Evaluation of the effect of vitreomacular interface disorders on anti-VEGF treatment in patients with diabetic macular edema in real life: MARMASIA study group report No. 10.

PURPOSE: The aim of this study is to investigate the effect of vitreomacular interface disorders (VMID) on treatment response in patients treated with anti-vascular endothelial growth factor (anti-VEGF) due to diabetic macular edema (DME). METHODS: Three hundred seventy-seven eyes of 239 patients in the MARMASIA Study Group who received intravitreal anti-VEGF treatment (IVT) due to DME were included in the study. The group 1 consisted of 44 eyes of the patients who had not received any treatment before, were followed up regularly for 24 months after at least a 3-month loading dose, and suffered from VMID such as epiretinal membrane, vitreomacular adhesion or traction, and lamellar hole. The group 2 consisted of 333 eyes of the patients without VMID. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients at baseline, 3rd month, 6th month, 1st year and 2nd year follow-ups were measured. RESULTS: The mean age of the Groups 1 and 2 was 67.1 ± 11.3 and 61.9 ± 10.2 years, respectively. 61.3% of the group 1 and 58.8% of the group 2 were female (p > 0.05). The duration of diabetes was 19.2 ± 3.7 and 15.8 ± 3.2 years, respectively, and the number of follow-ups was 16.09 ± 4.68 and 12.06 ± 4.58, respectively in the groups (p < 0.001, 0.001, respectively). The number of IVT was 7.13 ± 2.71 and 7.20 ± 2.22, respectively in the groups 1 and 2 and no statistically significant difference was observed between them (p = 0.860). According to logMAR, BCVA values at baseline were 0.63 ± 0.24 and 0.59 ± 0.26 (p = 0.29), respectively, in the groups and the amount of change in BCVA at the end of the 2nd year was - 0.02 ± 0.48 in the group 1 and - 0.12 ± 0.48 in the group 2. It was observed as 0.48 (p = 0.13). Although the increase in BCVA was greater at all follow-ups in the group 2 compared to their initial examination, no significant difference was observed between the groups in terms of BCVA change. The CMT values of the groups at baseline were 442.5 ± 131.3 µm and 590.9 ± 170.6 µm, respectively (p = 0.03) The decrease in CMT after IVT was significantly greater in the group 2 at all follow-ups when compared to the first group (p < 0.05). CONCLUSION: While the presence of VMID in DME patients receiving IVT did not affect visual results, it negatively affected the anatomical response and macular edema morphology. The presence of VMID at baseline affected the success of IVT. It should be taken into consideration that VMID may resolve spontaneously or with IVT, and new cases of VMID may occur in patients during the treatment process.

Choroidal vascularity index as an activity criterion and a treatment response measure in chronic central serous chorioretinopathy.

PURPOSE: This study aimed to evaluate the choroidal vascularity index (CVI) as an activity criterion in chronic central serous chorioretinopathy (CSC) and as a measure of treatment response after full-dose-full-fluence photodynamic therapy (fd-ff-PDT). METHODS: This fellow-eye-controlled, retrospective cohort study included 23 patients with unilateral chronic CSC treated with fd-ff-PDT (6 mg/m2 ; 50 µcm2 ; 83 s). Subfoveal choroidal thickness (SFCT, µm) and CVI (%) of the affected and fellow eyes at baseline as well as at 1, 3 and 6 months after fd-ff-PDT were compared. RESULTS: The patients' mean age was 43.4 ± 7.3 years, and 18 (78.3%) were male. CVI was comparable between the affected and fellow eyes at baseline (66.09 ± 1.56 vs. 65.84 ± 1.57, p = 0.59). However, it became significantly lower in the affected eyes 1 (64.45 ± 1.68 vs. 65.87 ± 1.19, p = 0.002), 3 (64.21 ± 2.08 vs. 65.71 ± 1.59, p = 0.009) and 6 (64.47 ± 2.19 vs. 65.62 ± 1.52, p = 0.045) months after fd-ff-PDT. The mean SFCT and the mean CVI were significantly decreased in the affected eyes at all follow-up visits compared with baseline after fd-ff-PDT (p < 0.001). CONCLUSION: At baseline, CVI was comparable between affected and fellow eyes. Therefore, its use as an activity criterion in chronic CSC patients is questionable. However, it was significantly decreased in fd-ff-PDT-treated eyes, supporting its role as a measure of treatment response in chronic CSC.

