Resveratrol and quercetin protect from Benzo(a)pyrene-induced autophagy in retinal pigment epithelial cells.

PURPOSE: This study aims to investigate the role of Resveratrol (RES) and quercetin (QR) treatments against Benzo(a)pyrene (B(a)p)-induced autophagy in retinal pigment epithelial cells. METHODS: The IC50 doses of B(a)p, RES and QR in retinal pigment epithelial cells were determined by MTT assay and the relevant agents were administered singly or in combinations to ARPE-19 cells for 24 h. Occurrence of autophagy in the cells was verified by detection of autophagosomes using fluorescence microscope. Also, the mRNA expression levels of LC3 and Beclin 1 genes were analyzed by RT-PCR to collect further data on autophagy. Caspase-3 and IL-1ß levels in lysed cells were analyzed by ELISA. RESULTS: Autophagosomes were detected in B(a)p-treated ARPE-19 cell lines, as well as a 1.787-fold increase in LC3 mRNA expression levels. No autophagosome occurred in RES and QR treatments, and a significant decrease in their percentage amounts were observed in B(a)p + RES and B(a)p + QR. The mRNA expression levels of LC3 and Beclin 1 also supported these findings. B(a)p had no effect on Caspase-3 levels in ARPE-19 cells, but combined with RES and QR, it increased Caspase-3 levels significantly.IL-1ß levels were higher in B(a)p, B(a)p + QR, B(a)p + RES, RES and QR than control group. This rise in IL-1ß levels was correlated with suppression of mRNA expression levels of Beclin 1. CONCLUSION: B(a)p exposure caused autophagy in ARPE-19 cells, but did not induce apoptosis. RES and QR treatments prevented B(a)p-induced autophagy. Therefore, RES and QR treatments showed protective effect against potential degenerative diseases caused by chronic exposure to B(a)p.

Evaluation of Macular and Optic Disc Radial Peripapillary Vessel Density Using Optical Coherence Tomography Angiography in Gout Patients.

In this cross-sectional study, optical coherence tomography angiography (OCT-A) findings were compared in patients with gout (n = 30) and healthy participants (n = 32). The superficial and deep vessel density variables measured using OCT-A were compared between the groups. The superficial foveal and perifoveal vessel densities of the patient group were lower than those of the healthy participants (p = 0.014 and p = 0.045, respectively). However, all superficial and parafoveal vessel densities were similar in both groups (p = 0.469 and p = 0.284, respectively). The deep capillary plexus density measurements of the whole-zone, foveal, parafoveal, and perifoveal vessel densities using OCT-A revealed no significant differences between the groups (p = 0.251, p = 0.074, p = 0.177, and p = 0.881, respectively). A higher serum uric acid (SUA) level was found to be independently associated with a decreased superficial capillary plexus density and an increased choriocapillary flow deficit in the study population. Men were less sensitive to high SUA levels than women. These findings suggest that an elevated uric acid concentration may play a role in the development and progression of cardiovascular disease through changes in the microvasculature, as shown by the OCT-A parameters.

Optical Coherence Tomography Angiography Is a Useful Tool for Distinguishing Primary Raynaud's Phenomenon from Systemic Sclerosis and/or Very Early Disease of Systemic Sclerosis.

