Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series.

PURPOSE: To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. METHODS: In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS: Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. CONCLUSION: Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.

Comparison of posterior segment ocular parameters of Familial mediterranean fever with homozygous M694V mutation and carriers with heterozygous M694V mutation in children.

PURPOSE: The aim of this study is to comparatively evaluate the posterior segment ocular parameters of Familial Mediterranean fever (FMF) patients, asymptomatic FMF carriers, and the healthy controls in the pediatric age group. METHODS: The study included 30 FMF patients with homozygous M694V mutation in remission under colchicine therapy, 12 asymptomatic FMF carriers with heterozygous M694V mutation, and 41 age-sex-matched healthy controls. All patients underwent detailed eye examination, and peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vascular densities, and foveal avascular zone (FAZ) areas were measured using swept-source optical coherence tomography angiography. RESULTS: In this study, the mean pRNFL thickness was statistically significantly thinner (p = 0.010) in the FMF patients group compared to the FMF carriers group and the healthy control group, especially in the inferior quadrant of pRNFL (p = 0.042). The CMT in asymptomatic FMF carriers group was statistically significantly thicker than in FMF patients group (p = 0.037), especially the superior and inferior quadrants of macula were affected (p = 0.024; p = 0.020, respectively). In addition, this study showed that the changes of pRNFL thickness and CMT in pediatric patients with FMF were moderately correlated with the duration of diagnosis. There was no significant difference between the groups in terms of macular vascular densities and FAZ values. CONCLUSION: FMF is a hereditary autoinflammatory disease that causes multi-organ involvement, and this study showed that posterior segment ocular parameters could be affected not only in FMF patients but also in asymptomatic FMF carriers.

Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness in Adult Children of Patients With Pseudoexfoliation Glaucoma.

PRCIS: The adult children of patients with pseudoexfoliation glaucoma (PXG) had universally lower retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness values compared with individuals with a negative family history of PXG. PURPOSE: This study aimed to evaluate RNFL and GCC thicknesses in the adult children of individuals with PXG compared with people without a parental history of PXG. MATERIALS AND METHODS: This cross-sectional observational study included 40 eyes of 40 adults with confirmed parental history of PXG and 40 eyes of 40 healthy adults with no parental history of PXG. RNFL and macular GCC thicknesses were measured by spectral-domain optical coherence tomography (Nidek RS-3000 Advance) and compared between the groups. All subjects also underwent visual field testing (program 30-2 of the Humphrey Field Analyzer), and their mean deviation and pattern SD values were compared. RESULTS: Compared with adults without parental PXG, those with a parental history of PXG had significantly lower RNFL thickness overall (mean 98.2 vs 109.5 µm) and in all quadrants (inferior, superior, nasal, and temporal) ( P <0.001 for all). They also had significantly lower GCC thickness overall (mean 97.9 vs 109.4 µm) and in both hemispheres (superior and inferior) ( P <0.001 for all). There was no significant difference between the groups in terms of mean deviation or pattern SD values ( P >0.05). CONCLUSION: PXG in a parent was associated with significantly thinner RNFL and GCC compared with those with no history of PXG in a parent. Longer follow-up and prospective controlled clinical studies are needed to evaluate whether these findings may serve as an early indicator of glaucoma in the adult children of known PXG patients.

Quantitative assessment of left atrial functions by speckle tracking echocardiography in hypertensive patients with and without retinopathy.