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers.

PURPOSE: To evaluate the effects of the Valsalva manoeuvre (VM) on the choroidal vascularity index (CVI) in healthy volunteers. METHODS: This prospective, cross-sectional study included 60 eyes of 30 healthy volunteers. Enhanced depth imaging-optical coherence tomography scans of both eyes involving the fovea were taken, and a 1500 µm subfoveal choroidal area was selected for image binarization with open-access Fiji software. The binarized image was segmented into the stromal area (SA) and luminal area (LA), and CVI was calculated as the ratio (%) of LA to the total choroidal area (TCA). CVI, subfoveal choroidal thickness (SFCT), IOP, systolic and diastolic blood pressure were evaluated at rest and during the VM. RESULTS: During the VM, a mean ± standard deviation increase in LA (0.02 ± 0.05 mm2 , p < 0.001) and CVI (1.72 ± 2.83%, p < 0.001) was observed, whereas SA (-0.02 ± 0.05 mm2 , p < 0.001) decreased. There was no significant change in TCA (0.00 ± 0.03 mm2 , p = 0.55) or SFCT (1.05 ± 10.92 µm, p = 0.46). There was a moderate positive correlation between the spherical equivalent refractive error (SE) and SFCT both at rest and during VM (r58  = 0.49, p < 0.0005 and r58  = 0.49, p < 0.0005, respectively). However, there was no significant correlation between SE and CVI either at rest or during VM (p = 0.11 and 0.06, respectively). In a multiple linear regression analysis, CVI was only associated with SFCT; however, SFCT was also associated with SE, both at rest and during VM (p < 0.001). CONCLUSION: Valsalva manoeuvre increases CVI by choroidal vascular dilation as demonstrated by an increase in LA and a decrease in SA. Researchers should be careful about unintentional VM during examinations.

Comparison of Retinochoroidal Vascular and Structural Changes after Half-Dose Photodynamic Therapy versus Half-Fluence Photodynamic Therapy Based on Optical Coherence Tomography Angiography in Eyes with Chronic Central Serous Chorioretinopathy.

PURPOSE: The aim of this study is to compare the efficacy of half-fluence photodynamic therapy (PDT) and half-dose PDT on the choroidal structure via perfusion of the retinal plexus and choriocapillaris in eyes with chronic central serous chorioretinopathy (cCSCR). MATERIALS AND METHODS: This retrospective study included 43 eyes in 43 patients with cCSCR. Patients in group 1 received half-fluence (verteporfin 6 mg m-2) PDT and those in group 2 received half-dose (verteporfin 3 mg m-2) PDT. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were recorded 1 day before and 3 months after PDT. Total choroidal area (TCA), luminal area (LA), and stromal area (SA) were calculated using Image J software. RESULTS: From baseline to 3 months post PDT TCA decreased from 2.43 ± 0.47 mm2 to 2.08 ± 0.59 mm2 (p < 0.001), LA decreased from 1.78 ± 0.11 mm2 to 1.54 ± 0.26 mm2 (p < 0.001), and SA decreased from 0.76 ± 0.33 mm2 to 0.53 ± 0.37 mm2 (p < 0.001) in group 1. Choriocapillaris vascular density measured via OCTA increased from 37.82 ± 10.99 at the initial visit to 44.96 ± 15.34 at month 3 after half-fluence PDT administered to the fovea (p < 0.001). Deep capillary plexus vessel density was 32.49 ± 11.36 at baseline and increased to 43.27 ± 11.40 at month 3 after half-fluence PDT administered to the fovea (p < 0.001) in group 1. TCA decreased to 2.00 mm2 ± 0.51 mm2 from 2.39 mm2 ± 0.43 mm2 (p < 0.001), LA decreased to 1.53 ± 0.29 mm2 from 1.74 ± 0.16 mm2 (p = 0.019). Although SA decreased from 0.76 ± 0.33 mm2 to 0.53 ± 0.37 mm2 in group 2, the difference was not significant (p = 0.07). Based on OCTA, choriocapillaris vascular density increased from 43.68 ± 10.38 mm2 at baseline to 47.46 ± 6.42 mm2 at 3 months after half-dose PDT onto the fovea (p = 0.049). Deep capillary plexus vessel density increased from 34.37 ± 9.36 mm2 at the initial visit to 38.17 ± 8.81 mm2 3 months after half-dose PDT onto the fovea (p = 0.046) in group 2. At 3 months, post-PDT subretinal fluid (SRF) was significantly higher resolution in group 1 than in group 2 (p = 0.021). CONCLUSIONS: OCTA shows there is a significant increase in deep capillary plexus and choriocapillaris perfusion 3 months after both half-fluence PDT and half-dose PDT. Although there was a significant decrease in LA in both groups, based on OCTA there was a significant decrease in SA, a significant increase in choriocapillaris and deep capillary perfusion in group 1; therefore, the level of SRF resolution at month 3 post PDT might explain its higher incidence in group 1.

