Blood Whispers: Exploring Hematologic Indicators for Diagnosing and Predicting Severity of Vogt-Koyanagi-Harada Syndrome.

PURPOSE: To investigate the association of clinical findings and indocyanine green angiography (ICGA) score with inflammatory markers derived from complete blood count (CBC) parameters in patients with Vogt-Koyanagi-Harada (VKH) to determine the diagnostic and predictive role. METHODS: Demographic characteristics, presenting complaints, ocular findings, optical coherence tomography findings, ICGA scores and best corrected visual acuity were recorded in treatment-naive VKH patients at presentation. Patients were divided into two groups as acute stage and chronic recurrent stage. CBC parameters were noted in patients at presentation and healthy controls (HC, n = 25). Neutrophil-lymphocyte-platelet-monocyte counts, neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), monocyte/lymphocyte and systemic immune-inflammation index (SII) were recorded. The association between these markers and clinical severity were evaluated. RESULTS: Thirty-two patients with VKH (23 females/9 males) with a mean age of 34.1 ± 14.6 years were included in the study. There was an increase in neutrophil count, NLR and SII in patients with VKH compared to HC (p < 0.001). The cut-off values for these three parameters were 4.37, 2.24 and 562.35, respectively. Twenty-six patients presented in the acute stage and six patients presented in the chronic recurrent stage. Choroidal thickness, early stromal hyperfluorescence and total ICGA scores were higher in patients presenting in the acute stage (p < 0.001, 0.001 and 0.025, respectively). Patients with higher disease severity at presentation were treated earlier. Early stromal vessel hyperfluorescence and choroidal vasculitis scores were correlated with decreased lymphocyte count, increased NLR, PLR and SII (p < 0.05). CONCLUSION: CBC-derived inflammatory parameters indicate that VKH is a systemic inflammation. These parameters can be used in the diagnosis and determination of disease severity of VKH.

Optical coherence tomography angiography findings in optic disc drusen and idiopathic intracranial hypertension.

PURPOSE: To evaluate the changes in peripapillary microvascularity in idiopathic intracranial hypertension (IIH) and optic disc drusen (ODD) patients, by comparing them with those in healthy individuals, via optical coherence tomography angiography (OCTA). METHODS: Sixty-two eyes of 33 patients with ODD, 58 eyes of 30 patients with IIH, and 70 eyes of 70 healthy people were imaged for 6 × 6-mm optic disc scans on a spectral-domain OCTA. Vascular densities in superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) of ODD, IIH, and healthy eyes were compared with a one-way analysis of variance. Post-hoc analysis was performed with the Gabriel test. RESULTS: There was a significant decrease in peripapillary vessel density in SCP, DCP, and CC in patients with IIH compared to the control group (p < 0.05). In ODD patients, especially peripapillary vessel density in DCP was significantly reduced compared to the control group (p < 0.05). Peripapillary vessel density in DCP was significantly lower in the IIH group than ODD group (p < 0.05). CONCLUSIONS: Peripapillary vascular density may be affected during the course of the disease in both IIH and ODD. Compared to healthy individuals, the decrease in vascular density in these patients and the consequent decrease in perfusion in the peripapillary region may guide the pathogenesis of the complications in the course of these two diseases. Although vascular density in DCP and CC differs significantly between IIH and ODD, case-controlled studies are needed to evaluate the role of OCTA in the differential diagnosis of IHH and ODD.

Erdheim-Chester disease with chorioretinal and orbital involvement: a case report / Doença de Erdheim-Chester com envolvimento coriorretiniano e orbitário: relato de caso

ABSTRACT A 42-year-old woman presented with bilateral proptosis, chemosis, leg pain, and vision loss. Orbital, chorioretinal, and multi-organ involvement of Erdheim-Chester disease, a rare non-Langerhans histiocytosis, with a negative BRAF mutation was diagnosed based on clinical, radiological, and pathological findings. Interferon-alpha-2a (IFNα-2a) was started, and her clinical condition improved. However, 4 months later, she had vision loss with a history of IFNα-2a cessation. The same therapy was administered, and her clinical condition improved. The Erdheim-Chester disease is a rare chronic histiocytic proliferative disease that requires a multidisciplinary approach and can be fatal if left untreated because of multisystemic involvements.

