straightening of the temporal vascular arcade and residual fibrovascular tractional bands on the temporal periphery. The mean progression of temporal retinal vascularization was 3.6 ± 2.0 horizontal disc diameters (DD) within 7.3 weeks and 5.1 ± 2.5 horizontal DD within 69.1 weeks in the short-term (n=15) and long-term evaluated eyes (n=21), respectively. The mean spherical equivalent was -4.1 diopters at a mean age of 21 months (n=28). CONCLUSIONS: A favorable outcome had been achieved in almost all bevacizumab-treated eyes, but additional treatments were required. Significant progression of retinal vascularization was detected even in the eyes with short follow-up.

Refractive outcomes following unilateral laser treatment for type 1 retinopathy of prematurity.

PURPOSE: To compare refractive outcomes of infants with type 1 retinopathy of prematurity (ROP) in whom one eye was treated with laser and the fellow eye spontaneously regressed. METHODS: The medical records of infants who underwent IVB and laser treatment for type 1 ROP or aggressive posterior-ROP between January 2016 and December 2019 were retrospectively evaluated. Infants in whom ROP in the fellow eye regressed and for whom refractive data was available in the record were included in the study. Refractive outcomes of unilaterally treated infants were assessed. RESULTS: A total of 283 cases were reviewed: of these, 17 experienced spontaneous regression in the fellow eye and were included. All unilateral laser-treated eyes had type 1 ROP in zone Ⅱ. The median age at treatment was 40 weeks' postmenstrual age (IQR, 39-41). The mean spherical equivalent at the last examination was 2.1 ± 2.5 D in treated eyes and 2.50 ± 1.4 D in nontreated eyes, at a mean age of 25.0 ± 9.1 months (P = 0.378). Of the 7 infants who underwent fluorescein angiography, the median of the ratio of the length of the temporal retinal vascularization to the optic disk-to-fovea distance was 3.71 (3.22-3.79) in treated and 4.28 (3.90-4.49) in untreated eyes, at a median age of 18 months (P = 0.018). CONCLUSIONS: In laser-treated eyes with peripheral zone Ⅱ ROP and with advanced treatment age, we did not observe a significant myopic change compared to the fellow untreated eye.

Fluorescein Angiography Findings in Treatment-Naive Premature Infants with Retinal Vascular Immaturity and Persistent Avascular Retina.

PURPOSE: To evaluate the fluorescein angiography (FA) findings in eyes with spontaneously regressed retinopathy of prematurity (ROP). METHODS: Fluorescein angiography images of 162 eyes of 81 treatment-naive infants who underwent FA due to retinal vascular immaturity and persistent avascular retina (PAR) despite exceeding postmenstrual age of 60 weeks were analyzed retrospectively. Disc diameter (DD), optic disc-to-fovea distance (FD), the length of temporal retinal vascularization (LTRV), and the length of measurable temporal avascular retina distance (LMTAR), were quantitatively measured. RESULTS: The mean gestational age and FA imaging age were 29.39 ± 3.13 and 86.51 ± 24.80 weeks postmenstrual, respectively. The mean ratios of LTRV/FD and LMTAR /DD were 4.47 ± 0.36 and 2.21 ± 1.01, respectively. Pigmentary changes were detected in the peripheral retina in 21% of the eyes. There was at least one angiographic finding in 88% of the eyes, but these findings were usually mild. Based on the FA findings, laser photocoagulation was performed to the peripheral avascular retina in ten eyes of five patients. CONCLUSION: Even in larger preterm infants and without severe retinopathy and anti-VEGF treatment, PAR and peripheral pigmentary changes may be detected, and mild angiographic vascular activity may continue. These findings may lead to late-onset retinal pathologies that may threaten vision. In eyes with PAR, follow-up with FA and prophylactic laser application may be applicable. Further investigation is required for this topic.

Factors associated with refractive outcome in children treated with bevacizumab for retinopathy of prematurity: the importance of retinal vascularization.