Long term results of three anti-vascular endothelial growth factor agents in pachychoroid neovasculopathy.

PURPOSE: To assess morphological changes and visual results in eyes with pachychoroid neovasculopathy (PNV) that underwent different intravitreal anti-vascular endothelial growth factor (VEGF) agents. MATERIALS AND METHODS: This is a retrospective, observational, comparative study that included 76 PNV eyes in 76 patients that were allocated to three groups according to the monotherapy injection procedure, as follows: the intravitreal bevacizumab (IVB) group, intravitreal ranibizumab (IVR) group, and intravitreal aflibercept (IVA) group. Central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were measured at baseline, after treatment 1st month, 3rd month, 6th month, and 12th month, and at the final post-treatment examination. RESULTS: Mean age of the patients was 57.31 ± 5.91 years (range: 34-67 years). The mean duration of follow-up was 31.50 ± 12.91 months (range: 13-60 months). The IVB group included 30 eyes, the IVR group included 22 eyes, and the IVA group included 24 eyes. There weren't any significant differences in BCVA changes between the groups at any post-baseline measurement time point. Although CMT did not change significantly in the IVB group from baseline to the final follow-up visit (baseline: 376.33 ± 86.31 µm; final visit: 340.80 ± 122.70 µm) (p = 0.172), CMT did change significantly in the IVA group (baseline: 383.41 ± 131.83 µm; final visit: 297.33 ± 103.81 µm) (p = 0.029) and IVR group (baseline: 379.18 ± 97.93 µm; final visit: 335.72 ± 111.45 µm) (p = 0.041). SFCT decreased significantly in the IVR and IVA groups (p = 0.015 and p < 0.001, respectively). The mean number of injections was 12.06 ± 4.72 (range: 6-20) in the IVB group, 11.81 ± 3.31(range: 7-17) in the IVR group, and 7.16 ± 3.15 (range: 4-13) in the IVA group (p = 0.004). CONCLUSION: All three anti-VEGFs were effective in terms of visual results in patients with PNV. Patients treated with IVA required fewer injections than those treated with IVB or IVR. Furthermore, IVR and IVA treatment significantly decreased SFCT, whereas IVB did not.

Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF.

