Intense pulse light therapy treatment for refractory dry eye disease due to meibomian gland dysfunction.

PURPOSE: To assess the effect of the intense pulse light (IPL) therapy for the treatment of meibomian gland dysfunction (MGD) and dry eye parameters. METHODS: Patients who underwent an IPL therapy for the treatment of MGD were included in this retrospective study. Ocular Surface Disease Index (OSDI) scores, the frequency of daily lubricant use, non-invasive tear break-up time (NIBUT), meibomian glad dropout scores, corneal staining scores, and Schirmer test results were collected from patient charts that recorded at baseline and follow-up visits at 1 month, 3 months, and 12 months. For the analysis, patients were grouped based on the severity of their baseline meibomian gland dropout score as mild, moderate, and severe atrophy. RESULTS: Forty-three patients (mild atrophy = 22, moderate atrophy = 17, and severe atrophy = 4) were included for analysis. Except for the Schirmer test, all dry eye parameters significantly improved in patients with mild and moderate atrophy following the treatment and this effect lasted until the 12-month follow-up visit (p < 0.001). No significant improvement in any parameter was observed in patients with severe atrophy at any time point (p > 0.05). In the mild and moderate atrophy groups, OSDI scores, as well as NIBUT, started improving at 1 month (p < 0.01), while corneal staining and meibomian gland dropout scores showed earliest improvements at 3 months (p < 0.01). No adverse events were observed, except for temporary redness in 4 patients. CONCLUSION: The IPL treatment seems an effective and safe treatment for patients with MGD. This study shows that the IPL resulting in an earlier improvement in symptoms and signs with long-lasting beneficial effect on the meibomian glands.

Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema.

PURPOSE: This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME). METHODS: Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment. RESULTS: After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6 LogMAR and 478.2 ± 107.8 µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4 LogMAR (p = 0.005) and 313.8 ± 62.7 µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5 LogMAR and 298.4 ± 71.5 µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively). CONCLUSION: Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.

Multimodal imaging including optical coherence tomography angiography in patients with type B Niemann-Pick disease.

PURPOSE: To evaluate accumulation patterns of deposits in retinal layers of type B Niemann-Pick patients by multimodal imaging. METHODS: Seven patients with type B Niemann-Pick disease were included in this study. All participants underwent a complete ophthalmologic evaluation, high-resolution digital colour imaging, spectral-domain optical coherence tomography, blue light fundus autofluorescence and optical coherence tomography angiography (OCTA). RESULTS: We demonstrated different accumulation patterns in the retinal ganglion cell layer, the retinal nerve fibre layer and the subfoveolar region by multimodal imaging. Local retinal capillary nonflow areas in the superficial plexus, increased vascular tortuosity and deformed foveal avascular areas were shown in OCTA scans. CONCLUSION: Multimodal imaging including OCTA is a useful technique for the identification of different types of accumulation patterns, diagnosis and follow-up of type B Niemann-Pick patients.

EFFECTS OF INTRAVITREAL RANIBIZUMAB AND BEVACIZUMAB ON THE RETINAL VESSEL SIZE IN DIABETIC MACULAR EDEMA.

PURPOSE: The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema. MATERIALS AND METHODS: In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. The study groups were composed of the injected eyes, whereas the noninjected fellow eyes served as the control groups. The patients underwent complete ophthalmic examinations, including optical coherence tomography and fundus fluorescein angiography, and the primary outcome measures included the central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio. RESULTS: In the RAN study group (n = 32), the preinjection mean central retinal artery equivalent (175.42 µm) decreased to 169.01 µm after 1 week, and to 167.47 µm after 1 month (P < 0.001), whereas the baseline central retinal vein equivalent (235.29 µm) decreased initially to 219.90 µm after 1 week, and to 218.36 µm after 1 month (P < 0.001). In the BEV study group (n = 30), the preinjection central retinal artery equivalent (150.21 µm) decreased to 146.25 µm after 1 week, and to 145.89 µm after 1 month (P < 0.001); whereas the baseline central retinal vein equivalent (211.87 µm) decreased initially to 204.59 µm after 1 week and was 205.24 µm after 1 month (P < 0.001). The preinjection artery-to-vein ratio values changed significantly (P = 0.001) after 1 week and after 1 month in the RAN group, but no significant alteration in the artery-to-vein ratio was observed in the BEV group (P = 0.433). In both the RAN (n = 32) and BEV (n = 30) control groups, none of the 3 parameters changed throughout the study period, when compared with the baseline. CONCLUSION: The results of this study showed that both RAN and BEV injections significantly constricted the retinal blood vessel diameters.