RESUMO Uma mulher de 42 anos apresentou proptose bi-lateral, quemose, dor nas pernas e perda de visão. Com base em achados clínicos, radiológicos e patológicos, foi diag-nosticada doença de Erdheim-Chester com acometimento orbitário, coriorretiniano e multiorgânico. Trata-se de uma rara histiocitose não Langerhans negativa para a mutação BRAF. Foi iniciado tratamento com interferon alfa-2a (IFNα-2a) e o quadro clínico melhorou. No entanto, quatro meses depois, a paciente apresentou perda visual após a cessação do IFNα-2a. A mesma terapia foi administrada novamente e sua condição clínica melhorou novamente. A doença de Erdheim-Chester é uma doença proliferativa histiocítica crônica rara que necessita de uma abordagem multidisciplinar e pode ser fatal se não tratada, devido a envolvimentos multissistêmicos.

Erdheim-Chester disease with chorioretinal and orbital involvement: a case report.

A 42-year-old woman presented with bilateral proptosis, chemosis, leg pain, and vision loss. Orbital, chorioretinal, and multi-organ involvement of Erdheim-Chester disease, a rare non-Langerhans histiocytosis, with a negative BRAF mutation was diagnosed based on clinical, radiological, and pathological findings. Interferon-alpha-2a (IFNα-2a) was started, and her clinical condition improved. However, 4 months later, she had vision loss with a history of IFNα-2a cessation. The same therapy was administered, and her clinical condition improved. The Erdheim-Chester disease is a rare chronic histiocytic proliferative disease that requires a multidisciplinary approach and can be fatal if left untreated because of multisystemic involvements.

Assessment of Choroidal Vascularity in Inactive Thyroid Associated Orbitopathy.

Objectives: The objectives of the study were to evaluate the vascular and stromal structure of the choroid in patients with inactive thyroid associated orbitopathy (TAO) by measuring choroidal vascularity index (CVI) and choroidal thickness (CT) using enhanced depth imaging (EDI) optical coherence tomography (OCT). Methods: The choroidal image was taken with EDI mode spectral domain (SD)-OCT. All scans were taken between 9.30 am and 11.30 am to avoid the diurnal variation of CT and CVI. To calculate CVI, macular SD-OCT scans were binarized using the publicly available software ImageJ and luminal area and total choroidal area (TCA) were measured. CVI was calculated as the proportion of LA to TCA. Furthermore, the relation between CVI and axial length, gender, and age was evaluated. Results: This study included 78 individuals with a mean age of 51.4±7.3 years. Group 1 consisted of 44 patients with inactive stage TAO, and Group 2 consisted of 34 healthy controls. Subfoveal CT was 338.92±73.93 µm in Group 1 and 303.97±40.35 µm in Group 2 (p=0.174). The CVI significantly differed between the two groups, which was higher in group 1 (p=0.000). Conclusion: Although CT was not different between groups, CVI which is the indicator of the vascular status of the choroid, was higher in patients with TAO in the inactive stage compared with healthy control subjects.

Optic disc tilt and rotation effects on positions of superotemporal and inferotemporal retinal nerve fibre layer peaks in myopic Caucasians.