PURPOSE: This study aimed to determine the changes that occur in the vasculature, as based on optical coherence tomography angiography (OCTA) after non-damaging endpoint management (EpM), using a continuous wave yellow laser. The study was on eyes with diabetic macular edema (DME) that were resistant to anti-vascular endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS: This was a retrospective analysis of OCTA images of 44 eyes in 44 patients with DME refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the DME area and utilized 10% continuous wave laser energy and 0.50 µm beam diameter spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) images were recorded at baseline, and 3 and 6 months posttreatment. Total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI) were calculated using Image J software. The macula was divided into five quadrants in accordance with the mapping system in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS: All patients (mean age: 58.90 ± 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at baseline was 0.30 ± 0.11 logarithm of the minimum angle of resolution (logMAR) versus 0.23 ± 0.10 logMAR at 3 months (p = 0.032) and 0.17 ± 0.10 logMAR at 6 months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris decreased significantly in the fovea at 3 and 6 months compared to baseline (p < 0.05 for both follow-up time points). There were significant decreases in SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and p = 0.038, respectively). There was a significant decrease in the nasal quadrant of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, respectively). Although there was a significant decrease in central macular thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS: Non-damaging EpM therapy using a continuous wave yellow laser in eyes with DME that are resistant to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most commonly, the DCP, which caused a significant decrease in VDs during 6 months of follow-up.

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol.

PURPOSE: To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). METHODS: The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP (VRP) were evaluated according to their last visit before the RP (V0). For outcome analysis, the patients who attend VRP and have follow-up (Group 1a, 46 eyes) and who did not attend VRP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP (V1) and last visit within six months after RP (V2). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. RESULTS: The adherence rate of the patients to VRP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean ± SD years, 71.0 ± 8.1 vs. 74.7 ± 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean ± SD delay of planned IVI at VRP in Group 2a was 13.9 ± 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V1 (0.70 [0.58]) and V2 (0.70 [0.59]) than V0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). CONCLUSIONS: More than half of the scheduled nAMD patients in TAE protocol missed their IVI visits during the RP, which resulted in a delay of their treatments. The delay of IVI treatment in those patients resulted in an increase in OCT disease activity and a decrease in BCVA.

Everything is ok on YouTube! Quality assessment of YouTube videos on the topic of phacoemulsification in eyes with small pupil.

OBJECTIVE: Usage of YouTube as an educational tool is gaining attention in academic research. To date, there has been no study on the content and quality of eye surgery videos on YouTube. The aim of this study was to analyze YouTube videos on phacoemulsification in eyes with small pupil. METHODS: We searched for the phrases "small pupil cataract surgery," "small pupil phacoemulsification," "small pupil cataract surgery complications," and "small pupil phacoemulsification complications" in January 2015. Each resulting video was evaluated by all authors, and Krippendorff's alpha was calculated to measure agreement. Videos were classified according to pupil size (small/very small) in the beginning of the surgery, and whether pupillary diameter was large enough to continue surgery safely after pupillary dilation by the surgeon in the video (safe/not safe). Methods of dilatation were also analyzed. Any stated ocular comorbidity or surgical complications were noted. RESULTS: A total of 96 videos were reviewed. No mechanical intervention for pupillary dilatation was performed in 46 videos. Fifty-eight operated eyes had no stated ocular comorbidity. Ninety-five operations ended successfully without major complication. There was fair agreement between the evaluators regarding pupil sizes (Kα = 0.670) but poor agreement regarding safety (Kα = 0.337). CONCLUSIONS: YouTube videos on small pupil phacoemulsification have low complication rates when compared to the literature, although no reliable mechanical dilatation methods are used in almost half of these videos. Until YouTube's place in e-learning becomes clearer, we suggest that viewers be cautious regarding small pupil phacoemulsification videos on YouTube.

Exploring the Potential of Code-Free Custom GPTs in Ophthalmology: An Early Analysis of GPT Store and User-Creator Guidance.