This cross-sectional study aimed to compare optical coherence tomography angiography (OCT-A) findings in patients with primary Raynaud's phenomenon (PRP; n = 22), very early disease of systemic sclerosis (VEDOSS; n = 19), and systemic sclerosis (SSc; 25 patients with limited cutaneous SSc (lcSSc) and 13 patients with diffuse cutaneous SSc (dcSSc)). Whole, parafoveal, and perifoveal superficial capillary plexus (SCP) vessel densities (VDs), deep capillary plexus VDs, and whole, inside, and peripapillary VDs were significantly higher in the PRP group (p < 0.001). In the lcSSc group, the FAZ perimeter was significantly higher than that in the VEDOSS group (p = 0.017). Retinal nerve fiber layer VDs were significantly lower in the lcSSc group than in the PRP and VEDOSS groups (p < 0.001). The whole and peripapillary optic disc VDs of the VEDOSS group were significantly higher than in the lcSSc group (p < 0.001). Whole SCP VDs (94.74% sensitivity, 100.00% specificity) and parafoveal SCP VDs (89.47% sensitivity, 100.00% specificity) showed the best performance in distinguishing patients with SSc from those with PRP. OCT-A seems to have potential diagnostic value in differentiating patients with PRP from patients with SSc and VEDOSS, and there is potential value in assessing prognostic roles, since findings from OCT-A images could be early indicators of retinal vascular injury long before overt SSc symptoms develop.

Conjunctival Impression Cytology and Tear Film Changes in Sarcoidosis: A Subjective and Objective Diagnosis Study.

Objectives: To evaluate sarcoidosis-induced tear film changes using subjective and objective diagnostic tests, particularly conjunctival impression cytology (IC), and to compare the results with healthy individuals. Materials and Methods: This study evaluated clinical data collected between January 2019 and January 2021 from 57 right eyes of 57 sarcoidosis patients without ocular involvement (Group 1) and 33 right eyes of 33 healthy individuals with similar demographic characteristics (Group 2). The Schirmer I test, tear break-up time (TBUT), fluorescein staining, and conjunctival IC were all performed as part of the conjunctival and corneal examinations following a thorough ophthalmological examination. The Ocular Surface Disease Index (OSDI) was used to assess subjective ocular symptoms. Results: The mean ages in Groups 1 and 2 were 49.26±3.18 and 51.91±2.89 years, respectively (p=0.720). The mean Schirmer I test, TBUT, and OSDI scores differed significantly (p<0.05 for all), with Group 1 having a significantly higher percentage of dry eyes than Group 2. Group 1 had significantly higher Nelson's grading system grades than Group 2 based on conjunctival IC analysis (p=0.001). There were no significant differences in visual acuity (p=0.17) or intraocular pressure (p=0.14) between groups. Conclusion: Sarcoidosis patients had significantly higher Nelson grades in conjunctival IC, as well as significantly higher percentages of dry eye as determined by the Schirmer I test, TBUT, and OSDI. Reduced tear quantity and quality may destabilize the tear film layer, resulting in a variety of ocular symptoms.

Low-dose rosmarinic acid and thymoquinone accelerate wound healing in retinal pigment epithelial cells.

PURPOSE: Thymoquinone (TQ) and rosmarinic acid (RA) are two biologically active compounds found in plants and that possess remarkable anti-oxidant and anti-inflammatory properties. The present study aimed to investigate the potential protective effects of RA and TQ, which have known anti-inflammatory and anti-oxidant effects, on retinal damage by establishing a wound healing model for retinal pigment epithelial cells (ARPE-19). METHOD: To this end, IC50 doses of RA and TQ in ARPE-19 cells were calculated by MTT assay. Both agents were administered at IC50, IC50/2 and IC50/4 doses for wound healing assay, and wound closure percentages were analyzed. Since the best wound healing was found at IC50/4 dose (low dose) for both agents, other biochemical and molecular analyses were planned to be performed using these doses. Following low dose RA and TQ treatments, the cells were lysed and TGF-ß1 and MMP-9 levels were analyzed by ELISA technique from the cell lysates obtained. In addition, the mRNA expression levels of TLR3, IFN-γ and VEGF were calculated by RT-PCR technique. RESULTS: Low dose of RA and TQ dramatically increased wound healing. RA may have achieved this by increasing levels of MMP-9 and TLR-3. In contrast, the mRNA expression level of VEGF remained unchanged. TQ accelerated wound healing by increasing both the protein levels of TGF-ß1 and MMP-9. Furthermore, low dose of TQ decreased both TLR3 and IFN-γ mRNA expression levels. CONCLUSION: Low doses of RA and TQ were clearly demonstrated to have protective properties against possible damage to retinal pigment epithelial cells.