A role for repressive complexes and H3K9 di-methylation in PRDM5-associated brittle cornea syndrome.

Type 2 brittle cornea syndrome (BCS2) is an inherited connective tissue disease with a devastating ocular phenotype caused by mutations in the transcription factor PR domain containing 5 (PRDM5) hypothesized to exert epigenetic effects through histone and DNA methylation. Here we investigate clinical samples, including skin fibroblasts and retinal tissue from BCS2 patients, to elucidate the epigenetic role of PRDM5 and mechanisms of its dysregulation in disease. First we report abnormal retinal vascular morphology in the eyes of two cousins with BCS2 (PRDM5 Δ exons 9-14) using immunohistochemistry, and mine data from skin fibroblast expression microarrays from patients with PRDM5 mutations p.Arg590* and Δ exons 9-14, as well as from a PRDM5 ChIP-sequencing experiment. Gene ontology analysis of dysregulated PRDM5-target genes reveals enrichment for extracellular matrix (ECM) genes supporting vascular integrity and development. Q-PCR and ChIP-qPCR confirm upregulation of critical mediators of ECM stability in vascular structures (COL13A1, COL15A1, NTN1, CDH5) in patient fibroblasts. We identify H3K9 di-methylation (H3K9me2) at these PRDM5-target genes in fibroblasts, and demonstrate that the BCS2 mutation p.Arg83Cys diminishes interaction of PRDM5 with repressive complexes, including NuRD complex protein CHD4, and the repressive chromatin interactor HP1BP3, by co-immunoprecipitation combined with mass spectrometry. We observe reduced heterochromatin protein 1 binding protein 3 (HP1BP3) staining in the retinas of two cousins lacking exons 9-14 by immunohistochemistry, and dysregulated H3K9me2 in skin fibroblasts of three patients (p.Arg590*, p.Glu134* and Δ exons 9-14) by western blotting. These findings suggest that defective interaction of PRDM5 with repressive complexes, and dysregulation of H3K9me2, play a role in PRDM5-associated disease.

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration.

PURPOSE: The aim of this paper was to assess and compare the effects of intravitreal ranibizumab and bevacizumab on retinal vessel diameter in eyes with neovascular age-related macular degeneration (AMD). METHODS: Patients with neovascular AMD who underwent intravitreal injection of either ranibizumab or bevacizumab were included. Noninjected fellow eyes served as a control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and the artery-vein ratio (AVR). RESULTS: In the ranibizumab group, the mean CRAE value decreased significantly at 1 week and 1 month (p = 0.002). The AVR value decreased significantly at 1 month (p = 0.028). CRVE values did not change at 1 week and 1 month (p = 0.083). In the bevacizumab group, the preinjection CRAE, CRVE, and AVR values did not change through the study period (p = 0.128, p = 0.600, and p = 0.734, respectively). CONCLUSION: These results suggest that intravitreal ranibizumab led to significant retinal arteriolar vasoconstriction in eyes with neovascular AMD.

Evaluation of the results of contact lens assisted corneal cross-linking treatment in keratoconus patients with thin corneas.