PURPOSE: To evaluate the factors that may be associated with refractive outcome in eyes treated with intravitreal bevacizumab (IVB) injection for retinopathy of prematurity (ROP). METHODS: Retrospective case series. Refractive outcomes of 181 infants who were treated with primary IVB for Type I ROP or aggressive ROP, were retrospectively evaluated. According to the pretreatment retinal vascularization, eyes were classified into zone I, zone I-zone II, and zone II groups. The first year, third year, and final refractive error were analyzed. Univariate logistic regression test was performed to evaluate the effect of factors on the development of ≥ 1 diopter (D) myopia. RESULTS: At the final examination, the mean age was 22.9 ± 10.9 months. The zone II group was more hyperopic than the zone I-zone II and zone I zone groups (P = 0.001). Of the 331 eyes, 17 eyes (5.1%) had high myopia, 50 eyes (15.1%) had low myopia, and 83 eyes (25.1%) had emmetropia. During follow-up, 110 (33.2%) eyes underwent laser treatment. Gestational age, birth weight, neonatal intensive care unit type, the presence of additional laser treatment, number of injections, the type of ROP, and the dose of IVB were not associated with the development of ≥ 1 D myopia. The pretreatment and prelaser retinal zones were associated with the development of ≥ 1 D myopia. CONCLUSION: The most important factors affecting the refractive outcome in infants who underwent primary IVB treatment was the extent of pretreatment and prelaser retinal vascularization.

The Effect of Intravitreal Bevacizumab Dose on Retinal Vascular Progression in Retinopathy of Prematurity.

INTRODUCTION: In this study, we investigated the effect of drug dose on the progression of retinal vascularization in eyes treated with different doses of intravitreal bevacizumab (IVB). METHODS: The patient charts of 259 eyes of 142 patients who were administered 0.3125 mg or 0.625 mg IVB as primary therapy for type 1 retinopathy of prematurity (ROP) or aggressive ROP (A-ROP) were retrospectively evaluated. Eighty-four eyes of 42 infants met all study inclusion criteria and underwent further morphological evaluation. Eyes treated with 0.3125 mg and 0.625 mg bevacizumab were grouped as the low dose and standard dose groups, respectively. Horizontal disc diameter (DD), optic disc-to-fovea distance (FD), and the length of temporal retinal vascularization (LTRV) were measured on pretreatment photographs (PPs) and final fluorescein angiography (FA) images. LTRV, measured in pixels, was converted to DD and FD units and analyzed. All PPs and FA images were captured with 130° PanoCam Pro camera. The difference between final LTRV and pretreatment LTRV was defined as the difference of LTRV. The ratio of difference of LTRV to pretreatment LTRV was defined as the rate of increase of LTRV. RESULTS: Of the 255 eyes, re-treatment rate before 55 weeks postmenstrual age (PMA) was 23% in the eyes treated with 0.3125 mg IVB and 19% in the eyes treated with 0.625 mg IVB (p = 0.362). Of the 42 infants included for further morphological evaluation, the median age at the time of treatment was 36 (35-38) weeks PMA, and the median age at the time of FA imaging was 66 (62-75) weeks PMA. While the difference of LTRV by unit of DD was higher in the low dose group (p = 0.017), this difference was similar between groups by unit of FD (p = 0.412). The ratio of the increase of the LTRV was similar between groups by units of DD and FD (p = 0.081, p = 0.390; respectively). The FD/DD ratio was 4.13 ± 0.49 and 3.26 ± 0.33 at the pretreatment and final sessions, respectively (p = 0.000). CONCLUSION: The ratio of FD to DD decreased significantly with increasing age. The additional treatment rate and progression of retinal vascularization by unit of FD were similar between the groups. The difference of LTRV by unit of DD was higher in the low dose group. The usage of dif-ferent formulas and methods may affect the evaluation of the progression of retinal vascularization.

Inter-eye comparison of retinal vascular growth rate and angiographic findings following unilateral bevacizumab treatment.

