Evaluation of Ocular Surface Parameters and Systemic Inflammatory Biomarkers in Hazelnut Harvesters.

AIM: To assess the relationship between systemic inflammation markers and ocular surface parameters in hazelnut harvesters. MATERIAL AND METHOD: This prospective study included 30 patients presenting with moderate ocular surface diseases during the hazelnut harvesting season. A detailed ophthalmological examination was performed during the harvesting season and the first month after the end of treatment (control). Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) scores were determined. In complete blood count analysis, in addition to the evaluation of inflammatory cells, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated. RESULTS: Eosinophil percentage had a high level of negative correlation with the TBUT and Schirmer values and a high level of positive correlation with the OSDI score during the hazelnut picking season (r = -0.727, r = -0.735, r = 0.750, respectively). During the hazelnut harvesting season, the NLR and SII parameters had a moderate level of negative correlation with the TBUT (r = -0.29 and r = -0.276) and Schirmer (r = -0.33 and r = -0.298) values and a moderate level of positive correlation with the OSDI score (r = 0.389 and r = 0.264). CONCLUSION: In hazelnut harvesters, ocular allergy and inflammation may be associated with systemic biomarkers.

Comparison of dominant- and non-dominant-hand cateract surgery outcomes by a single surgeon.

PURPOSE: To compare dominant and non-dominant hand phacoemulsification surgery outcomes. METHODS: This retrospective, single-center study included 300 patients who underwent phacoemulsification surgery by a single, right-handed surgeon. The patients were divided into two groups according to whether the surgeon used his dominant or non-dominant hand during surgery. Right eye operations were performed with the right hand, and left eye operations were performed with the left hand. Detailed ophthalmological examinations were performed on all patients preoperatively and postoperatively. Intraoperative phacoemulsification parameters, the presence of intraoperative and postoperative complications, postoperative refractive errors, visual acuity, and surgically induced astigmatism values were compared between the groups. RESULTS: There were 171 patients in the dominant hand phacoemulsification group and 129 patients in the non-dominant hand phacoemulsification group. The distributions of age, gender, systemic diseases, and lens opacification were similar between the groups (p>0.05, for all). No statistically significant difference was observed between the two groups in terms of total operation time, phaco power, ellips fx, or ultrasonic time (p>0.05, for all). There was also no significant difference in relation to intraoperative and postoperative complication distributions, postoperative third-month refractive errors, visual acuity, or surgically induced astigmatism values (p>0.05, for all). CONCLUSION: This study demonstrated that cataract surgery performed by a single surgeon can be effectively and safely performed using both hands on patients in a real operating theater environment. More objective results can be obtained with surgeries performed by a larger number of experienced surgeons.

Assessment of the Choroidal Vascular Structure in Multisystem Inflammatory Syndrome in Children.

PURPOSE: To evaluate the choroidal vascular structure in cases of multisystem inflammatory syndrome in children (MIS-C). METHODS: This prospective study included 38 eyes of 19 patients with MIS-C and 60 eyes of 30 healthy participants. Optical coherence tomography (OCT) imaging was performed at 1 month after diagnosis in the MIS-C group. Using enhanced depth imaging OCT, choroidal thickness was measured in the subfoveal, nasal, and temporal quadrants at 500 and 1,500 µm distances from the fovea (SCT, N500CT, T500CT, N1500CT, and T1500CT, respectively). The luminal, stromal, and total choroidal areas were evaluated with the binarization method in ImageJ software (National Institutes of Health). The ratio of the luminal area to the total choroidal area was determined as the choroidal vascular index (CVI). RESULTS: The age and sex distributions of the two groups without any ophthalmologic pathology were similar (P > .05). The choroidal thickness values in all quadrants except for T1500CT were similar between the two groups (P > .05). T1500CT was significantly lower in the MIS-C group (P = .02). The luminal choroidal area was 1.04 ± 0.10 mm2 in the MIS-C group and 1.26 ± 0.24 mm2 in the healthy control group (P < .001), and the CVI values were 0.52 ± 0.04 and 0.57 ± 0.09, respectively (P = .01). The stromal and total choroidal area values did not significantly differ between the two groups (P > .05). CONCLUSIONS: This is the first study to evaluate CVI in patients with MIS-C. It was observed that the choroidal vascular structure could be affected in the early period of MIS-C, as shown by a decrease in the CVI value and luminal vascular area. OCT can be used to monitor ocular vascular changes in these patients. [J Pediatr Ophthalmol Strabismus. 2024;61(2):120-126.].

