The effect of intravitreal anti-VEGF injections on choroidal vascular index in patients with diabetic macular edema.

PURPOSE: This study aims to examine and compare the effects of intravitreal bevacizumab injection (IVB) at subfoveal 1500 micron (µm) and submacular 6000 µm in patients with diabetic macular edema (DME). METHODS: Fifty eyes of 45 patients with DME who completed six doses of IVB were included in the study group, and 50 eyes of 42 patients who had diabetic retinopathy (DR) but did not receive any treatment were included in the control group. Central macular thickness (CMT), central choroidal thickness (CCT), subfoveal and total choroidal area (TCA), and choroidal vascular index (CVI) were calculated and their changes at zero, three and six months were evaluated. RESULTS: At baseline, CVI was significantly lower in both the subfoveal and total macular areas in the study group (p = 0.004, p = 0.003). In the study group, a significant decrease was observed in CVI between zero and six months in the subfoveal area (p = 0.001). In the submacular area, the decrease in CVI in the study group was significant between zero to three months and zero to six months. There was moderate correlation between measurements of CVI in the subfoveal and total macular areas (r = 0.66, p < 0.001). CONCLUSION: These findings indicate that intravitreal bevacizumab injection reduces the CVI and the effects of intravitreal anti-VEGF on CVI emerge earlier and more prominently in the submacular 6000 µm area.

Changes in retinal nerve fiber layer thickness may be the cause of post-COVID-19 headaches.

OBJECTIVE: The prevalence of post-COVID headaches is not low. The eye can be affected by this infection, but it is not clear yet what the relationship is between persistent headaches and the thickness of the retinal nerve fiber layer (RNFL) after COVID-19 infection this study aims to investigate the relationship between these subjects. METHODS: In this retrospective study, in patients who have had a persistent headache, SD-OCT analysis of RNFL was obtained, and RNLF thickness values before and after COVID-19 infection were analyzed. RESULTS: A total of 26 eyes from 13 patients (nine (69.2%) females, four (30.8%) males) with persistent headaches after COVID-19 infection were studied. The average age was 47,35 years for females and 63 years for males. The mean RNFL thickness of both eyes between before and after COVID-19 infection decreased, which was statistically significant. CONCLUSION: In this study, a correlation between headache and changes in RNLF after COVID-19 infection was found. It may have wider ramifications to look into the COVID-19-associated headache phenotype of people with a history of migraines, contributing to a more comprehensive understanding of migraine pathogenesis. This relationship can provide further insight into this infection.

Evaluation of early period changes in intraocular pressure, ocular biometry and anterior segment after upper eyelid blepharoplasty.

PURPOSE: To investigate the acute effects of upper eyelid blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. METHOD: This prospective cross sectional study examined the eyes of 49 patients with dermatochalasis. Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes mesopic and photopic pupil diameter, anterior chamber depth, and corneal astigmatism on the day of surgery and on days first and seventh postoperatively. Ocular biometry was used to assess axial length and intraocular lens power. Goldmann applanation tonometry was used to measure intraocular pressure. RESULTS: Forty-nine eyes (26 males and 23 females) of 49 patients aged between 44 and 76 years (mean 61 ± 7.9) were included in our study. The mean anterior chamber depth (ACD) was 2.90 ± 0.37 mm preoperatively, 3.00 ± 0.29 mm at postoperative day first, and 3.04 ± 0.29 mm at postoperative day seventh, and the increase in anterior chamber depth was statistically significant (p < 0.001). The mean astigmatism values were measured as preoperative 0.73 ± 0.69 D, postoperative first day 0.93 ± 0.81 D, and postoperative seventh day 1.26 ± 0.90 D. The increase in astigmatism values was statistically significant (p < 0.001). The mean pupil diameter measurements in the mesopic environment were 4.20 ± 0.61 mm preoperatively, 4.40 ± 0.59 mm on the first postoperative day, and 4.39 ± 0.57 mm on the seventh postoperative day, and there was a statistically significant difference between the three measurements (p = 0.03). The mean IOP measurements of the patients were 15.91 ± 3.51 mmHg preoperatively, 16.81 ± 3.36 mmHg on the first postoperative day, and 16.97 ± 3.13 mmHg on the seventh postoperative day. The increase between these three measurements was statistically significant (p = 0.013). CONCLUSION: This study includes important insights into the potential acute phase impact of blepharoplasty surgery on ocular findings. Patients undergoing upper eyelid surgery should be informed about the possible change in ocular biometric parameters, intraocular pressure, and pupil diameter.

Evaluation of corneal endothelial cell morphology off and on treatment by specular microscopy in children and adolescents with attention deficit hyperactivity disorder.

