Optic coherence tomography angiography findings in fuchs heterochromic iridocyclitis.

PURPOSE: To evaluate macular capillary perfusion in patients with fuchs heterochromic iridocyclitis (FHI) by using optical coherence tomography angiography (OCTA). MATERIAL AND METHOD: A total of 19 eyes of 19 patients with unilateral FHI underwent detailed eye examination. OCTA (RTVue-XR Avanti) images were obtained from both eyes. OCTA parameters, including foveal avascular zone, superficial capillary plexus and deep capillary plexus vessel densities, were compared between the involved and fellow control eyes. RESULTS: The median age of the patients (11 females, 8 males) was 42.0 ± 9.63 (range 24-57) years. DCP and SCP densities at the parafoveal and perifoveal area were significantly lower in the FHI eyes compared to the control eyes (44.80 ± 5.24% vs. 54.70 ± 3.76% and 43.30 ± 5.10% vs. 53.70 ± 2.73%, respectively; p < 0.05). The median FAZ was 0.29 ± 0.12 (0.11-0.42) mm2 in the FHI eyes and 0.26 ± 0.09 (0.10-0.40) mm2 in the control eyes. This difference did not reach statistical significance (p = 0.199). CONCLUSION: Macular capillary perfusion was significantly reduced in both SCP and DCP in the eyes with FHI. FHI, which is known to affect the choroid layer, could also compromise macular capillary perfusion of the retina.

Assessment of macular capillary perfusion in patients with inactive Vogt-Koyanagi-Harada disease: an optical coherence tomography angiography study.

PURPOSE: To assess macular capillary perfusion in patients with inactive Vogt-Koyanagi-Harada (VKH) disease by using optical coherence tomography angiography (OCTA). METHODS: A total of 51 eyes of 51 patients with inactive VKH (group 1, n = 23) and healthy volunteers (group 2, n = 28) underwent detailed eye examination including OCTA (RTVue-XR Avanti) scanning. OCTA images (6 × 6 mm) were assessed for central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), vessel densities (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris (CC) flow area and vessel flow density (VFD), foveal avascular zone (FAZ) area and acircularity index (AI). RESULTS: The mean ages of group 1 (13 female, 10 male) and group 2 (15 female, 13 male) were 39.9 ± 11.8 (range, 24-58) and 38.9 ± 8.5 (range, 29-51) years, respectively (p = 0.773). CRT and SFCT were 218.2 ± 39.4 µm and 195.6 ± 28.6 µm in group 1, while 243.5 ± 9.7 µm and 316.7 ± 20.1 µm in group 2, respectively (p < 0.05). VD in SCP and DCP were significantly lower in group 1 (50.6 ± 4.7% vs. 54.3 ± 3.4% and 53.9 ± 3.6% vs. 61.1 ± 2.7% respectively; p < 0.05). FAZ areas were 0.32 ± 0.11 mm2 in group 1 and 0.25 ± 0.06 mm2 in group 2 (p = 0.046). There was no statistically significant difference between groups regarding AI, CC flow area, and VFD (p > 0.05). There was weak negative correlation between BCVA (logMAR) and parafoveal and perifoveal VD in SCP and DCP of group 1 (p < 0.05). CONCLUSION: Macular capillary perfusion was significantly reduced both in SCP and DCP in patients with inactive VKH disease.

THE IMPORTANCE OF THE PERIPHERAL RETINA IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: This research investigated the peripheral retinas of patients with central serous chorioretinopathy (CSCR). METHODS: Sixty patients with CSCR and 60 age- and gender-matched controls were included in this prospective cross-sectional study. All 120 participants underwent ocular examinations and peripheral retinal evaluations using a Goldmann three-mirror lens. RESULTS: The examinations demonstrated peripheral retinal degeneration, atrophic or hyperplastic retinal pigment epithelial changes, and retinal breaks. The peripheral retinal degeneration rate was 39% in the CSCR group and 15% in the control group, and the CSCR group reported significantly more lattice degeneration than the control group (22 vs. 3%) (P = 0.004, odds ratio = 1.97, confidence interval = 0.68-5.65 and P = 0.002, odds ratio = 4.55, confidence interval = 0.77-26.83, respectively). Symptomatic U-shaped retinal breaks were found in three eyes (5%) in the CSCR group, and the rate of peripheral retinal degeneration was higher in the patients with chronic CSCR (vs. acute CSCR). However, this difference was not significant (P = 0.244). CONCLUSION: This study showed that peripheral retinal abnormalities, particularly lattice degeneration, are more common in patients with CSCR. Therefore, the authors recommend regular retinal examinations, with the inclusion of peripheral retinal assessments, for patients with CSCR.