Ocular hemodynamics in epileptic children treated with antiepileptic drugs.

PURPOSE: To evaluate the quantitative measurements obtained for vessel density (VD) of the optic nerve head, macula, peripapillary retinal nerve fibre layer (p-RNFL) and total retinal thicknesses (Trt) by optical coherence tomography angiography (OCT-A) and the choroidal vascular structure using an image binarization method in children with epilepsy using three different antiepileptic drugs (AEDs) and to compare these measurements with healthy participants. METHODS: This observational, cross-sectional study included 124 patients divided into 4 groups: Group-1: patients receiving carbamazepine(n = 30), group-2: patients receiving levetiracetam (n = 31), group-3: patients receiving valproic acid (n = 32), and group 4: healthy controls (n = 31).A fully automated microstructural analysis of the VD of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and the choriocapillaris (CC) layers and radial peripapillary capillary, and Trt, p-RNFL thickness were analyzed by using OCT-A. Enhanced depth imaging (EDI)-OCT scans of the macula were obtained and the images were binarized using the ImageJ software. RESULTS: The mean age, gender distribution and the duration of epilepsy were similar in all groups. Evaluation of the p-RNFL thickness and perifoveal Trt between the groups showed a statistically significant difference in all quadrants.The p-RNFL thickness was lower in patients receiving carbamazepine and valproic acid. The lowest values of the luminal area and choroidal vascular index (CVI) were found in patients receiving valproic acid; comparison with matched healthy controls showed statistically significant differences. CONCLUSION: Valproic acid and carbamazepine are associated with thinning of the p-RNFL in epilepsy patients, but the macular and radial peripapillary VD were not affected.However, a reduction of choroidal vascular blood flow was found in epilepsy patients taking valproic acid.

Comparison of different methods of correcting astigmatism in cataract surgery.

CLINICAL RELEVANCE: Astigmatism causes a decrement in visual acuity, and deterioration in visual quality. BACKGROUND: The aim of this study is to compare clear corneal incision (CCI) in the steepest meridian, opposed clear corneal incision (OCCI) and toric intraocular lens implantation methods for the correction of astigmatism in cataract surgery. METHODS: Total of 93 preoperative patients with the rule corneal astigmatism (between 1.00-3.00 D)underwent uncomplicated cataract surgery are retrospectively included in this study. Whole patients are divided into three groups of equal number of patients of 31 by considering the astigmatism correcting methods that are as follows. Group 1 consists of patients underwent CCI on the steepest meridian, group 2 consists of the patients underwent paired OCCI, and group 3 consists of those with toric intraocular lens implantation. The preoperative and postoperative 3rd month uncorrected distance visual acuity, refraction and, keratometry values, and surgically induced astigmatism values calculated by Alpins method are recorded. RESULTS: The age, preoperative and postoperative 3rd month spherical, spherical equivalent refraction and keratometry values of the groups are similar (p > 0.05). The preoperative uncorrected distance visual acuity values are similar in whole groups, postoperative uncorrected distance visual acuity values are the highest in group 1, and lowest in group 3 (p = 0.85, p = 0.02, respectively). The preoperative and postoperative 3rd month mean cylinder refraction values are -1.86 D, -1.00 D in group 1, -1.77 D, -0.70 D in group 2, and -1.95 D, -0.40 D in group 3. There is a statistically significant difference among the groups (p = 0.01). The surgically induced astigmatism values are statistically different among the groups [it was 0.46 ± 0.21 in group 1, 0.91 ± 0.44 in group 2, 0.33 ± 0.18 in group 3 (p < 0.001, respectively)]. CONCLUSION: This study indicated that; CCI, paired OCCI, and toric intraocular lens implantation should be preferred and performed for the steepest meridian in low D, middle D, and high D astigmatism patients, respectively. CCI can easily be applied for low to medium D without needing extra skills and tools. On the other hand, toric intraocular lens implantation is a better option for a high astigmatism with proper and accurate planning before the surgery.