PURPOSE: We aimed to compare the efficacy and safety of accelerated contact lens-assisted cross-linking (CA-CXL) with Lotrafilcon B and Comfilcon A lenses in keratoconus (KC) patients with thin corneas. STUDY DESIGN: Retrospective, single-center study. MATERIALS AND METHODS: We retrospectively included 51 eyes of 39 KC patients with corneal thickness <400µm after epithelial scraping (Epi-off), who underwent accelerated CA-CXL treatment with Lotrafilcon B (n=20) and Comfilcon A (n=31). Uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest refraction values, corneal topographic data and endothelial cell density were recorded at preoperative and postoperative 1st, 3rd and 6th month controls. RESULTS: CDVA in the Comfilcon A group was higher than CDVA before surgery at 6 months postoperatively (p<0.001). When the two lenses were compared, CDVA was found to be significantly higher in the Lotrafilcon B group in the preoperative, postoperative 1st month and 3rd month values, but there was no significant difference between the postoperative 6th month values (p=0.028, p=0.018, p=0.044, p=0.181, respectively). The maximum keratometry (Kmax) value at the 6th month after surgery in the Comfilcon A group was significantly lower than in the Lotrafilcon B group (p=0,009). There was no significant difference between the endothelial cell density values between the groups (p=0.623, p=0.609, p=0.794, p=0.458, respectively). There was no significant difference between the progression, regression, and stability rates of the two groups (p=0.714). CONCLUSIONS: Accelerated CA-CXL with Lotrafilcon B and Comfilcon A silicone hydrogel lenses is a safe and effective method to stop progression in patients with thin corneas.

Comparison of the effects of aflibercept and dexamethasone in central retinal vein occlusion with serous retinal detachment.

CLINICAL RELEVANCE: Previous studies have shown the efficacy of aflibercept and dexamethasone in central retinal vein occlusion. However, the efficacy of these two drugs in central retinal vein occlusion accompanied by serous macular detachment has not been investigated and compared. This results in a search for more precise data to evaluate the effects of two drugs in real-world studies. BACKGROUND: The aim of this study is to compare the efficacy of intravitreal aflibercept and dexamethasone implantation injections in central retinal vein occlusion accompanied by serous retinal detachment. METHODS: Sixty-eight eyes of 68 patients with treatment-naive macular oedema post-central retinal vein occlusion were enrolled in the retrospectively designed study. All of the patients had serous retinal detachment at baseline. The patients received three intravitreal aflibercept injections with an interval of four weeks and followed by pro re nata treatment protocol (intravitreal aflibercept group, n = 37) or a single dose dexamethasone implantation injection (dexamethasone implantation group, n = 31). Best-corrected visual acuity, central retinal thickness and the height of serous retinal detachment parameters were compared at baseline, and in the first, second, third and sixth months. RESULTS: The groups were similar in terms of baseline characteristics (p > 0.05 for all). The visual gain was greater in the intravitreal aflibercept group (p = 0.013). While the intravitreal aflibercept group had a significant central retinal thickness decrease in the first and sixth months (p = 0.011 and p = 0.001, respectively), this superiority was not observed during the entire follow-up period (p = 0.212). There was no difference in serous retinal detachment resolution between the groups (p = 0.403). Two patients in the intravitreal aflibercept group (5.4%) and five patients in the dexamethasone implantation group (16.1%) had serous retinal detachment at the final visit (p = 0.158). CONCLUSION: Both intravitreal aflibercept and dexamethasone implantation injections seemed to be effective in the treatment of central retinal vein occlusion with serous retinal detachment. Intravitreal aflibercept treatment yielded better results in terms of visual gain and showed a faster anatomical response.

Factors Affecting Visual Gain after Accelerated Crosslinking in Pediatric Keratoconic Cases.

OBJECTIVES: This study was designed to evaluate factors affecting visual gain following accelerated crosslinking (A-CXL) in pediatric cases with keratoconus. METHODS: Pediatric patients with a diagnosis of keratoconus who underwent A-CXL for 10 minutes ultraviolet A (UV-A) 9 mW/cm2 between February 2015 and May 2019 and had at least 1 year of follow-up data were analyzed retrospectively. Uncorrected visual acuity, best corrected visual acuity (BCVA), and refractive value changes (spherical, cylindrical values) at the preoperative and postoperative 12th month were compared. Correlation analysis was used to evaluate the relationships between visual gain and corneal topography values (K1, K2, Kmaximum [Kmax], anterior elevation, posterior elevation) obtained using a Sirius topography device (Costruzione Strumenti Oftalmici, Florence, Italy). RESULTS: A total of 33 eyes of 22 patients (mean age: 16.85±1.15 years) who underwent A-CXL (9 mW/cm2 UVA irradiation for 10 minutes) were included in the study. The mean BCVA had increased from 0.45±0.27 logMAR to a mean of 0.33±0.24 logMAR at the end of 1 year (p=0.014). Changes to spherical and cylindrical values were not statistically significant (p>0.05). The correlation analysis revealed a statistically significant relationship between visual gain and the preoperative BCVA and the preoperative Kmax. CONCLUSION: The study results indicated that the visual gain at 1 year after A-CXL (10 minutes at 9 mW/cm2) was associated with preoperative BCVA and Kmax values in pediatric cases of keratoconus.