The Prevalence and Characteristics of Charles Bonnet Syndrome in Turkish Patients with Retinal Disease.

PURPOSE: The aim of this study is to investigate the prevalence and clinical characteristics of Charles Bonnet syndrome (CBS) in a group of Turkish patients with various retinal diseases. METHODS: Two hundred and sixty-four patients with a best-corrected visual acuity of ≤20/40 in the better-seeing eye were asked with a standardized question whether they had symptoms of CBS. If they responded positively, a questionnaire was verbally administered to learn more about the details of the symptoms. RESULTS: There were 125 (47.3%) females and 139 (52.7%) males with a mean age of 72.1 years (range 31-90). Seventeen (6.4%) patients were diagnosed with CBS. Three (17.7%) patients had noncomplex hallucinations and 14 (82.3%) had complex hallucinations. CONCLUSION: CBS is not uncommon in visually impaired patients with retinal disease. Clinicians who care for visually impaired patients should be aware of CBS.

Correlation of Handheld Infrared Skin Thermometer and Infrared Videothermography Device for Measurement of Corneal Temperature.

PURPOSE: In our study, we aimed to investigate the correlation of handheld infrared skin thermometer and videothermography device for the measurement of corneal temperature. METHODS: Forty healthy individuals (80 eyes) were enrolled to the study. Participants underwent a detailed ophthalmologic examination and medical history review for excluding any ocular and systemic diseases. The measurements of the central corneal temperature were performed in a room having constant temperature, humidity, and brightness levels. To avoid any variability, all the temperature measurements were performed in the same examination room by a single examiner. The temperature was measured with a handheld infrared skin thermometer (MEDISANA, FTN) from the corneal surface. The same instrument was also used to measure the subjects' body temperature. Moreover, the subjects underwent the corneal temperature measurement by a noncontact videothermography device (Optris PI 450; Optris GmbH). RESULTS: The male to female ratio was 19:21 among the subjects. The mean age was 25.1±4.7 years. The mean body temperature was 36.93±0.33°C. The mean corneal temperatures measured by the handheld infrared skin thermometer and the ocular videothermography device were 36.94±0.28°C and 35.61±0.61°C, respectively (P<0.01). The mean temperature difference was 1.34±0.57°C, with a 95% confidence interval. There was a moderate correlation between the corneal temperatures measured by the 2 devices in the right, the left eyes, and both eyes, respectively (P=0.450, 0.539, 0.490). CONCLUSIONS: Handheld infrared skin thermometers can be used for the evaluation of the corneal temperature. These devices may provide a simple, practical, and cheaper way to detect the corneal temperature, and the widely performed corneal temperature measurements may afford us to understand the temperature variability in numerous ocular conditions in a better way.

A CASE OF ALSTRÖM SYNDROME WITH A NOVEL VARIANT IN ALMS1 GENE PRESENTING WITH CONE ROD DYSTROPHY AS FIRST FINDING.