Evaluation of effect of covid-19 pandemic on anatomical and functional changes and vision-related quality of life in patients with glaucoma.

BACKGROUND: To evaluate anatomical and functional changes and vision-related quality of life in patients whose glaucoma follow-up was disrupted by the COVID-19 restrictions. METHODS: This retrospective observational study included 100 patients who were followed up at the glaucoma unit. For the patients whose follow-up evaluations were postponed due to COVID-19 restrictions, visual acuity (VA), intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, visual field parameters [mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)], and the National Institute of Ophthalmology Visual Function Scale-25 (NEI-VFQ-25) score were evaluated based on the measurements performed at the last visit before COVID-19 (V1) and at the first visit after the removal of COVID-19 restrictions (V2). RESULTS: The mean age of the patients was 61.1 ± 13.4 years, the mean follow-up time was 11.4 ± 4.2 months, and the mean interval between the last two visits was 7.2 ± 2.7 months. In the evaluation of the last two visits, VA was lower and IOP was higher at V2, and there was progression in the MD, PSD, and VFI values (p<0.05, for all). RNFL thickness progression was seen in 13-23% of the patients. According to the NEI-VFQ-25 evaluation, except for peripheral vision and near vision, all the remaining subscale scores and the total score were lower at V2 (p<0.05, for all). CONCLUSIONS: This study demonstrates the devastating impact of the COVID-19 pandemic on the anatomical and functional changes and vision-related quality of life together in patients with glaucoma.

Evaluation of choroidal thickness and choroidal vascular index in patients using combined oral contraceptive pills.

PURPOSE: To evaluate the choroidal thickness and choroidal vascular index (CVI) in healthy women using the combined oral contraceptive pill (COCp). METHODS: This prospective study included 30 women using COCp (3 mg drospirenone/0.03 mg ethinylestradiol) for contraception for at least 1 year and 30 healthy women who did not use COCp. Intraocular pressure (IOP), axial length (AL) and body mass index (BMI) values of all participants were recorded. Subfoveal choroidal thickness (SCT) and choroidal thickness at 1500 micron distance in nasal and temporal regions (NCT, TCT) were measured through optical coherence tomography (OCT) images. Luminal, stromal and total choroidal area values were evaluated by binarization method. The ratio of the luminal choroidal area to the total choroidal area was determined as the CVI value. RESULTS: There was no statistically significant difference in IOP and AL values between the two groups at no significant difference in age and BMI index (p > 0.05, for all). SCT, NCT and TCT values were no significant difference in the two groups (p > 0.05, for all). Luminal and stromal choroidal area values were found to be lower in the group using COCp (p = 0.01, p = 0.02 respectively). The CVI value was 62.1 ± 3.6% in the COCp group and 65.6 ± 4.3% in the control group. There was a significant difference between the two groups in terms of CVI value (p = 0.002). CONCLUSION: To our knowledge, this is the first study to evaluate CVI in women using COCp, and CVI was found to be lower in individuals using COCp. Therefore, CVI can be used in the follow-up of possible ocular pathologies that may develop in individuals using COCp.

The effect of Nd:YAG Laser applied in the posterior capsule opacification on retinal and choroidal structures.