PURPOSE: The association between hypertensive retinopathy and left atrial (LA) impairment is unknown. Accordingly, it was aimed to investigate the possible relationship between hypertensive retinopathy and LA phasic functions by means of two-dimensional speckle-tracking echocardiography (2D-STE). METHODS: A total of 124 hypertensive patients and 27 control subjects were included in the study. LA reservoir strain (LAS-S ), LA conduit strain (LAS-E ), and LA booster strain (LAS-A ) parameters were used to evaluate LA myocardial functions. RESULTS: Hypertensive patients (with and without retinopathy) displayed an obvious reduction in the LA reservoir strain (LAS-S ), and LA conduit strain (LAS-E ). Moreover, further impairment in LA reservoir and conduit strain was found in patients with hypertensive retinopathy than in the isolated hypertensive patients. There were no significant differences in LA booster strain (LAS-A ) among the three groups. Impaired LAS-S (OR: 0.764, CI: 0.657-0.888, and p < 0.001), LAS-E (OR: 0.754, CI: 0.634-0.897, and p = 0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568-3.507, and p < 0.001) were shown to be independent predictors of hypertensive retinopathy. CONCLUSION: Impaired LA reservoir and conduit strain may be used to predict hypertensive patients at higher risk of developing hypertensive retinopathy, and to determine which patients should be followed more closely for hypertensive retinopathy.

Effects of Dexamethasone Implant on Multifocal Electroretinography in Central Retinal Vein Occlusion.

PURPOSE: To investigate the effect of Ozurdex (dexamethasone intravitreal implant) on multifocal electroretinography (mfERG) findings during the treatment of macular edema secondary to the central retinal vein occlusion (CRVO). METHODS: Fifteen eyes of 15 patients who were treated with Ozurdex implant due to CRVO-related macular edema were included in this study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and mfERG evaluations were performed for all patients before injection of Ozurdex. After the injection, BCVA and CMT were measured at months 3 and 6 and mfERG test was performed at month 6 for all patients. RESULTS: Pre-implantation mfERG P wave amplitude values of r1, r2, r3, r4 and r5 were 57.8 ± 14.8, 25.1 ± 10.6, 17.2 ± 7.3, 12.0 ± 5.0 and 7.1 ± 3.6 nV/deg2, respectively. They increased to 72.9 ± 33.2, 31.2 ± 9.3, 22.6 ± 7.6, 15.6 ± 7.1 and 10.9 ± 5.7 nV/deg2, respectively, at month 6. However, these increases were not statistically significant (all P > 0.05). Pre-implantation mfERG r1, r2, r3, r4 and r5 P wave implicit times were 40.1 ± 10.9, 39.4 ± 3, 38.4 ± 3.4, 38.2 ± 3.1 and 39.3 ± 2.2 ms, respectively and these values were measured as 38.9 ± 8.2, 38.4 ± 4.7, 37 ± 3.8, 37.5 ± 4.6 and 37.7 ± 4.7 ms at 6 months. Although there were reductions in P wave implicit times in all rings, they were not statistically significant (all P > 0.05). CONCLUSION: In this prospective study, we found that the Ozurdex implant had no effect on mfERG findings 6 months after insertion for treatment of CRVO-related macular edema.

Evaluation of Peripapillary Nerve Fiber Layer after Dexamethasone Implantation (Ozurdex) in Branch Retinal Vein Occlusions.

Purpose. To evaluate the peripapillary retinal nerve fiber layer (RNFL) thicknesses of patients treated with intravitreal Ozurdex implant due to branch retinal vein occlusion (BRVO) related macular edema (ME). Methods. Thirty-three eyes of 33 patients treated with Ozurdex implant due to ME associated with BRVO were included in the study. Ophthalmic examinations including determination of best corrected visual acuity (BCVA), measurement of intraocular pressure (IOP), and central macular thickness (CMT) and peripapillary RNFL assessment with optical coherence tomography (OCT) were performed before the injection of Ozurdex implant and during the 6-month follow-up period after the injection. Results. The mean age was 55.2 ± 7.4 (range: 40-68) years. The BCVAs were significantly increased and CMTs were significantly decreased at month 3 and month 6 visits compared to baseline values. The mean IOP was significantly increased from baseline at day 1, week 1, and month 1 visits (p1 = 0.008, p2 = 0.018, and p3 = 0.022, resp.). The average and inferior quadrant peripapillary RNFL thicknesses were significantly reduced at month 6 control visit compared to baseline values (both p < 0.001). Conclusions. Ozurdex implant improved the BCVA and reduced the CMT in the eyes with RVO related ME. However, IOP elevations occurred within the first month after the injection and the average and inferior quadrant RNFL thinning was found six months after the injection. Further controlled studies are warranted.