PURPOSE: To compare retinal vascularization progression rate, final retinal vascularization, and fluorescein angiography (FA) findings in infants who received intravitreal bevacizumab (IVB) treatment in one eye and with spontaneous regression in the other eye. METHODS: Thirty eyes of 15 infants who underwent IVB in one eye due to asymmetric retinopathy of prematurity, and who had pre-treatment fundus photographs and fluorescein angiography images were included in the study. Horizontal disc diameter (DD), optic disc-to-fovea distance (FD), and the length of temporal retinal vascularization (LTRV) distance were measured by evaluating pre-treatment and FA images. RESULTS: The mean ages at the time of treatment and FA were 40.38 ± 3.35 and 68.72 ± 10.52 weeks postmenstrual age, respectively. The pre-treatment LTRV/FD ratio was 3.11 ± 0.41 in the treated eyes and 3.26 ± 0.43 in the non-treated eyes (p = 0.053). The final LTRV/FD ratio was 4.23 ± 0.38 in the treated group and 4.33 ± 0.37 in the non-treated group (p = 0.286). Staining of the vessels, hyperfluorescent focus, and irregular branching of the vessels were similar between the groups, respectively (p = 1.000; p = 0.250; p = 0.625). CONCLUSION: The progression rate of retinal vascularization and angiographic findings were similar between the treated eyes and the non-treated eyes. Our study suggests that incomplete retinal vascularization in eyes treated with anti-vascular endothelial growth factor (VEGF) is due to the nature of the disease, and anti-VEGF treatment was not to cause cessation in vascular progression.

Evaluation of Optical Coherence Tomography Findings and Choroidal Thickness in Beta-Thalassemia Major Patients Using Chelation Therapy.

Objectives: This study aims to analyze the posterior segment of the eye in children with thalassemia major (TM) treated with chelation therapy. Methods: Forty-four patients diagnosed with TM and 44 age- and gender-matched participants without systemic diseases were included in this cross-sectional comparative study. A complete ophthalmologic examination, including visual acuity and fundus examination, was performed on all participants. The study and control groups' optic coherence tomography (OCT) evaluation was performed with a spectral domain featured OCT device. Central macular thickness (CMT), macular volume, ganglion cell complex (GCC) thickness, retinal nerve fiber layer (RNFL) thickness, subfoveal choroidal thickness (CT), CT at 1 mm temporal to the fovea, CT at 1 mm nasal to the fovea, CT at the 1 mm temporal to the optic nerve head, and CT at the 1 mm nasal to the optic nerve head were compared between the study and control groups. Results: The mean ages for the study group and for the control group were 15.2±6.2 and 14.2±4.9 years, respectively. The mean subfoveal CT was 287.73±47.04 µm in the TM group and 312.66±39.95 µm in the control group (p=0.014). CT at the nasal to the fovea and temporal to the optic nerve head was thinner in the TM group than in the healthy group. The mean CMT, macular volume, GCC thickness, and RNFL thickness of the study and the control groups were similar. No significant difference was found between the patients with and without deferoxamine therapy concerning macular thickness, GCC thickness, and macular and peripapillary CT. Conclusion: Our results suggested that subfoveal, perifoveal, and peripapillary CTs were significantly thinner in children with TM than the control group. The use of deferoxamine did not cause a further reduction in CT.

Anterior Segment Analysis and Evaluation of Corneal Biomechanical Properties in Children with Joint Hypermobility.

Objectives: To compare anterior segment parameters and biomechanical analysis of the cornea in children with joint hypermobility (JH) and healthy children. Materials and Methods: Cross-sectional case-control study. Fifty eyes of 25 children with JH were compared with 74 eyes of 37 healthy age- and sex-matched controls in terms of refractive, anterior segment topographic, and corneal biomechanical measurements. Axial length (AL) was measured with a Nidek AL-Scan biometry device; corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were measured with a Reichert ocular response analyzer (ORA). Central corneal thickness (CCT), anterior chamber depth (ACD), K1/K2 values, iris diameter, and anterior chamber volume (ACV) were measured with a Sirius topography device. Results: Mean age in the JH group was 10.56±4.03 years, while that of the control group was 11.27±2.59 years (p=0.23). Spherical equivalent was -0.22±1.02 diopter (D) in the JH group and -0.12±1.12 D in the control group (p=0.60); CCT was 23.01±0.82 µm in the JH group and 23.17±0.82 µm in the control group (p=0.33). There were no significant differences between the two groups in terms of age, sex, IOP, IOPcc, IOPg, CH, CRF, AL, K1, K2, iris diameter, ACD, and ACV. Conclusion: JH, which causes increased flexibility of the joints, was concluded not to cause a significant change in the corneal biomechanical markers of CRF and CH or in anterior segment topographic parameters.