CLINICAL RELEVANCE: In myopic eyes, the optic disc may become tilted and rotated, making glaucoma diagnosis more difficult. BACKGROUND: To determine the presence of tilted optic disc, the degree of optic disc rotation, and their effects on the angular location of superotemporal and inferotemporal retinal nerve fibre layer (RNFL) peaks in healthy myopic Caucasians. METHODS: Non-glaucomatous healthy myopic Caucasian eyes with an axial length > 24 mm were evaluated. ImageJ was used to quantify optic disc tilt and torsion on red-free fundus photography. The RNFL was scanned using spectral-domain optical coherence tomography. The angle of the superotemporal and inferotemporal peaks with the vertical-horizontal meridian was measured. RESULTS: Fifty-four eyes of 54 individuals were evaluated. The axial length was correlated with the angular location for both the superotemporal (r = -0.549, p < 0.001) and inferotemporal (r = -0.415, p = 0.002) RNFL peaks; they were placed more temporally in eyes with higher axial lengths. For each 1 mm increase in axial length, the angle between the superotemporal peak and the temporal horizontal meridian decreased by 3.976°, and the angle between the inferotemporal apex and the temporal horizontal meridian decreased by 3.028°. The angle between the inferotemporal peak and the temporal horizontal meridian decreased by 0.231° for each 1° increase in optical disc torsion (R2 = 0.09 Regression coefficient = -0.231, p = 0.027). CONCLUSIONS: The temporal shift of superior and inferior peaks, the thickening of temporal and nasal RNFL, the presence of tilted optic disc, and optic disc rotation may cause misinterpretation of the RNFL in myopic Caucasians. When evaluating peripapillary RNFL thickness in myopic individuals, it would be better to consider these to avoid misinterpretation.

The Impact of COVID-19 Pandemic on Ophthalmology Residency Education.

Objectives: The aim of this study is to investigate the theoretical, practical, and academic effects of the Coronavirus disease 2019 (COVID-19) pandemic on ophthalmology residents. Methods: The web-based survey consisting of 28 questions was sent through Email to 37 educators who provides resident training. We divided the pandemic period into three, according to the severity of the pandemic and the measures, compared with pre-pandemic period (PreP), separately. Between March 2020 and June 2020 was named as P1, June 2020-October 2020 was named as P2, and October 2020-March 2021 was named as P3. Results: Responses received from 35 centers (17 university hospitals, 18 training and research state hospitals). There were totally 458 residents in the hospitals. Two hundred and forty-six of them (53.71%) worked on COVID-19 duties, with an average working time of 69.57 days. There were significant decreases in the number of patients examined by resident doctors and theoretical training time in the P1, P2, and P3 periods compared to PreP (p<0.05 for all). Furthermore, in terms of the total number of surgeries in clinics and surgeries performed by residents, there were significant decreases in P1 and P2 compared to PreP (p<0.001 for both), but there was no significant difference in P3 (p=0.109). In the examinations held in the clinic, in the 1st year of the pandemic, the grade average was lower than before the pandemic (p<0.05). Seventeen residents (3.74%) resigned or moved to another hospital. Conclusion: The COVID-19 pandemic has severely affected the theoretical, practical, and academic training of ophthalmology residents.

The Effect of Lower Eyelid Malposition Repair on Palpebral Fissure Size Changes.

Objectives: The aim of the study was to evaluate the effect of changes in the horizontal and vertical palpebral fissure dimensions on surgical success performed due to entropion and ectropion of the lower eyelid. Methods: The present research was conducted as a retrospective and interventional case series who had undergone involutional lower eyelid malposition repair with a lateral tarsal strip (LTS) alone, LTS with a medial spindle, and LTS with the advancement of the lower eyelid retractors. The subjects' medical records, including demographic and clinic characteristics, pre-operative assessment of horizontal eyelid laxity, and surgical outcomes, were reviewed. The distance between the pupillary light reflex and the lower-eyelid margin marginal reflex distance 2 (MRD-2) and the horizontal palpebral aperture (HPA) width were measured using the Image J program in the pre-operative and post-operative 6-month follow-up. The correlation between surgical success, changes in pre-operative and post-operative MRD-2, and HPA width was assessed by the Spearman rank correlation test. Results: A total of 66 eyelids of 48 patients were included in the study. This cohort comprised of 41 males (86.4%) and 7 females (13.6%), 18 of whom underwent bilateral surgery. The pre-operative mean MRD-2 was 7.13 ± 1.98 mm, and the post-operative 6-month mean MRD-2 was 6.21±1.19 mm (p<0.01). The mean post-operative HPA width was statistically significantly higher in comparison with the mean pre-operative HPA width (27.35±2.41, 26.89±2.39, p=0.02, respectively). There was no correlation between success rate and changes in horizontal and vertical palpebral fissure dimensions. Conclusion: LTS surgery is a method that turns the shortened HPA width to normal and enables the successful correction of the lower eyelid malpositions.