Effect of the Presence of Silicone Oil in the Anterior Chamber After Complicated Retinal Detachment Surgery on Corneal Morphology by In Vivo Confocal Microscopy.

PURPOSE: This study evaluated the corneal endothelium, stromal keratocytes, subbasal nerve number and density in patients with silicone oil transferred to the anterior camera after pseudophakic complicated retinal detachment surgery by in vivo laser scanning confocal microscopy (IVLSCM). METHODS: Sequential measurements were made by IVLSCM between 3-6 months after surgery in two groups of patients: a) with silicon oil migration (Group 1) and without silicone oil migration (Group 2). RESULTS: A total of 63 cases (Group 1: 32 and Group 2: 31) were examined. The mean ages of patients were 65 ± 12 and 61 ± 11 and M/F ratio was 18/14 and 17/14, respectively. Mean intraocular pressures were 16.60 ± 4.60 and 15.75 ± 5.70 mm Hg, respectively. Changes were detected by IVLSCM mostly on the superior part of the cornea. A significant decrease in endothelial cell density and the number was detected in group 1 (2072 ± 116.2 cells/mm2 vs 2752 ± 512.3 cells/mm2; p < 0.001). Significant increases in posterior keratocyte density and stromal hyperreflective deposits were observed in group 1 (887 ± 45.8 cells/mm2 vs 725 ± 65.8 cells/mm2; p < 0.001). A significant negative correlation was observed between the size of stromal deposits and endothelial cell density (r=-0.758; p < 0.001). The number and density of corneal subbasal nerves were significantly lower in group 1 (1.8 ± 0.8 and 4.8 ± 1.2 vs 420 ± 101 and 701 ± 112 µm/square; p < 0.001). CONCLUSION: IVLSCM is a useful tool for the early detection of corneal abnormalities caused by silicone oil injection. This study verified silicone oil's detrimental effect on the corneal endothelium and revealed stromal changes in the anterior chamber, which we believe can be also been associated with the presence of silicone oil.

Impacts of protective face masks on ocular surface symptoms among healthcare professionals during the COVID-19 pandemic.

BACKGROUND: To assess the impacts of prolonged protective face masks (PFM) wear on ocular surface symptoms among healthcare professionals (HCPs), and how these symptoms affected PFM wear. METHODS: Thirty-question survey forms were distributed via social media platform to 396 HCPs (110 doctors, 164 nurses, and 122 health technicians) between September 8 and 30, 2021. Participants who could not be reached via social media were given a face-to-face questionnaire. Aside from sociodemographic data, the questionnaire inquired about PFM wear, PFM types, ocular surface symptoms, and how PFM wear has changed during the COVID-19 pandemic. RESULTS: A total of 74.5% of HCPs reported wearing PFMs, mostly surgical ones (76.8%), for half a day at work but not at home, with redness (29.3%) being the most frequently encountered ocular surface symptom, followed by burning (15.7%), pain (14.1%), tingling (10.9%), and rash (6.6%). The presence of associated restrictions in conjunction with PFM-related ocular symptoms was more likely in dry and hot environments. There was no significant relationship between PFM type, PFM-wearing duration, and HCPs' daily activities (p > 0.05). Despite the lack of a significant relationship between PFM types and ocular surface symptoms (p > 0.05), there was a significant relationship between PFM-wearing duration and ocular pain (p < 0.05). CONCLUSIONS: PFM-related ocular surface symptoms can be alleviated by properly wearing PFMs, reducing wear time, and using long-acting topical lubricants. This could improve PFM wear compliance, prevent disease transmission, and ultimately help with COVID-19 protection.

Evaluation of the factors that influence surgical outcome in conjunctival-limbal allograft transplantation.