PURPOSE: To assess the effect of neodymium:yttrium-aluminum-garnet (Nd-YAG) laser procedure on the choroid and retina in patients who developed posterior capsular opacification (PCO) after cataract surgery. METHODS: In this study, 32 eyes of 30 patients who underwent Nd:YAG laser treatment for PCO were evaluated. Visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography device (OCT), ganglion cell layer (GCL), inner plexiform layer (IPL), retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (SCT) were measured. Choroidal vascular index (CVI) was calculated from HD line images obtained by spectral domain OCT with the software Image J. RESULTS: The mean age of the patients participating in the study was 60.1 ± 8.9 years. There was no significant difference in IOP, CMT, RNFL, GCL, IPL and SCT values ​​in all comparisons before and after laser (p>0.05 for all values). While Nd:YAG laser pretreatment CVI was 63.2 ± 3.2%, it was 66.8 ± 2.9% at 1 week and 67.1 ± 2.6% at 1 month after laser treatment. A significant difference was detected in the comparison of pre-laser CVI and post-laser 1 week and 1 month CVI (p<0.05 for all values). DISCUSSION: CVI was found to be significantly higher in the post-laser period in patients who underwent Nd:YAG laser. As far as the author knows, this study is the first research in the literature to evaluate this relationship. CVI can be used to evaluate choroidal vascular changes after Nd:YAG laser.

Effect of oral contraceptive pills on the retinal microvascular structure: An optical coherence tomography angiography study.

BACKGROUND: To investigate the effect of oral contraceptive pills (OCPs) on foveal avascular zone (FAZ), peripapillary capillary plexus, and superficial and deep capillary plexus (SCP and DCP) measurements. METHODS: This cross-sectionally designed study included 32 healthy female participants using OCPs (3 mg drospirenone and 0.03 mg ethinylestradiol) for at least one year for contraception and 32 healthy controls that did not use any drugs. All subjects were evaluated using optical coherence tomography angiography (OCTA). Using OCTA, the measurements of SCP, DCP, radial peripapillary capillary (RPC) vessel density; FAZ area and perimeter; acircularity index (AI); and foveal density (FD) were undertaken. Each participant's measurements were taken while they were in the follicular phase of their menstrual cycles (day 3). RESULTS: Age and body mass index did not significantly differ between the groups (p = 0.56 and p = 0.15, respectively). The DCP vessel densities in all the regions were lower in the OCP group (p<0.05 for all). The vessel densities of SCP and RPC, FAZ area and perimeter, AI, and FD were similar between the two groups (p>0.05 for all). CONCLUSION: We determined that the DCP vessel density was reduced in women using this drug. OCPs can cause changes in retinal microvascular structures. Therefore, OCTA can be used in the follow-up of healthy women using OCP.

Effect of Nondominant Left-Handed Phacoemulsification Surgery on Corneal Endothelium.

PURPOSE: To evaluate the effect of phacoemulsification surgery performed with the nondominant left hand on the corneal endothelium. METHODS: The study included 160 patients who were followed up for at least six months after uneventful cataract surgery. Seventy-seven patients who underwent nondominant left-handed phacoemulsification were evaluated as Group 1 and 83 patients who underwent dominant right-handed phacoemulsification were evaluated as Group 2. In all the patients, preoperative axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were evaluated. All phacoemulsification procedures were undertaken with the same device by two surgeons using the same technique, and the intraoperative cumulative dissipated energy (CDE) value, effective phacoemulsification time, and total operative time were recorded. Corneal endothelial cell density (ECD), coefficient of variation (CV) percentage, hexagonal cell percentage (HCP), and central corneal thickness (CCT) measurements were evaluated by specular microscopy preoperatively and at the postoperative first and sixth months. RESULTS: The two groups had a similar age and gender distribution and did not significantly differ in terms of the preoperative AL, AD, ACD, LT, intraoperative CDE, effective phacoemulsification time, and total operative time with similar age and gender distribution (p > 0.05 for all). The preoperative and postoperative first- and sixth-month specular microscopy measurements of ECD, CV, HCP, and CCT ​​were also similar in the groups (p > 0.05 for all). CONCLUSIONS: In this study, it was observed that nondominant left-handed phacoemulsification resulted in similar changes in endothelial cell count and morphology to those obtained from dominant-handed phacoemulsification.