Comparison of Long-Term Visual and Refractive Results of Transepithelial and Mechanical Photorefractive Keratectomy.

Objectives: The aim of the study was to present and compare 2 years results of mechanical photorefractive keratectomy (M-PRK) and transepithelial photorefractive keratectomy (T-PRK) for myopia. Methods: One hundred and nine eyes of 55 patients were included in this retrospective study. The mean age of the patients was 26.9±5.2 years. Forty-four eyes (40.4%) had M-PRK and 65 eyes (59.6%) had T-PRK. Follow-up time was 2 years. Refractive errors (RE), uncorrected visual acuity (UCVA), and high-order corneal aberrations were compared. Results: The mean RE was -2.33±0.88 D and the mean UCVA was 0.24±0.17 logMAR at baseline for M-PRK patients. At month 24, those measurements were changed to -0.27±0.32 D and 0.99±0.04 logMAR. The mean RE was 2.19±0.73 D and the mean UCVA was 0.23 ± 0.15 logMAR at baseline for T-PRK patients. At month 24, those measurements were changed to -0.14±0.32 D and 0.99±0.01 logMAR. The mean REs significantly decreased and the mean UCVA significantly increased after both type of surgeries (all p<0.001). In M-PRK group, 4 mm zone total corneal aberration and 6 mm total-coma-spherical corneal aberrations were statistically significantly increased in post-operative term. In T-PRK group, only 6 mm total-spherical corneal aberrations were statistically significantly increased in post-operative term. There was no serious complication during surgeries or follow-up time. Conclusion: M-PRK and T-PRK were a safe and effective in the treatment of myopia in 2 years term. Some high-order aberrations may be increase after those treatments.

Evaluation of post phacoemulsification inflammation in eyes with and without pseudoexfoliation syndrome according to phaco parameters via laser flare photometry.

BACKGROUND: To compare the changes in anterior chamber laser flare after phacoemulsification and intraocular lens implantation according to phaco parameters in eyes with and without pseudoexfoliation syndrome. METHODS: Patients (39 without pseudoexfoliation (PEX), 28 with pseudoexfoliation) who underwent the surgery with the same device (Centurion System, Alcon Laboratories, USA) and same experienced surgeon were divided according to the presence of PEX. Anterior chamber laser flare was assessed using a laser flare meter (Kowa-FM700, Kowa Company, Japan) by the same blinded researcher. RESULTS: Total CDE, total U/S time, total torsional amplitude on time, average longitudinal power, average longitudinal power (FP3), equivalent average ultrasonic power (FP3) were higher in eyes with pseudoexfoliation (p<0.05 for each). The linear regression model suggested that presence of pseudoexfoliation and total CDE had a positive-correlation with the difference between postoperative day 1 and preoperative anterior chamber laser flare. There were significant differences in preoperative anterior chamber laser flare and those measured on postoperative days 1 and 30 between two groups (p<0.05). CONCLUSIONS: Early-postoperative anterior chamber laser flare is affected by the phaco parameters and there is a positive correlation between intraoperative phaco parameters and anterior chamber laser flare. Anterior chamber laser flare was significantly higher in eyes with pseudoexfoliation both pre- and postoperatively. Patients with pseudoexfoliation especially with high intraoperative total CDE should be followed carefully for early postoperative inflammation.

Muller muscle conjunctival resection or external levator advancement; a quantitative comparison of symmetry in unilateral ptosis.