OBJECTIVE: To evaluate the surgical results and the variables affecting the outcomes in conjunctival-limbal allograft transplantation (CLAL). METHODS: Patients who underwent CLAL for limbal stem cell deficiency (LSCD) between 2007 and 2019 were included in the study. LSCD staging was performed according to the staging system developed by the 'Limbal Stem Cell Working Group'. Stage 1C and higher stage LSCD patients were included in the study. 'Successful surgical outcome' was defined as improvement in LSCD stage at 1 year postoperatively. RESULTS: A total of 19 eyes of 19 LSCD patients were included. The mean age of the patients was 40.21 ± 14.65 (6-65) years, and the male/female ratio was 12/7. CLAL was performed in 9 (47.3%) patients with Stage 2B, 9 (47.3%) patients with Stage 3 and 1 (5.4%) with Stage 1C. LSCD aetiology; chemical injury (12), vernal keratoconjunctivitis (2), aniridia (1), corneal degeneration (1), and unknown (3). Surgery was successful in 52.6% of cases. Surgical success was associated with lower LSCD stage (p = 0.04). Lower grades of chemical injury at presentation and a longer time interval between injury and CLAL were associated with higher surgical success (p = 0.001; p = 0.001). The mean postoperative follow-up time was 50.77 ± 29.46 (6-98) months. CONCLUSIONS: Despite graft rejection and long-term use of immunosuppressants, CLAL is still one of the most preferred techniques in the treatment of bilateral LSCD. Preoperative LSCD stage and degree of chemical burn are important factors affecting the surgical outcome. Also, CLAL surgery should not be rushed and should be performed when inflammation has subsided.

Comparison of sweep visual evoked potential of visual acuity and Snellen visual acuity in healthy and amblyopic children / Comparação da acuidade visual por potenciais evocados visuais de varredura e pelo teste de Snellen em crianças saudáveis e ambliópicas

ABSTRACT Purpose: To evaluate the visual acuity of healthy and amblyopic children using sweep visual evoked potential and compare the results with those of Snellen visual acuity testing. Methods: A total of 160 children aged 6-17 years were included in the study. Of these, 104 (65%) were aged 7-17 years old, able to verbally communicate, and did not have any systemic or ocular pathology (Group 1). Group 2 included 56 (35%) children aged 6-17 years, able to verbally communicate, and had strabismus or anisometropic amblyopia whose best corrected visual acuity was between 0.1 and 0.8. All subjects underwent a detailed ophthalmological examination and sweep visual evoked potential measurement. Demographic characteristics, ocular findings, best corrected visual acuity, and sweep visual evoked potential results were recorded. Results: In Group 1, the mean and maximum visual acuity values for sweep visual evoked potential were lower than the Snellen best corrected visual acuity (p<0.001, for both, respectively). Bland-Altman analysis revealed that in Group 1, the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.11 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.023 logMAR. In Group 2, the mean and maximum sweep visual evoked potential visual acuity were lower than the Snellen best corrected visual acuity (p<0.001 and p=0.009, respectively). Bland-Altman analysis revealed that the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.16 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.19 logMAR. Conclusions: Sweep visual evoked potential visual acuity measurements have comparable results with Snellen visual acuity measurements. This technique is an objective and reliable method for evaluating visual acuity in children.