PURPOSE: Alström Syndrome (AS) is a rare autosomal recessive monogenic ciliopathy which is caused by a mutation of the Alström syndrome 1 (ALMS1) gene. It is a multisystemic disorder characterized by insulin resistance, childhood obesity, cardiomyopathy, progressive hepatic and renal failure, sensorineural hearing loss and retinal degeneration. Herein, we aimed to report a novel variant in ALMS1 gene causing AS in a patient presenting with visual impairment. METHODS: Case report. RESULTS: A 10-year-old male patient presented with photophobia and visual impairment in both eyes. Anterior and posterior segment examinations were unremarkable bilaterally. Optical coherence tomography (OCT) showed attenuated ellipsoid zone. Electroretinography revealed diminished cone and rod responses consistent with cone rod dystrophy (CRD). Genetic testing demonstrated a novel homozygous variant in ALMS1 (NM_015120.4) gene. The patient also was found to have early-stage dilated cardiomyopathy through systemic evaluation after the diagnosis of AS. CONCLUSION: Cone-rod dystrophy in pediatric population is relatively rare condition that can be associated with syndromic ciliopathies. The authors presented a case of AS with a novel variant in ALMS1 gene based on ophthalmic findings. Ophthalmologists play an important role in the diagnosis of this syndrome and early detection of systemic manifestations.

Comparison of Optical Coherence Tomography Angiography Findings between Healthy Children and Children with Type 1 Diabetes Mellitus and Autoimmune Thyroiditis

Objective: The aim of this study was to compare the development of early diabetic retinopathy (DR) findings, a microvascular complication, between patients with isolated type 1 diabetes mellitus (T1DM) (Group 1), concurrent T1DM and autoimmune thyroiditis (AT) (Group 2), and healthy controls (Group 3), who were matched for age, sex, number, and body mass index for comparison. Methods: This was a prospective observational study that included individuals aged 10-20 years, and patients in Groups 1 and 2 had been followed up for ≥5 years. None of them developed clinical DR during the follow-up period. Optical coherence tomography angiography (OCTA) was used to evaluate the foveal avascular zone (FAZ) and parafoveal vascular density (PVD) for the development of early DR. OCTA findings were compared between patients and healthy controls. Results: Thirty-five individuals were included in each of the groups. The mean FAZ and PVD differed significantly between the three groups (FAZ, p=0.016; PVD, p=0.006). The mean FAZ was higher in Groups 1 and 2 than in Group 3 (p=0.013 and p=0.119, respectively). The mean PVD was lower in Groups 1 and 2 than in Group 3 (p=0.007, respectively). No significant difference was found between Groups 1 and 2 in terms of the mean FAZ and PVD (p=0.832 and p=0.653, respectively). The mean glycated hemoglobin (HbA1c) level was significantly correlated with FAZ and PVD (FAZ: r=0.496, p<0.001; PVD: r=-0.36, p=0.001). Conclusion: In patients with T1DM who did not develop clinical DR, OCTA findings revealed an increase in FAZ, which was associated with higher HbA1c levels. The mean PVD was significantly lower in the group with coexisting AT and T1DM than in the control group. These results suggest that the coexistence of AT and T1DM can contribute to the development of microvascular complications. However, studies with larger patient series are required.

Investigation of the choroidal structure in non-neovascular age-related macular degeneration patients with reticular pseudodrusen.

BACKGROUND: This study aimed to compare choroidal thickness, total choroidal area (TCA), luminal area (LA), stromal area (SA) and choroidal vascularity index (CVI) in patients with reticular pseudodrusen (RPD) and drusen. METHODS: A total of 100 eyes of 100 patients with non-neovascular age related macular degeneration (AMD) with five or more medium drusen (63-125 µm) and RPD in two or more quadrants were recruited to the study. 48 eyes of 48 patients with RPD were assigned as Group 1 and 52 eyes of 52 patients with drusen were assigned as Group 2. 40 right eyes of 40 healthy subjects were included as controls. Patients with neovascular AMD or advanced non-neovascular AMD were excluded from the study. After a detailed ophthalmic examination, infrared reflectance images and OCT with enhanced depth imaging mode was obtained from all patients. TCA, SA, LA and CVI were calculated using the Image J program. The data were analyzed for statistics using SPSS software. RESULTS: The female/male ratio was 56/44 in the patient groups and 20/20 in the control group. The mean age was 73.63±6.14 (61-91) years for Group 1 and 69.43± 6.97 (59-87) years for Group 2 (p=0.005). The mean age of Group 3 patients was 71.14±8.17 (60-79) years and was statistically similar to Groups 1 and 2 (p=0.09 and p=0.12, respectively). Choroidal thickness, TCA, SA and LA were significantly lower in Group 1 (p<0.001). CVI and foveal thicknesses were not significantly different between Group 1 and 2 (p=0.214 and p=0.384 respectively). CVI was significantly lower in Group 3 (p<0.01). RPD was most commonly seen in the superior quadrant followed by temporal, nasal, and inferior quadrants. CONCLUSIONS: TCA, SA and LA, which reflect choroidal vasculature, were decreased in patients with RPD. These parameters can help evaluate the pathophysiology of the disease.