Evaluation of structural and vascular changes in the choroid after uneventful phacoemulsification surgery.

Objective: The aim of this study was to evaluate structural and vascular changes in the choroid after phacoemulsification surgery. Methods: This research comprised 50 eyes of 50 individuals who received uneventful surgical treatment for cataracts. Intraocular pressure, axial length, subfoveal choroidal thickness, and choroidal thickness in the nasal and temporal areas at 1,500-micron distance from the fovea were measured before surgery and at one and three months after surgery. At the same evaluation times, the choroidal luminal area and choroidal stromal area were calculated with the binarization method using image J software, and the choroidal vascular index (CVI) was calculated by dividing the luminal area by the total area. In addition, total surgery time and effective phacoemulsification time were recorded. Results: The patients had a mean age of 64.7 ± 8.5 years. The mean total operative time was 13.9 ± 3.8 minutes, and the mean effective phacoemulsification time was 3.8 ± 2.1 minutes. The mean intraocular pressure value was 14.4 ± 3.4 mmHg before surgery, and 13.2 ± 2.9 mmHg at the first month and 13.0 ± 2.1 mmHg at the third month postoperatively. Although there was a decrease in the intraocular pressure after surgery, no significant difference was found (p>0.05 for all). The axial length measured during the first and third months postoperatively did not significantly differ from the evaluation undertaken preoperatively (p>0.05 for all). A significant increase was detected in the subfoveal, nasal, and temporal choroidal thicknesses at the first postoperative month compared to the preoperative values (p<0.05), but no significant difference was found at the third month postoperatively (p>0.05). The mean CVI was 61.6 ± 3.5% preoperatively, 65.2 ± 4.2% at the first postoperative month, and 65.9 ± 3.9% at the third postoperative month. The increase at the first and third postoperative months was significant when compared to the evaluation made preoperatively (p=0.004 and p<0.001, respectively). Conclusion: Structural and vascular choroidal changes in the after-cataract surgery are important. In this study, it was observed that after uneventful phacoemulsification, the choroidal thickness increased at the first postoperative month and reached the preoperative values at the third month. It was also determined that CVI increased at the first and third postoperative months. CVI can offer an idea about whether cataract surgery is a predisposing factor in diseases involving the choroid. Abbreviations: CVI = choroidal vascular index.

Comparison of Pain between First and Second Operated Eyelids after Upper Eyelid Blepharoplasty.

PURPOSE: To evaluate and compare intraoperative pain during upper eyelid blepharoplasty (UEB) between on first and second operated eyelids. METHODS: In this cross-sectional observational study, the patients were divided into two groups, with group 1 representing 40 patients whose surgery was first started on the right and group 2 representing the other 40 patients who started surgery on the left first. UEB was performed to all patients by the same surgeon under the same and equal amount of local anesthesia. Degree of pain felt during surgery on first and second operated eyelid was evaluated with the visual analoge scale (VAS) and Wong-Baker Facial Pain Expression Scale (WBFPES) of all patients immediately after surgery and was compared using paired t-test. RESULTS: There were 20 female and 20 male patients in both groups. In group 1, the VAS value was 2.8 ± 1.5 and WBFPES value was 2.7 ± 1.6 UEB in the first operated eyelid; the VAS value was 4.1 ± 1.8 and WBFPES value was 3.9 ± 1.8 UEB in the second operated eyelid. A significant difference was found between pains felt during first and second operated eyelid UEB regarding VAS and WBFPES values in group 1 (p = 0.003 and p = 0.002, respectively). In group 2, the VAS value was 1.9 ± 1.0 and WBFPES value was 2.0 ± 1.0 UEB in the first operated eyelid; the VAS value was 3.0 ± 1.5 and WBFPES value was 2.8 ± 1.6 UEB in the second operated eyelid. A significant difference was found between pains felt during first operated and second operated eyelid UEB regarding VAS and WBFPES values in group 2 (p = 0.009 and p = 0.005, respectively). CONCLUSIONS: To the best of our knowledge, this study is the first to evaluate which eyelid is more painful during surgery in UEB. Patients tend to feel more pain during surgery on the second operated eyelid. Therefore, surgeons should consider using local anesthetics with more volume or longer duration in the second operating eyelid in light of this information and patients should be given detailed information about pain.