RESUMO Objetivo: Avaliar a acuidade visual através de po­tenciais evocados visuais de varredura em crianças saudáveis e ambliópicas, comparando-a com a acuidade visual pelo teste de Snellen. Métodos: Foram incluídas no estudo 160 crianças com idades entre 6 e 17 anos. Desse total, 104 crianças (65%) estavam entre 7 e 17 anos de idade, eram capazes de comunicação verbal e não tinham nenhuma patologia ocular ou sistêmica (Grupo 1). O grupo 2 incluiu 56 crianças verbais (35%) com idades entre 6 e 17 anos e portadoras de estrabismo ou ambliopia anisometrópica, com a melhor acuidade visual corrigida entre 0,1 e 0,8. Todos os pacientes foram submetidos a um exame oftalmológico detalhado e a uma medição do potencial evocado visual por varredura. Registraram-se as características demográficas, os achados oculares, a melhor acuidade visual corrigida e os resultados do potencial evocado visual por varredura. Resultados: No Grupo 1, os valores médios e máximos da acuidade visual pelo potencial evocado visual por varredura mostraram-se menores que a melhor acuidade visual corrigida medida através do teste de Snellen (p<0,001 para ambas as medições). Uma análise de Bland-Altman revelou que no grupo 1, a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e a média do potencial evocado visual por varredura foi de ± 0,11 logMAR, enquanto a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e o valor máximo do potencial evocado visual por varredura foi de ± 0,023 logMAR. No Grupo 2, os valores médio e máximo do potencial evocado visual por varredura mostraram-se menores que a melhor acuidade visual corrigida pelo teste de Snellen (respectivamente, p<0,001 e p=0,009). A análise de Bland-Altman revelou que a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e a média do potencial evocado visual por varredura foi de ± 0,16 logMAR, enquanto a distribuição das diferenças entre a melhor acuidade visual corrigida pelo teste de Snellen e o valor máximo do potencial evocado visual por varredura foi de ± 0,19 logMAR. Conclusões: As medidas da acuidade visual através do potencial evocado visual por varredura mostram resultados comparáveis às medidas da acuidade visual pelo teste de Snellen. Essa técnica é um método objetivo e confiável de se avaliar a acuidade visual em crianças.

Quantifying contact lens-related changes in keratoconus corneal topographic indices: an updated Pentacam Scheimpflug imaging analysis.

Purpose: Slowing ectasia progression is critical for maintaining visual potential in keratoconus (KC), for which various therapeutic approaches have been implemented. A Pentacam Scheimpflug imaging device was used to quantify contact lens (CL)-related changes in keratoconus corneal topographic indices. Methods: Thirty KC patients (group 1; 60 eyes) were using one of the three CL (rigid gas-permeable CL (RGPCL)-10, hybrid CL (HCL)-10, and scleral CL (SCL)-10 patients). A control group included 30 KC patients (group 2; 60 eyes) not using CLs due to intolerance or inappropriateness. The Pentacam® HR Scheimpflug imaging device was used to measure topographic indices such as Km anterior, Km posterior, K max, corneal thickness (CT, corneal central, apex, and thinnest), corneal volume (CV), anterior chamber volume (ACV), and anterior chamber depth (ACD) at baseline, 3rd, 6th, and 12th months. Results: The mean ages for groups 1 and 2 were 32±10 and 31±09 years, respectively. Group 1 had a lower but statistically significant change in K max than group 2 (p<0.038). Also, group 1 had a minor but non-significant decrease in anterior and posterior keratometry values compared to group 2 (pKm ant. right/ left eye = 0.063/ 0.065 and 0.087/ 0.094, respectively). RGPCL users had significant changes in central CT, thinnest CT and ACD (p<0.041). SCL users had more stable changes than other CLs for the thinnest CT along with significant changes in K max, pachy apex and ACV (p<0.036). HCL users had significantly higher K max stability (p<0.039). Conclusion: Regular use of appropriate therapeutic CLs may help to stabilize corneal deformity, thereby slowing changes in corneal topographic indices in KC.

Comparison of sweep visual evoked potential of visual acuity and Snellen visual acuity in healthy and amblyopic children.