The Impact of COVID-19 Infection on Macular Capillary Perfusion.

Objectives: Thromboembolic complications related to the COVID-19 infection are frequently reported. This study aims to evaluate the impact of a prior non-severe COVID-19 infection on retinal microcirculation with optical coherence tomography angiography (OCTA). Methods: A total of 83 eyes of 43 patients with a history of non-severe COVID-19 infection confirmed with a positive PCR test (Group 1) and 30 healthy controls (Group 2) underwent detailed eye examination, including optic coherence tomography angiography (OCTA, RTVue-XR Avanti) scanning. Vessel densities (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone were evaluated. Results: The mean duration between the COVID-19 positive PCR test and ocular examination was 144.6±82.2 days. VD of SCP and DCP in the foveal and perifoveal regions were significantly lower in Group 1 compared to Group 2 (p<0.05). Conclusion: A non-severe COVID-19 infection may cause a decrease in the VD of retinal SCP and DCP.

Multimodal Imaging of Reticular Pseudodrusen in Turkish Patients.

Objectives: To investigate the presence and prevalence of reticular pseudodrusen (RPD) in patients with age-related macular degeneration using multiple imaging modalities and to compare the sensitivity and specificity of these modalities in the detection of RPD. Materials and Methods: Images from a total of 198 consecutive patients were analyzed prospectively. Color fundus photography, red-free imaging, spectral domain optical coherence tomography (SD-OCT), infrared and blue reflectance (BR) imaging, fundus autofluorescence (FAF), enhanced-depth imaging OCT (EDI-OCT), fundus fluorescein angiography (FFA) and indocyanine green angiography were performed. RPD was diagnosed in the presence of relevant findings in at least two of the imaging methods used. Results: RPD were detected in 149 eyes (37.6%). In the detection of RPD, color fundus photography, red-free photography, SD-OCT, infrared, FAF, BR, and FFA imaging had sensitivity values of 50%, 57.7%, 91.6%, 95%, 74.6%, 65.7%, and 28.2% and specificity values of 99.6%, 100%, 98.4%, 94.6%, 100%, 99.6%, and 69.8%, respectively. Conclusion: Infrared imaging had the highest sensitivity. SD-OCT combined with infrared imaging was the most sensitive imaging technique for detecting RPD. The high specificity of FAF, red-free, and BR imaging may be useful to confirm a diagnosis of RPD.

Expert recommendations for the management of diabetic macular edema with intravitreal dexamethasone implant: A Turkish Delphi study.

PURPOSE: To provide consensus on the clinical use of intravitreal dexamethasone (DEX) implant for the treatment of diabetic macular edema (DME) in Turkey. METHODS: A panel of 22 retina experts prepared 77 statements of recommendation, and 80 retinal specialists practicing in Turkey were chosen to vote either in support or against each one. A Delphi-based method was used through which the ophthalmologists were able to view all of the results anonymously after two rounds and modify their subsequent answers. The survey was conducted via a mini website, and statements without consensus were resent to the specialists with the latest vote results a week later. RESULTS: A total of 72 ophthalmologists answered the first and second round questions. After the first stage, consensus was achieved on 55 of the statements, leaving 22 without agreement. After the second stage, consensus was reached on 11 of the remaining statements. Strong consensus was achieved on statements regarding the etiopathogenesis of DME and the first-line indications and safety of the DEX implant procedure. The panel recommended the use of DEX implant for patients with an arterial thromboembolic event in the last three months and also agreed that pro re nata DEX implant treatment not only provides better outcomes for DME patients but also reduces the treatment burden for those who could not receive an adequate number of anti-vascular endothelial growth factor (VEGF) injections. CONCLUSION: This study provides clinical consensus and recommendations about the use of DEX implant in the clinical practice of DME management in Turkey.