INTRODUCTION: OpenAI recently introduced the ability to create custom generative pre-trained transformers (cGPTs) using text-based instruction and/or external documents using retrieval-augmented generation (RAG) architecture without coding knowledge. This study aimed to analyze the features of ophthalmology-related cGPTs and explore their potential utilities. METHODS: Data collection took place on January 20 and 21, 2024, and custom GPTs were found by entering ophthalmology keywords into the "Explore GPTS" section of the website. General and specific features of cGPTs were recorded, such as knowledge other than GPT-4 training data. The instruction and description sections were analyzed for compatibility using the Likert scale. We analyzed two custom GPTs with the highest Likert score in detail. We attempted to create a convincingly presented yet potentially harmful cGPT to test safety features. RESULTS: We analyzed 22 ophthalmic cGPTs, of which 55% were for general use and the most common subspecialty was glaucoma (18%). Over half (55%) contained knowledge other than GPT-4 training data. The representation of the instructions through the description was between "Moderately representative" and "Very representative" with a median Likert score of 3.5 (IQR 3.0-4.0). The instruction word count was significantly associated with Likert scores (P = 0.03). Tested cGPTs demonstrated potential for specific conversational tone, information, retrieval and combining knowledge from an uploaded source. With these safety settings, creating a malicious GPT was possible. CONCLUSIONS: This is the first study to our knowledge to examine the GPT store for a medical field. Our findings suggest that these cGPTs can be immediately implemented in practice and may offer more targeted and effective solutions compared to the standard GPT-4. However, further research is necessary to evaluate their capabilities and limitations comprehensively. The safety features currently appear to be rather limited. It may be helpful for the user to review the instruction section before using a cGPT.

One-Year Functional and Morphological Prognosis After Intravitreal Injection Treatments According to Different Morphological Patterns of Diabetic Macular Edema in Real-Life: MARMASIA Study Group Report No.13.

PURPOSE: To evaluate the responses of different optical coherence tomography (OCT) patterns of diabetic macular edema (DME) to intravitreal injection therapy. METHODS: In this retrospective, comparative, and multicenter study, patients who had previously untreated DME, who received intravitreal ranibizumab (IVR) or aflibercept (IVA) and/or steroid treatment with the pro re nata (PRN) treatment regimen after a 3-month loading dose, and had a 12-month follow-up in the MARMASIA Study Group were included. Morphological patterns of DME were divided into four groups based on OCT features diffuse/spongious edema (Group 1), cystoid edema (Group 2), diffuse/spongious edema+subretinal fluid (SRF) (Group 3), and cystoid edema+SRF (Group 4). Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) at months 3, 6, and 12, and the number of injections at month 12 were compared between the DME groups. RESULTS: 455 eyes of 299 patients were included in the study. The mean baseline BCVAs [Logarithm of the Minimum Angle of Resolution (logMAR)] in groups 1, 2, 3, and 4 were 0.54 ± 0.24, 0.52 ± 0.25, 0.55 ± 0.23, and 0.57 ± 0.27, respectively. There was no significant difference between the baseline mean BCVAs between the groups (p = .35). The mean BCVAs were significantly improved to 0,47 ± 0,33 in group 1, 0,42 ± 0,33 in group 2, 0,47 ± 0,31 in group 3, and 0,45 ± 0,43 at month 12. There was no significant difference between the groups in terms of BCVA change at month 12 (p = .71). The mean baseline CMTs in groups 1, 2, 3, and 4 were 387,19 ± 128,19, 447,02 ± 132,39, 449,12 ± 109,24, and 544,19 ± 178,61, respectively. At baseline, the mean CMT was significantly higher in Group 4 than in the other groups (p = .000). The mean CMTs were significantly decreased to 325,16 ± 97,55, 334,94 ± 115,99, 324,33 ± 79,20, and 332,08 ± 150,40 in four groups at month 12 respectively (p > .05). The groups had no significant difference in mean CMT at month 12 (p = .835). The change in CMT was significantly higher in Group 4 than in the other groups at month 12 (p = .000). The mean number of intravitreal anti-VEGF injections at month 12 was 4.51 ± 1.57 in Group 1, 4.63 ± 1.54 in Group 2, 4.88 ± 1.38 in Group 3, and 5.07 ± 1.49 in Group 4. The mean number of anti-VEGF injections in Group 1 and Group 2 was significantly lower than in Group 4 (p = 0,014 and p = 0,017). CONCLUSIONS: In real life, there was no significant difference between the DME groups in terms of visual improvement at month 12. However, better anatomical improvement was achieved in Group 4 than in the other DME groups.