The Intraoperative Corneal Pachymetry Changes during Accelerated Corneal Cross-linking in Progressive Keratoconus Patients with Thin Corneas.

PURPOSE: To report the intraoperative corneal pachymetry changes during accelerated corneal cross-linking (A-CXL) in progressive keratoconus patients with thin corneas. METHODS: Thirty-six eyes (mean age, 22.26 ± 4.02 years) with progressive keratoconic thin corneas (<400 µm without epithelium) who underwent A-CXL with ultraviolet (UV)-A (UVA) (9 mW/cm2) using isotonic riboflavin5-phosphate 0.1% with 1.1% hydroxypropyl methycellulose (RF-HPMC, MedioCROSS M) were included in this retrospective study. Intraoperative corneal pachymetric changes were noted before the procedure, after removal of epithelium, after RF-HPMC instillation, before and after UV irradiation. The mean of corneal pachymetric values were compared statistically. RESULTS: The mean corneal pachymetry reduced from 415.72 ± 29.66 to 369.50 ± 23.45 µm after removal of the epithelium (p < 0.05). After the application of RF-HPMC solution the mean thinnest corneal pachymetry (TCP) increased to 412.89 ± 26.94 µm. Statistically significant increase was observed in TCP after saturation with RF-HPMC (p = 0.001). The mean corneal pachymetry before and after UVA irradiation was 419.86 ± 10.41 and 417.47 ± 8.25 µm, respectively (p > 0.05). CONCLUSIONS: Isotonic RF-HPMC lead to a significant increase in intraoperative mean TCP. RF-HPMC seems to be a favorable riboflavin option in keratoconus patients with thin corneas.

Tolerating subretinal fluid in the treatment of neovascular age-related macular degeneration with intravitreal aflibercept.

OBJECTIVE: To compare the anatomical and functional outcomes of intensive and relaxed intravitreal aflibercept regimen in the management of neovascular age-related macular degeneration. METHODS: The medical records of 50 eyes of 50 patients with treatment-naive neovascular age-related macular degeneration, who underwent intravitreal aflibercept therapy in the Retinal Department of University of Health Sciences Okmeydani Training and Research Hospital (Istanbul, Turkey), were retrospectively reviewed. The demographic features and best-corrected visual acuities at baseline and at 1st-, 2nd-, 3rd-, 4th-, 6th-, 10th- and 12th- months, optical coherence tomography measurements, presence of intraretinal fluid, subretinal fluid and intraocular pressure values were studied. The patients were divided into two groups: intensive (subretinal fluid intolerant) and relaxed (<200 microns subretinal fluid tolerated) intravitreal aflibercept regimens. RESULTS: The change in the mean best-corrected visual acuities from baseline to 12th month was 13.72 ± 33.97 letters in the intensive treatment group and 8.68 ± 27.22 in the relaxed group. There was no statistically significant difference between the groups (p = 0.566). Similar proportions of both groups achieved ⩾10 letters gain (%48 vs. %40, respectively; p = 0.755) and ⩾10 letters loss (%20 vs. %24, respectively; p = 0.755). The mean central subfield thickness values decreased statistically significantly in both groups (p < 0.001). There was no statistically significant difference between the groups (442.40 ± 161.32 to 318.0 ± 63.10 vs. 431.64 ± 151.52 to 303.08 ± 140.91, respectively; p = 0.724). The mean total injection numbers were significantly lower in the relaxed group (6.4 ± 1.65 vs. 4.8 ± 1.45, respectively; p = 0.01). CONCLUSION: Relaxed intravitreal aflibercept regimen has comparable efficiency and safety outcomes at 12 months with intensive intravitreal aflibercept regimen with fewer injections in the management of neovascular age-related macular degeneration.