Evaluation of Choroidal Vascular Index in Amblyopic Patients.

Objectives: To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects. Materials and Methods: The study included 17 patients with strabismic amblyopia (Group 1), 29 patients with hyperopic refractive amblyopia (Group 2), and 16 eyes of 16 healthy volunteers (Group 3). Best corrected visual acuity was noted in all patients and volunteers. In addition to detailed anterior and posterior segment examinations, macular images were obtained by enhanced-depth imaging mode of optical coherence tomography (OCT). SFCT measurements were made from these images and CVI was calculated using the Image J program. Results: No significant difference was found between the groups in terms of age, gender, and intraocular pressure (p=0.27, 0.64, and 0.85, respectively). Mean BCVAs in Group 1 were 0.57±0.16 (0.3-0.8) in the amblyopic eyes, 0.94±0.08 (0.8-1.0) in the fellow eyes, and in Group 2 were 0.61±0.17 (0.2-0.8) in amblyopic eyes, 0.92±0.1 (0.8-1.0) in fellow eyes. BCVA in Group 3 was 1.0±0 (1.0-1.0). Mean SFCT of the amblyopic eyes in Groups 1 and 2 was 341.50±60.4 (277-481) and 370.06±65.3 (247-462), respectively, and in the healthy eyes of Groups 1 and 2 and Group 3 was 321.92±68.26 (251-440), 330.35±74.00 (194-502), and 327.62±40.79 (238-385), respectively. SFCT was significantly greater in the amblyopic eyes of Group 2 compared to Group 3 (p=0.01). Mean CVI was 0.681±0.032 (0.642-0.736) in the amblyopic eyes and 0.685±0.054 (0.587-0.788) in the fellow eyes of Group 1 patients; 0.664±0.033 (0.592-0.719) in the amblyopic eye and 0.707±0.039 (0.625-0.779) in the fellow eye in Group 2 patients; and 0.689±0.031 (0.612-0.748) in Group 3 patients. CVI was significantly lower in the amblyopic eyes of Group 2 compared with fellow eyes (p=0.02) and Group 3 (p=0.025). Conclusion: Morphological changes may be seen in the choroid in amblyopic eyes. We observed that the choroidal stromal component is increased in hyperopic amblyopic patients especially.

Radiation-Induced Ocular Surface Disorders and Retinopathy: Ocular Structures and Radiation Dose-Volume Effect.

PURPOSE: This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm. MATERIALS AND METHODS: A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated. RESULTS: Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose. CONCLUSION: Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit.

Aflibercept Treatment Results and Association with Baseline Characteristics in Cases of Newly Diagnosed Neovascular Age-Related Macular Degeneration

Objectives: To evaluate functional and anatomical responses to intravitreal aflibercept (IVA) treatment in newly diagnosed and untreated neovascular age-related macular degeneration (nvAMD) cases and to investigate the effect of baseline lesion characteristics on anatomical responses. Materials and Methods: This prospective, cross-sectional study included a series of 139 eyes of 133 patients that were diagnosed with active nvAMD and had not been treated. All eyes were subjected to complete ophthalmological examination, spectral-domain optical coherence tomography and fluorescein angiography, and 42 eyes also underwent indocyanine green angiography. IVA treatment was performed using a "treat and extend" regimen after 3 injections at 4-6 weeks intervals. Anatomical and functional responses at 4 weeks after the last injection were evaluated in eyes that completed 3 injections and the subgroup of eyes that completed 6 IVA injections. The effect of baseline lesion characteristics on IVA treatment results was also investigated. Results: All 139 eyes included in the study received 3 IVA injections (group 1) and 62 received 6 IVA injections. Both groups showed statistically significant improvement in best-corrected visual acuity (p<0.001 for both). The rate of complete response was 54.6% and 58.0% in groups 1 and 2, respectively. In group 1, the presence of pigment epithelial detachment (PED) and serous PED were identified as negative initial factors (p=0.043, p=0.005, respectively). However, none of the baseline characteristics were significantly associated with anatomical response in group 2. Conclusion: In our study, it was determined that successful anatomical and functional results were achieved with 3 and 6 doses of IVA in eyes with newly-diagnosed and untreated nvAMD. Among baseline characteristics, the presence of PED and serous PED in particular were found to be factors affecting treatment response negatively.