Efficacy of ranibizumab and aflibercept on reducing maximum diameter of largest cyst in diabetic cystoid macular edema: MARMASIA study group.

PURPOSE: This study aimed to compare the effect of intravitreal aflibercept (IVA) and ranibizumab (IVR) on the maximal diameter of the largest intraretinal cyst (mdIRC), indicating chronicity in patients with diabetic cystoid macular edema (CME). METHODS: This retrospective, comparative study included a subgroup of patients from the MARMASIA Study with treatment-naïve diabetic CME who had IVA (IVA group) or IVR (IVR group) on a pro re nata regimen after a loading dose of 3-monthly injections and followed-up for 24 months. Best-corrected visual acuity (logMAR), central macular thickness (CMT, µm), and mdIRC (µm) and their changes during the study period in the IVA and IVR groups were compared. RESULTS: A total of 175 eyes (65 [37.1%] in IVA and 110 [62.9%] in IVR group) of 113 patients were included in the study analysis. Both groups had statistically significant improvements in BCVA and CMT during the follow-up (p < 0.05 for all), which were comparable between the groups at each time point. However, the mean reduction in mdIRCs was consistently and significantly higher in the IVA group compared to the IVR group at each follow-up examination (F[1, 3.52] = 6.93, p = 0.009). CONCLUSION: IVA seems to have a greater impact in reducing cyst sizes than IVR in diabetic CME.

Staphylococcus hominis: a rare cause of endophthalmitis.

Staphylococcus hominis (S. hominis) is a coagulase-negative Staphylococci and an infrequent cause of endophthalmitis. Due to its ability to produce biofilm, especially in diabetic patients, strains may acquire antibiotic resistance. We present two cases of S. hominis endophthalmitis, one with acute endophthalmitis after intravitreal bevacizumab injection and one with chronic endophthalmitis following undiagnosed penetrating ocular trauma. Although there are only four published S. hominis endophthalmitis cases in the literature, to the best of our knowledge, there has been no previously published case after intravitreal bevacizumab.

A Useful Method for the Practice of Pneumatic Retinopexy: Slit-Lamp Laser Photocoagulation through the Gas Bubble.

This study aimed to demonstrate the laser retinopexy method through the gas bubble under a slit-lamp biomicroscope using a wide-field contact lens to treat rhegmatogenous retinal detachment (RRD) with pneumatic retinopexy (PR) and report its anatomical and functional results. This single-center, retrospective case series included RRD patients treated with PR using sulfur hexafluoride (SF6). The demographics, preoperative factors, and anatomical and functional outcomes were collected from the patient files. The single-procedure success rate of PR at postoperative 6th months was 70.8% (17/24 eyes), and the final success rate after secondary surgeries was 100%. The BCVA was better in the successful PR eyes at postoperative 3rd (p = 0.011) and 6th month (p = 0.016) than in failed eyes. No single preoperative factor was associated with PR success. The single-procedure success rate of PR using the laser retinopexy method through the gas bubble with a wide-field contact lens system seems comparable to the PR literature.

Intestinal perforation after intravitreal low dose ranibizumab injection for the treatment of type 1 retinopathy of prematurity: A case report.

PURPOSE: To report a newborn patient with gastrointestinal (GIS) perforation after intravitreal ranibizumab (RBZ) treatment. CASE REPORT: The patient was born at 31 gestational week and hospitalized with the diagnosis of small for gestational age and prematurity. In the follow up he underwent GIS surgery due to necrotizing enterocolitis (NEC) and was diagnosed with retinopathy of prematurity (ROP). At 43 weeks of postmenstrual age, he developed intestinal perforation after 12 h of the second low-dose RBZ injection. According to our knowledge, this is the first report of GIS perforation due to low-dose intravitreal RBZ treatment in an infant with severe ROP. CONCLUSION: The risk of GIS perforation should be taken into consideration during the application of intravitreal vascular endothelial growth factor antagonist agents, especially in newborns with previous GIS surgery and a history of NEC, and these patients should be carefully monitored for GIS complications.

Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1.

Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, µm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 µm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 µm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion: This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.

Effect of the pandemic on surgical procedures in a tertiary care hospital: A retrospective review.

Objectives: The aim of this study was to examine the impact of performing surgeries with necessary precautions and to evaluate demographic characteristics of operated patients during novel coronavirus-2019 (COVID-19) pandemic and the infection rates during hospitalization and within 14 days after surgery. Material and Methods: Between March 15th, 2020 and April 30th, 2020, a total of 639 patients who had been operated on in our center were retrospectively analyzed. According to the triage system, the surgical procedures were classified as emergency, time-sensitive, and elective procedures. Data including age, sex, indication for surgery, the American Society of Anesthesiologists (ASA) class, pre- and postoperative symptoms, the presence and/ or absence of reverse transcriptase-polymerase chain reaction (RT-PCR) test result, type of surgery, surgical site, and documented COVID-19 infections during hospitalization and within 21 days after surgery were recorded. Results: Of the patients, 60.4% were males and 39.6% were females with a mean age of 43.08 ± 22.68 years. Malignancy was the most common indication for surgery (35.5%), followed by trauma (29.1%). The abdominal area and head and neck region were the most frequent surgical sites in 27.4% and 24.9% of the patients, respectively. Of all surgical procedures, 54.9% were emergency and 43.9% were time-sensitive procedures. Of the patients, 84.2% were in ASA Class I-II while 15.8% patients were in ASA Class III, IV and V. General anesthesia was the most common anesthesia type in 83.9% of the patients. The overall rate of COVID-19 infection was 0.63% in the preoperative period. The rate of COVID-19 infection during and after surgery was 0.31%. Conclusion: With similar infection rates to the general population, surgeries of all types can be performed safely taking preventive measures in the preand postoperative period. It would be wise to perform surgical treatment without delay in patients with an increased risk for mortality and morbidity in accordance with strict infection control principles.

Resolution of cystoid macular edema with topical carbonic anhydrase inhibitor in a patient with retinal dystrophy associated with Cohen syndrome.

Background: Cohen Syndrome (CS) is an autosomal recessive multisystemic disorder characterized by various ophthalmologic findings, including retinal dystrophy and associated cystoid macular edema (CME), in which there was no known effective treatment approach.Material and Methods: We describe a CS patient with a homozygous c.62 T > G, p.(Leu21*) mutation in the VPS13B gene with a topical carbonic anhydrase inhibitor (CAI; brinzolamide %1, thrice daily) responding CME.Case Description: A seven-year-old girl with an established diagnosis of CS was referred with a primary complaint of nyctalopia. On ophthalmologic examination, bilateral decreased visual acuity and normal-appearing macula with mild optic disc pallor were present. However, the detailed evaluation revealed bilateral blunted foveal reflexes, barely visible foveal pigmentation, and slightly attenuated retinal vessels without any peripheral retinal pigmentary changes in dilated fundus examination, and CME on optical coherence tomography. Bilateral topical brinzolamide thrice daily was initiated for CME. Visual acuity increased, and CME was resolved except for minimal schisis at the inner nuclear layer level at the third-month follow-up visit and remained stable up to one-year follow-up. CME reappeared after five months of self-discontinuation of the patient's therapy but resolved again with treatment resumption.Conclusion: We report the first case of CME secondary to rod-cone dystrophy associated with CS showing improvement in anatomy and visual acuity with a topical CAI.

Straatsma Syndrome: Should Visual Prognostic Factors Be Taken into Account? A Case Report.

Straatsma syndrome is the triad of myelinated retinal nerve fibers, myopia, and amblyopia and may be associated with strabismus, nystagmus, hypoplastic optic nerve, and heterochromia iridum. The degree of anisometropia, presence of strabismus, extent of myelination, and macular involvement have been reported to be associated with poor visual acuity after occlusion therapy for amblyopia in this syndrome. Here we present two cases of Straatsma syndrome with different responses to occlusion therapy and discuss their treatment responses according to prognostic factors for post-occlusion visual acuity.