PURPOSE: To determine the structure and properties of corneal endothelial cells in children and adolescents with ADHD who received methylphenidate treatment at least six months. METHOD: The prospective, observational study included 33 eyes of 33 patients diagnosed with ADHD who received methylphenidate treatment for at least six months, 33 eyes of 33 patients newly diagnosed with ADHD who did not start medication treatment, and 33 eyes of 33 healthy individuals. Average cell density, coefficient of variation, maximum cell area, normal cell area, minimum cell area, average cell area, and hexagonality ratio values were evaluated by non-contact specular microscopy. The parameters recorded in all three groups were compared. RESULTS: The average age of children in the ADHD + MPH, ADHD, and control groups is 9 ± 1.7, 8.9 ± 2.3, and 8.9 ± 1.8 years, respectively. (p > 0.05) The average MPH treatment dose is 0.94 ± 0.19 mg/kg, the average daily MPH intake is 34.12 ± 14.04 mg, and the average duration of use of MPH is 24.03 ± 12.46 months. Central corneal thickness (CCT) was measured as an average of 540.45 ± 31.23 in the ADHD + MPH group, 540.61 ± 29.69 in the ADHD group, and 546.58 ± 27.72 in the control group. (p = 0.499) The average coefficient of variation (CV) values were measured as 25.48 ± 4.22 in the ADHD + MPH group, 26.12 ± 3.48 in the ADHD group, and 26.12 ± 3.64 in the control group. (p = 0.491) The average hexagonality ratio (%) (HEX) values were measured as 69.45 ± 8.41 in the ADHD + MPH group, 68.21 ± 6.82 in the ADHD group, and 68.91 ± 7.97 in the control group. (p = 0.892) No statistically significant difference was observed between all three groups in terms of all parameters. CONCLUSION: Methylphenidate treatment administered for at least six months with a diagnosis of ADHD did not have a toxic effect on the corneal endothelium.

Does occupational radiation exposure affect retinal nerve fiber thickness?

PURPOSE: To evaluate the thickness of peripapillary nerve fibers in radiation-exposed healthcare workers. METHODS: The study included 60 radiation-exposed healthcare workers and 60 healthy control groups. SD-OCT was used to measure mean peripapillary RNFL thickness along with peripapillary RNFL thickness in the upper, lower, nasal, and temporal quadrants. RESULTS: The mean age of the subjects participating in the study was 37 ± 6.3 (range 25-50) in the radiation-exposed group and 38 ± 4.9 (range 26-48) in the control group. The mean duration of exposure to radiation in healthcare workers was 11 ± 5 years (range 5-27). While the mean total rim thickness was 94.25 ± 8.2 in the radiation-exposed group, it was 102.8 ± 7.4 in the control group (p < 0.001). The mean superior rim thickness was 123.93 ± 15.13 in the radiation-exposed group, while it was measured as 129.75 ± 14.64 in the control group (p = 0.34). While the mean inferior rim thickness was 110.88 ± 13.43 in the group exposed to radiation, it was 130.08 ± 13.44 in the control group (p < 0.001). The mean nasal rim thickness was 70.25 ± 9.50 in the group exposed to radiation, while it was 75.38 ± 13.77 in the control group (p = 0.46). While the mean temporal rim thickness was 71.77 ± 8.73 in the group exposed to radiation, it was measured as 75.78 ± 13.15 in the control group (p = 0.52). Significant thinning of nerve fiber thickness was found statistically significant in all and especially the inferior quadrants of the healthcare workers exposed to radiation compared to the control group. CONCLUSION: After at least 5 years of radiation exposure, the thickness of the peripapillary retinal nerve fibers may decrease in healthcare workers.

Comparison of the efficacy of intravitreal Anti-VEGF versus intravitreal dexamethasone implant in treatment resistant diabetic Macular Edema.

PURPOSE: Comparison of the efficacy of monthly anti-VEGF versus dexamethasone (DEX) implant in patients with diabetic macular edema (DME) whose macular edema persists despite three doses of anti-VEGF therapy. MATERIALS AND METHODS: This retrospective study included 94 eyes of 94 patients with central macular thickness (CMT) > 300 µm despite previously receiving three doses of anti-VGEF (aflibercept or ranibizumab) injections between January 2014 and January 2019. The patients were divided into four groups. The first and second groups were the patients who received three more doses of initial anti-VGEF treatment after the initial anti-VGEF treatment. The third and fourth groups were patients switched to intravitreal dexamethasone implants. Patients were followed up every month for six months after the injection. The primary outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at six months. RESULTS: The mean age of the patients included in the study was 64.64 ± 7; there were 58 men (61.7%) and 36 women (38.3%). There was no statistically significant difference between the groups regarding age, stage of retinopathy, and lens status. When CMT, BCVA, and IOP were assessed among the four groups at the end of the sixth month, no statistical difference between the groups was found. There was no need for medical intervention despite the statistically significant increase in IOP at the end of the sixth month compared to the third month in the dexamethasone implanted groups. In contrast to the decrease in CMT, which was statistically significant in all four groups at the end of the sixth month compared to the third month, the increase in BCVA was not statistically significant in any of the four groups at the end of the sixth month. CONCLUSION: According to the results of our study, there is no superiority between continuing with existing anti-VEGF or switching to a dexamethasone implant after three doses of anti-VEGF.

Evaluation of the effects of duloxetine treatment on anterior segment parameters by optical coherence tomography.

PURPOSE: To evaluate the effects of Duloxetine on anterior segment parameters and intraocular pressure (IOP) in open angle eyes. METHODS: 38 eyes of 38 patients with fibromyalgia who had open or wide open angles according to the Shaffer classification. Anterior segment optic coherence tomography was performed before and after (month 3) Duloxetine treatment. IOP, central corneal thickness (CCT), corneal endothelial cell density (CECD) and anterior chamber depth (ACD) were also recorded and evaluated. RESULTS: No statistically significant difference was determined in IOP, CCT and CECD (p > 0.05). However, a statistically significant decrease was determined in both the temporal and nasal anterior chamber angle, angle opening distance, nasal trabecular-iris space area and ACD values between the baseline and month 3 (p < 0.001). DISCUSSION: We think that the short term use of Duloxetine does not lead to clinically significant changes despite their statistically significant effects on the anterior chamber parameters.