PURPOSE: To compare muller muscle conjunctival resection (MMCR) and external levator advancement (ELA) in terms of objective and subjective symmetry in unilateral ptosis. METHODS: The patients who underwent unilateral MMCR (group1, n = 25) and ELA (group2, n = 25) were reviewed retrospectively. With the written algorithm, margin reflex distance-1 (MRD1), localization of the contour peak, and the percentage of overlapping curvatures (POC) of both upper eyelid curves were calculated. Semi-automated measurements were compared with the manual measurements. The correlation between objective and subjective symmetry was evaluated. RESULTS: Preoperative levator functions were similar in both groups (13.93 ± 3.25 mm and 13.3 ± 2.86 mm, respectively). We found strong correlations between manual and semi-automated measurements (ICC: 0.942, 95% CI = 0.924-0.956, p < 0.001). Preoperative MRD1 (2.15 ± 0.90 vs 1.51 ± 1.01, p = 0.022) and POC was lower in group 2 (66% vs 47.2%, p = 0.01). In the postoperative period, the increase in MRD1 and POC were similar in both groups (p = 0.2 and p = 0.7 respectively), and the contour peak displaced temporally (p < 0.01) providing a symmetric peak in both groups. Subjective symmetry increased as the difference in MRD1 between two eyes decreased (r = -0.456, p = 0.001), and POC increased (r = 0.396, p = 0.004). CONCLUSIONS: Besides subjective symmetry, MMCR and ELA are equally effective in ensuring symmetry objectively, as measured with MRD1 and contour peak symmetry and POC in unilateral ptosis. POC may be used as a criterion of symmetry in the evaluation of ptosis.

Predictive Factors for Corneal Scarring in Progressive Keratoconus Patients after Corneal Collagen Cross-linking.

Objectives: To evaluate predictive factors for corneal scar formation following corneal collagen cross-linking (CXL).Methods: The medical records of 295 progressive keratoconus patients who had undergone accelerated CXL were reviewed retrospectively in this comparative cohort study. Thirty-two eyes of 32 patients who still had a corneal scar in the first year (scar group) and 75 eyes of 75 patients without any scar (control group) were included. The patients' demographic characteristics, preoperative uncorrected distance visual acuity (UCVA) and corrected distance visual acuity (CDVA), slit-lamp biomicroscopy and corneal topographic parameters data were acquired from the patients' files. Multivariable logistic regression analysis and Receiver operating characteristic (ROC) curves were used for the purpose of evaluating predictive factors for corneal scar formation.Results: The UCVA and CDVA, which were determined to be similar between the groups during the preoperative period (P = .63, P = .71, respectively), improved postoperatively in both groups (P = .98, p = .10, respectively). The thinnest point of corneal thickness was statistically lower in the scar group (p = .03). In multivariable logistic regression analysis, preoperative keratometric astigmatism was a predictive value showing postoperative scar development (OR 11.81 95% CI 2.46-56.62, p = .002). Keratometric astigmatism had the highest sensitivity (90%), specificity (86.7%), and accuracy (95%) for scar formation at the best cut-off point of 5.61 D according to the ROC curve.Conclusions: A higher tendency for stromal haze development following CXL was determined in eyes with thinner corneas and higher keratometric astigmatism with the best cut-off value of 5.61 D.

Anterior Segment Surgery Performed During the COVID-19 Pandemic.

OBJECTIVES: This study evaluated anterior segment surgeries performed during the coronavirus 2019 (COVID-19) pandemic. Prevention of virus transmission is a critical consideration for surgeons, and includes assessment of etiology, the referral region, demographic characteristics, and the surgery to be performed. METHODS: The data of 144 patients who underwent anterior segment surgery between March 19, 2020 and June 1, 2020 were retrospectively reviewed. The patient demographic data and details of ophthalmological examination findings, the region patients were referred from, and the type of surgery performed were recorded and analyzed. RESULTS: A total of 144 patients, 49 women (34%) and 95 men (66%), were included in this study. The mean age of the patients was 31.30±25.88 years (range: 1-86 years). The presenting complaint was in the right eye in 43.7% of the cases, in the left eye in 52.8%, and in both eyes in 3.5% of the cases. While 94.4% of the applications were from Istanbul, the remaining 5.6% were from outside the province. Though 43.7% of the cases were patients seen previously at the study hospital in Istanbul, 56.3% presented for the first time. This hospital was the first referral center in only 39.6% of the cases. Evaluation of etiology indicated that corneal perforation (18.1%) was the most common, followed by keratitis (13.2%). The most common surgical intervention applied was amnion membrane transplantation (19.4%), followed by perforation repair (16.7%). CONCLUSION: Ophthalmological surgeries continue to be performed during the ongoing COVID-19 pandemic, however, special algorithms must be used to reduce the risk of COVID-19 transmission and to ensure continuity of healthcare for ophthalmology patients.