Retinal Nerve Fiber Layer Thickness Correlates with Serum and Cerebrospinal Fluid Neurofilament Levels and is Associated with Current Disability in Multiple Sclerosis.

INTRODUCTION: The main purpose of the present study is to confirm Peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness is a biomarker of axonal degeneration in patients with Multiple Sclerosis (MS) and to evaluate its relationship with Neurofilament heavy chain (NfH) and Nitrotyrosine (NT). METHOD: We quantified serum (s) and/or cerebrospinal fluid (CSF) NfH and NT levels in 30 relapsing-remitting MS patients (RRMS), 16 secondary progressive MS (SPMS) patients and in 29 control subjects matched for age and gender. Optical coherence tomography (OCT) measurements of pRNFL were performed in all subjects. Clinical outcomes were tested by Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS). RESULTS: RRMS patients exhibited significantly higher NfH/NT levels (99 pg/mL, 107.52 nM respectively) than controls (74 pg/mL, 48.72 nM) in CSF (p<0.0001), but not in sera. SPMS patients had significantly higher s NfH/NT values (111.25 pg/mL, 1251.77 nM respectively) and lower mean pRNFL thickness (79 µm) than patients with RRMS (98.50 µm) and controls (108 µm) (p<0.0001). pRNFL thickness was significantly correlated with all clinical disability measurements (EDSS, Trail Making test, 9-Hole Peg Test, and PASAT) in both RRMS and SPMS (p<0.001, p=0.02, p=0.03, p=0.02 respectively). A positive correlation was also found between serum and/or CSF NfH levels and EDSS scores in RRMS and SPMS (p<0.001, p=0.02 respectively). The pRNFL thickness was also correlated significantly with serum and/or CSF NfH levels but not with s/CSF NT levels in both clinical forms of MS (p<0.01, p<0.001 respectively). CONCLUSION: The current study demonstrated that both pRNFL and s/CSF NfH are reliable and quantitative biomarkers that correlate with current disease course and cross-sectional measure of disability in patients with MS.

Multimodal Imaging of Isolated Foveal Hypoplasia: A Case Report.

Fovea hipoplazisi, normal foveanin gelismemesi ile karakterizedir. Izole veya baska oküler durumlarda sekonder olarak gelisebilmektedir. Optik koherens tomografi (OKT), floresein anjiyografi, fundus otofloresans ve OKT anjiyografi tanida kullanilabilir. Bu olgu sunumunda multimodal görüntüleme ile tani konulan, foveal hipoplazili bir hastayi sunmaktayiz.

Paracentral Acute Middle Maculopathy

Paracentral acute middle maculopathy (PAMM) is a variant of acute macular neuroretinopathy which is characterized by a hyperreflective band-like lesion in the inner nuclear layer and outer plexiform layer on spectral domain optical coherence tomography (SD-OCT). The etiology is believed to involve vasopressor exposure or systemic microvascular diseases that cause retinal ischemia. SD-OCT is the main imaging method in the diagnosis or evaluation of progression of PAMM, whereas multimodal imaging is useful to support the diagnosis. Herein, we present a case of PAMM in a healthy young woman using multimodal imaging methods.