PURPOSE: To evaluate the visual acuity of healthy and amblyopic children using sweep visual evoked potential and compare the results with those of Snellen visual acuity testing. METHODS: A total of 160 children aged 6-17 years were included in the study. Of these, 104 (65%) were aged 7-17 years old, able to verbally communicate, and did not have any systemic or ocular pathology (Group 1). Group 2 included 56 (35%) children aged 6-17 years, able to verbally communicate, and had strabismus or anisometropic amblyopia whose best corrected visual acuity was between 0.1 and 0.8. All subjects underwent a detailed ophthalmological examination and sweep visual evoked potential measurement. Demographic characteristics, ocular findings, best corrected visual acuity, and sweep visual evoked potential results were recorded. RESULTS: In Group 1, the mean and maximum visual acuity values for sweep visual evoked potential were lower than the Snellen best corrected visual acuity (p<0.001, for both, respectively). Bland-Altman analysis revealed that in Group 1, the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.11 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.023 logMAR. In Group 2, the mean and maximum sweep visual evoked potential visual acuity were lower than the Snellen best corrected visual acuity (p<0.001 and p=0.009, respectively). Bland-Altman analysis revealed that the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.16 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.19 logMAR. CONCLUSIONS: Sweep visual evoked potential visual acuity measurements have comparable results with Snellen visual acuity measurements. This technique is an objective and reliable method for evaluating visual acuity in children.

Retinal microvascular morphology versus COVID-19: What to anticipate?

BACKGROUND: To investigate retinal microvascular morphological changes in previously COVID-19 infected patients using optical coherence tomography angiography (OCTA), and compare the findings to age- and gender-matched healthy subjects. METHODS: In this cross-sectional study, OCTA findings (6.0 × 6.0 mm scan size and scan quality index ≥7/10) from previously COVID-19 infected patients (group 1, 32 patients, 64 eyes) with ≥1 month of complete recovery were compared to healthy subjects (group 2, 33 subjects, 66 eyes) with no history of COVID-19 infection. A positive real-time reverse transcription-polymerase chain reaction test on a naso-pharyngeal swab sample confirmed the diagnosis. The AngioVueAnalytics, RTVue-XR 2017.1.0.155 software measured and recorded OCTA parameters. RESULTS: Group 1 had significantly lower superficial capillary plexus vessel densities in all foveal regions than group 2 (P<0.05). Foveal deep capillary plexus vessel density in group 1 was also significantly lower than in group 2 (P=0.009); however, no significant differences were found in other regions (P>0.05). All foveal avascular zone (FAZ) parameters were higher in group 1 than in group 2, with significant differences in FAZ area (P=0.019) and foveal vessel density 300 µm area around FAZ (P=0.035), but not FAZ perimeter (P=0.054). The outer retina and choriocapillaris flows were significantly lower in group 1 than in group 2 (P<0.05). CONCLUSIONS: Prior COVID-19 infection seems to be associated with significant changes in retinal microvascular density, as well as FAZ and flow parameters, which may be attributed to different pathogenic mechanisms that lead to SARS-CoV-2 infection, such as thrombotic microangiopathy and angiotensin-converting enzyme 2 disruption.

Obstructive sleep apnea in patients with central serous chorioretinopathy.

PURPOSE: In this study, we aimed to evaluate the relation between obstructive sleep apnea (OSA) and central serous retinopathy (CSR). METHODS: Twenty-three consecutive subjects aged >18 years with the diagnosis of CSR were included in this prospective study. Overnight polysomnography was performed to all subjects. Desaturation index and apnea-hypopnea index (AHI) were recorded. Obstructive sleep apnea was classified according to AHI as mild, moderate, or severe. Statistical analysis was performed using chi-square test, Fisher's exact test, and Mann-Whitney U test. RESULTS: Fourteen of 23 CSR patients (60.9%) had OSA. Prevalence of OSA was significantly higher in male subjects with CSR compared to female subjects with CSR (p = 0.018). One (16.7%) female subject with CSR had OSA whereas thirteen (76.5%) male subjects were found to have OSA. Desaturation index was found to be 5.1 ± 4.2 in females and 12.9 ± 11.1 in males (p = 0.036). CONCLUSION: Obstructive sleep apnea is seen nearly in 2/3 of patients with the diagnosis of CSR. There are possible common pathophysiological mechanisms like oxidative stress, vasoconstriction, or blood coagulation abnormalities. Screening for OSA should be considered in subjects with the diagnosis of CSR.