Ocular perfusion characteristics of children with newly diagnosed epilepsy.

BACKGROUND: To investigate the vascular changes of the optic nerve head (ONH) and macula by using optical coherence tomography angiography (OCT-A), and also the choroidal vascular structure by using an image binarization tool in children with newly diagnosed epilepsy and to then compare these parameters with healthy subjects. METHODS: Forty-one epilepsy children and 36 healthy controls were included in this prospective and cross-sectional study.The radial peripapillary capillary (RPC) vessel density (VD) and macular foveal,parafoveal,perifoveal of superficial capillary plexus (SCP),deep capillary plexus (DCP) and choriocapillaris (CC) VD, and CC flow area were analyzed.Enhanced depth imaging (EDI) OCT scans of the macula were obtained and the images were binarized using the ImageJ software (National Institutes of Health, Bethesda, MD, USA).The subfoveal choroidal thickness (SFCT),the area of choroidal, luminal, and interstitial and the percentage of luminal area in the choroid (Choroidal vascular index (CVI)) were analyzed.We also evaluated the thickness of the peripapillary retinal nerve fiber layer (RNFL),the macular ganglion cell layer (GCL), and the inner plexiform layer (IPL). RESULTS: There was a significant decrease in the VD of the CC and the CC flow area in children with epilepsy compared to healthy subjects (p<0.05).However, the VD of the RPC, and of the SCP and DCP of the macula were similar between the two groups(p>0.05).The SFCT,choroidal area,luminal area, and CVI were statistically significant lower in children with newly diagnosed epilepsy compared to healthy subjects. CONCLUSION: This study has demonstrated that the choroidal perfusion from the microcirculation is lower in children with newly diagnosed epilepsy.The pathophysiology of epilepsy and neurodegenerative processes may also include this vascular dysfunction as one of the factors.

Evaluation of the optical coherence tomography findings of patients with idiopathic epiretinal membrane.

BACKGROUND: This study aimed to determine the relationship between basal visual acuity (VA) and basal optical coherence tomography (OCT) parameters of patients with idiopathic epiretinal membrane (iERM). METHODS: The study included 200 eyes of 200 patients with iERM. In the evaluation of basal VAs, logMAR 0.3 (0.5 on Snellen chart) was accepted as the limit, and the patients were divided into two groups as Group 1 with VA values below logMAR 0.3 and Group 2 with those above logMAR 0.3. Using OCT, the ellipsoid zone (EZ), interdigitation zone (IZ), external limiting membrane (ELM) integrity, peaked appearance of EZ in the fovea, disorganization of the inner retinal layers (DRIL), central foveal thickness (CFT), maximum retinal thickness (MRT), total photoreceptor length (TPL), photoreceptor outer segment length (PROSL), photoreceptor deformity index (PDI), and inner retinal layer irregularity index (IRLII) were evaluated and compared between the groups. RESULTS: There were an equal number of patients in Group 1 and Group 2. The preservation of ELM, EZ, and IZ integrity and the peaked appearance of EZ in the fovea were observed at higher rates in Group 1, whereas the rate of DRIL was higher in Group 2 (p < 0.05 for all). In the multiple regression analysis performed to evaluate categorical OCT parameters, only the presence of DRIL was found to be significantly associated with VA (p < 0.003). CFT*, MRT*, and IRLII** were significantly lower in Group 1 (*p < 0.001, **p = 0.001). TPU, PROSL, and FDI were similar between the two groups (p > 0.05 for all). CONCLUSION: According to the multiple regression analysis, only the presence of DRIL was correlated with lower VA values. Among the OCT parameters, an increase in CFT and MRT, as well as the IRLII value moving away from 1 were related to lower VA values.