2D Analysis of Gold Weight Implantation Surgery Results in Paralytic Lagophthalmos.

OBJECTIVES: Gold weight implantation in the upper eyelid is a frequently performed treatment for paralytic lagophthalmos to prevent corneal exposure. A margin reflex distance of -1 and -2 (MRD1, MRD2), the palpebral fissure height (PFH), and the vertical lagophthalmos (LV) are 1-dimensional (1D) measurements used in follow-up. Because the exposure area is 2-dimensional (2D), this study was designed to investigate the results using both 1D and 2D analysis. METHODS: Ten patients who underwent pretarsal suborbicularis oculi gold weight implantation were included in the study. Photographs were taken with a digital camera and the images were analyzed using ImageJ software (US National Institutes of Health, Bethesda, MD, USA). The lagophthalmos area (LA) and ocular surface area (OSA) were measured in 2D in addition to the MRD1, MRD2, PFH, LV. Preoperative and postoperative values were compared using the Wilcoxon signed-rank test. Associations between parameters were evaluated using Spearman's correlation analysis. RESULTS: The mean age of the patients (7 male, 3 female) was 39.6±16.4 years (range: 14-60 years). The mean implant weight was 1.46 g (0.8-1.6 g). There were significant reductions in the MRD1, MRD2, PFH, OSA, LV, and LA values after surgery (p<0.05). The weight of the gold implant had a strong correlation with the PFH, OSA, MRD1, and MRD2, but not the LV or LA, preoperatively. The OSA was strongly correlated with the MRD1, PFH, and the implant weight, but not the MRD2. The LA was strongly correlated with the LV, preoperatively. In the postoperative period, the OSA was strongly correlated with the PFH and the MRD2 but not the MRD1, while the LA was strongly correlated with the LV, MRD1, and the PFH. CONCLUSION: It is easy to obtain 2D measurements using digital image analysis software, and they proved to be accurate and correlated strongly with 1D measurements. The OSA and LA measurements were significantly lower following upper eyelid gold weight implantation. The PFH and LV were compatible with the OSA and LA, preoperatively.

An algorithm for Botulinum toxin A injection for upper eyelid retraction associated with thyroid eye disease: long-term results.

PURPOSE: To evaluate the efficacy and complications of transconjunctival Botulinum toxin A injections performed according to an algorithm, for the management of upper eyelid retraction associated with thyroid eye disease. METHODS: Seventy one eyes of 60 patients at the inactive stage, who had undergone Botulinum toxin A injection were reviewed retrospectively. Botulinum toxin A was injected transconjunctivally, just above the superior tarsal border of the upper eyelid in doses between 2-15 units according to an algorithm, depending on the amount of retraction. Margin-reflex distances were measured according to the photographs taken under standard conditions before and after the injections at the tenth day, then the second month and the fourth month. Additional Botulinum toxin A injections were performed in patients who had an undercorrection on the tenth day. Complications such as diplopia and ptosis were recorded. RESULTS: The study included 38 females, 22 males with a mean age of 43.3 ± 13.1. Normal margin-reflex distances (3-4 mm) were reached in the 58 of 71 eyes (81.7%). Additional injections were needed in eight eyes (11.2%) for residual retraction on the tenth day. Ptosis was the major complication in four eyes for 1-3 weeks after injection. Upper eyelid retraction recurred after 5.1 ± 0.9 months in all patients. CONCLUSION: In the treatment of upper eyelid retraction due to thyroid eye disease, transconjunctival injection of Botulinum toxin A is an effective, safe, transient, and repeatable method with few complications in patients. The algorithm used in this study resulted in high success rate in long-term follow-up.

Comparing the outcome of Muller's muscle conjunctival resection for mild/moderate versus severe involutional aponeurotic ptosis.