Subgroups and Features of Poor Responders to Anti-Vascular Endothelial Growth Factor Treatment in Eyes with Neovascular Age-Related Macular Degeneration

Objectives: This study aimed to determine the incidence of poor response to intravitreal (IV) anti-VEGF treatment in neovascular age-related macular degeneration (nvAMD) and to define subgroups of poor responders. Materials and Methods: A total of 235 treatment-naive eyes of 202 patients completed this prospective study. Patients younger than 50 years of age and those with a contraindication for anti-VEGF therapy were excluded. All eyes were treated with IV ranibizumab. Poor response was defined as recurrence, persistence, or worsening despite treatment. Poor responders were classified into subgroups based on progression patterns. Results: Of the 235 eyes, 78 (33.2%) showed poor response. Pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were more common among poor responders (p<0.001) and 5 subgroups were identified. Conclusion: Poor response to anti-VEGF treatment is not uncommon and occult CNV and PED are frequently seen in these eyes. Various subgroups can be defined based on clinical features.

Dexamethasone Implant in Patients with Diabetic Macular Edema Resistant to Anti-VEGF Therapy

Objectives: To investigate the efficacy of single dose intravitreal dexamethasone implant in patients with diabetic macular edema (DME) resistant to anti-VEGF therapy. Materials and Methods: Twenty eyes of 14 patients (8 male, 6 female; mean age, 65±5.7 years) with DME resistant to intravitreal ranibizumab injections were studied. A single intravitreal dexamethasone implant was injected into each eye and patients were followed up for 6 months. Response to therapy was assessed monthly by measuring intraocular pressure (IOP), best-corrected visual acuity (BCVA), and central foveal thickness (CFT). Results: Baseline (before injection) IOP was 14.9±2.7 mmHg and did not change significantly in the six months following injection. Baseline BCVA was 1.04±0.35 LogMAR and improved to 0.86±0.31 at month 1 without statistical significance (p=0.056). CFT was significantly lower in all monthly measurements compared to its baseline value of 682.2±229.2 µm. During the follow-up period, endophthalmitis, significant cataract, or rhegmatogenous retinal detachment were not detected. Conclusion: Intravitreal dexamethasone implant injection is associated with significant CFT reduction for up to six months without causing any complications. Although BCVA did not improve in parallel with the CFT reduction, intravitreal dexamethasone implant should be considered as an effective and safe treatment option in the management of DME patients resistant to anti-VEGF injections.

The Preventive Effect of Oxytocin on Retinopathy in Streptozotocin-Induced Diabetic Rats

Objectives: The aim of this study was to investigate the impact of intravitreal and intraperitoneal use of oxytocin (OT) on retinopathy in streptozotocin-induced diabetic rats. Materials and Methods: Twenty-four 6­8-week-old adult male and female Sprague Dawley rats were used in the study. Diabetes was induced in the rats with a single injection of intraperitoneal streptozotocin. Diabetes was verified after 48 hours by measuring blood glucose levels of 260 mg/dl (14.4 mmol/L) or higher in diabetic rats. The rats were divided into 4 groups and treated as follows: intravitreal physiological saline group (0.01 mL saline weekly), intravitreal OT group (10 µU/µL OT weekly), intraperitoneal physiological saline group (1 mL daily), and intraperitoneal OT group (100 IU/kg OT daily). Hamilton syringes fitted with 27-gauge needles were used for intraperitoneal injections while 31-gauge needles were used for intravitreal injection. After 4 weeks of treatment the rats were euthanized to evaluate outer nuclear layer (ONL) thickness, vascular endothelial growth factor (VEGF) immunoexpression, and plasma VEGF levels from blood samples obtained by cardiac puncture. Results: Morphometric analysis of retinal cross-sections showed that intravitreal and intraperitoneal OT significantly increased ONL thickness compared to physiological saline-treated groups. Also, OT treatment significantly decreased VEGF protein expression compared with the physiological saline groups. Plasma VEGF level was significantly higher in the physiological saline treatment group compared to the OT treatment group. Conclusion: OT reduces diabetic retinopathy progression, particularly when administered intravitreally. To our knowledge, this is the first attempt to investigate the impact of OT on diabetic retinopathy and may provide a new area for further research.