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group.

AIM: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS: Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS: The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits. CONCLUSION: The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Evaluation of choroidal thickness measurements in patients with marked nasal septal deviation.

INTRODUCTION: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. OBJECTIVE: To assess choroidal thickness measurements of patients with marked nasal septal deviation. METHODS: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. RESULTS: In the study group, 52 eyes of 26 patients with a mean age of 26.34±8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69±7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p>0.05). CONCLUSION: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.

Correction to: Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

In the original publication, the authors' affiliations were published incorrectly.

Assessment of vascular leakage and its development with FFA among patients treated with intravitreal anti-VEGF due to aggressive posterior ROP.

OBJECTIVE: Evaluation of vascular leakage and retinal vascular development with fundus fluorescein angiography for infants diagnosed with aggressive posterior retinopathy of prematurity who underwent intravitreal anti-VEGF treatment. METHOD: Medical recordings of 30 patients who received RetCam fluorescein angiography during follow-up and had been treated with anti-VEGF on diagnosis of aggressive posterior ROP in the zone I or zone II between the dates of April 2014-January 2017 were evaluated retrospectively. RESULTS: Fifty-nine eyes of 30 patients were included in the study. Mean birth weight was 1145 g; gestation week was 28.4. Recurrence occurred in 30.5% of the patients, and 10.1% of them were given a second dose of injection of anti-VEGF. Leakage was detected in 15.3% of the eyes during angiography, and all of these eyes were treated with laser photocoagulation. Evaluation of vascular development revealed that in the temporal, complete retinal vascular development was achieved in only 8% of the eyes. It was detected that complete retinal vascularization was not observed in any of the cases which were given second dose of injection due to recurrence. The patients were distributed into groups according to postmenstrual week taken to angiography as 32 eyes of 16 patients in group 1, 17 eyes of 9 patients in group 2 and 10 eyes of 5 patients in group 3. The vascular leakage rate of group 3 patients was statistically significantly higher (p < 0.05) and vascular development between groups was not statistically significant (p > 0.05). DISCUSSION: With the initiation of FFA usage in pediatric cases, especially treated with anti-VEGF due to retinopathy of prematurity (ROP), more findings (vascular arrest, leakage, and abnormalities, etc.) are obtained than those achieved via ophthalmoscopic examination. In the light of these findings, early intervention with laser photocoagulation in early stages becomes possible enabling prevention of possible blindness.

The Effect of Acute Hypovolemia on the Eye.

INTRODUCTION: To investigate the effects of acute hypovolemia induced by blood donation on the eye. Methods or Study Design: This prospective, observational study included a single eye from each of 48 healthy men between 20 and 40 years of age who had donated 500 ml of blood and 28 eyes of 28 healthy, age- and gender-matched control subjects. The ocular parameters including ocular perfusion pressure (OPP), intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), choroidal and retinal thicknesses, and retinal nerve fiber layer (RNFL) were measured before blood donation and at 10 min and 1, 2, 3, and 4 h after blood donation. RESULTS: The mean OPP was significantly reduced following blood donation (baseline, 43.4 ± 4.9 vs. 40.8 ± 4.6 mmHg; p = 0.003). The mean subfoveal choroidal thickness (SFCT) was measured as 322.96 ± 76.23, 291.63 ± 77.85, 309.77 ± 75.72, 312.31 ± 75.98, 315.73 ± 75.43, and 317.75 ± 75.73 µm before blood donation, at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.462, 115.731) = 22.618, p < 0.001]. In the control group, the SFCT was measured as 302.04 ± 32.04, 301.43 ± 35.16, 298.07 ± 37.33, 298.96 ± 39.17, 302.54 ± 39.24, and 301.61 ± 40.41 µm at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.124, 57.340) = 0.592, p = 0.566]. There was no difference in AL, CCT, RNFL, retinal thicknesses, and IOP measurements performed before and after blood donation (p > 0.05). CONCLUSIONS: Acute hypovolemia caused a significant reduction in SFCT which persisted for 3 h. This study may pave way for better understanding of choroidal thickness changes in disease states.