AIMS: To compare predictability of the outcomes of Muller's muscle conjunctiva resection (MMCR) in patients with severe versus mild/moderate involutional aponeurotic ptosis. METHODS: This was a retrospective case-control study. All cases were recruited into the groups in terms of preoperative marginal reflex distance of upper eyelid (MRD-1). Group 1 consisted of patients with mild to moderate blepharoptosis was defined as an MRD-1 equal to 1.1 to 3 mm and Group 2 consisted of patients with severe blepharoptosis defined as MRD-1 ⩽ 1 mm. All patients underwent MMCR based on the response to phenylephrine and the amount of ptosis. MRD-1 obtained both manually and with ImageJ analysis program preoperatively and on the postoperative sixth month was compared. Successful surgical outcome criteria were defined as MRD-1 ⩾ 2.5 mm and inter-eyelid symmetry ⩽ 1 mm. RESULTS: A total of 97 eyes of 83 participants met the inclusion criteria for this study (Group 1 n = 50, Group 2 n = 47). In terms of MRD-1 success rates were 88% in Group 1, and 70.2% in Group 2 (p = 0.03). Preoperative MRD-1 which was measured by ImageJ, and the amount of resected tissue in mm were the predictive data of surgical outcome by the logistic regression analysis (OR 6.45, 95% CI 1.82-22.78, p = 0.004, OR 2.47, 95% CI 1.05-5.80, p = 0.037, respectively). CONCLUSION: The surgical success of MMCR can be predicted via tissue resection length and preoperative MRD-1. Higher surgical success rates were obtained in cases with mild-moderate ptosis and clinically acceptable success rates were obtained in cases with severe ptosis.

Correction: Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos.

PURPOSE: To investigate choroidal vascular index (CVI) in eyes with nanophthalmos (NO) with the use of optical coherence tomography (OCT). METHODS: Macular enhanced depth imaging OCT scans of 25 eyes of 25 patients with NO and age-gender-matched 25 eyes of 25 control subjects were analysed. Images were binarized using the ImageJ software, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were acquired. The main outcome measure was CVI, defined as the ratio of LA to TCA. RESULTS: Twenty-five eyes of 25 patients with NO and age-gender-matched control subjects were enrolled. The mean TCA, SA and LA were found to be significantly higher in patients with NO (2.51 ± 0.44 vs. 1.91 ± 0.35 mm2, P < 0.001; 0.86 ± 0.17 vs. 0.63 ± 0.13 mm2, P < 0.001; and 1.65 ± 0.29 vs. 1.27 ± 0.23 mm2, P < 0.000, respectively). On the contrary, CVI did not significantly differ between the two groups (65.72, 67.68, P = 0.099). CONCLUSION: As a novel OCT-based marker, CVI could be used to assess vascular status of the choroid in eyes with NO and can provide better understanding of the pathogenesis of this disease.

Serum calcium, magnesium, phosphorus, and vitamin D in benign essential blepharospasm.

PURPOSE: This study aims to compare serum calcium, magnesium, phosphorus, and 25-hydroxy (OH)-vitamin D levels in patients with benign essential blepharospasm (BEB) and healthy subjects and to determine their association with disease severity and frequency. METHODS: This is a prospective study conducted in a tertiary care hospital. Fifty patients (female, 39; male, 11) with BEB and 22 healthy subjects (female, 15; male, 7) included in the study. Serum calcium, magnesium, phosphorus, and vitamin D levels of BEB and healthy groups were measured. Blepharospasm severity and frequency were assessed using scales ranging from 0 to 4 by following the Jankovic Rating Scale (JRS). RESULTS: Though there was no significant difference regarding magnesium, phosphorus, and 25(OH)-vitamin D levels between the two groups, serum calcium levels of the BEB group were significantly lower than the control group (9.5 ± 0.4 and 9.9 ± 0.4 mg/dl, respectively; P = 0.002), although in the normal range (9-10.5 mg/dl). In the BEB group, the mean Jankovic severity and frequency scores were 3.29 ± 0.54 and 3.59 ± 0.61, respectively. There was a moderate negative correlation between serum 25(OH)-vitamin D levels and Jankovic severity score (r = - 0.332; P = 0.022). CONCLUSION: Serum calcium levels of the BEB group were significantly lower than the healthy group. Serum vitamin D levels showed a moderate negative correlation with disease severity. The role of calcium and vitamin D in the evolution of the BEB need further investigation at the cellular and anatomical levels.