Intravitreal Ranibizumab Versus Intravitreal Ranibizumab Combined with Posterior Subtenon Triamcinolone Acetonide in Diabetic Macular Edema.

OBJECTIVES: This is a retrospective, comparative evaluation of the short-term efficacy and safety of intravitreal ranibizumab (IVR) and IVR combined with posterior subtenon triamcinolone acetonide (STA) in the treatment of diabetic macular oedema (DME). METHODS: A total of 79 pseudophakic eyes of 57 patients with DME who underwent IVR injection treatment were examined retrospectively. All of the patients were treatment-naive. In the study group (STA+IVR), consisting of 30 eyes of 39 patients, the STA and IVR were administered in the first treatment session simultaneously, followed by 2 consecutive monthly IVR injections. In the control group (IVR only) comprised 40 eyes of 27 patients, 3 consecutive monthly IVR injections were administered. Patients with serous retinal detachment (SRD) according to optical coherence tomography images were identified in both groups for subgroup analyses. The primary outcome measures were changes in central macular thickness (CMT), best corrected visual acuity (BCVA), and the intraocular pressure (IOP) at 1, 2, and 3 months post-injection. RESULTS: There was no statistically significant difference between the demographic characteristics of the patients' baseline BCVA and CMT measurements (p>0.05). For the IVR group, the mean pre-treatment CMT and BCVA was 421.20±89.10 µm and 0.42±0.24 logMAR, respectively. After the third injection, the mean was 308.12±59.07 µm and 0.20±0.12 logMAR, respectively. The combined treatment group baseline measurements were 454.50±122.52 µm and 0.54±0.29 logMAR, respectively. After the third injection, the mean was 294.22±50.33 µm and 0.27±0.21 logMAR, respectively. The decrease was statistically significant for both groups (p=0.001). Comparison of the CMT within groups revealed a statistically significant difference in favor of the combined group after the second injection (p=0.017). There was no statistically significant difference in the BCVA gains between groups (p>0.05). Patients with SRD were evaluated as a subgroup, and at the first month, the mean gain in CMT was -71.63±57.98 µm in the control group and -123.61±93.46 µm in the study group (p=0.048). The required anti-glaucomatous treatment was statistically significant in the combined group (p=0.008). CONCLUSION: Both treatments provided improvement in BCVA and CMT and can be considered functional and anatomically effective treatment options for DME.

Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema.

PURPOSE: To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME). MATERIALS AND METHODS: Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment. RESULTS: There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months (p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months (p < 0.001). When groups were compared, the change in CRT was higher in the SRD group (p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes (p = 0.448). CONCLUSION: The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME.

Subfoveal Choroidal Thickness and Ganglion Cell Complex in Children with Type 1 Diabetes Mellitus Without Diabetic Retinopathy.

OBJECTIVES: This study is an analysis of the subfoveal choroidal thickness (SFCT) and ganglion cell complex (GCC) in children who have type 1 diabetes mellitus (T1D) without diabetic retinopathy. METHODS: In all, 36 right eyes of 36 patients with T1D and 36 right eyes of sex- and age-matched healthy subjects were included in this prospective study. SFCT and GCC measurements were obtained using spectral domain optical coherence tomography (SD-OCT). Correlations between SCFT, GCC and duration of T1D, glycated hemoglobin, and age were also investigated. RESULTS: The mean SFCT was 342.1±42.3 µm in the T1D group and 354±70.8 µm in the control group (p>0.05). There was no significant difference between the groups in the GCC superior and inferior retina values. The average GCC was thinner in the T1D group (T1D group: 88.11±14.93 µm, control group: 103.39±15.65 µm; p=0.005). The mean central retinal thickness (CRT) was decreased in the T1D group (T1D group: 248.1±16.5 µm, control group: 262.1±18.3 µm; p=0.021). CONCLUSION: The mean SFCT was not significantly different in diabetic children compared with healthy eyes. The CRT and average GCC thickness were lower in children with T1D. SD-OCT can reveal neurodegenerative changes that may occur before vascular changes in diabetic children.

The corneal effects of intravitreal dexamethasone implantation.

OBJECTIVES: To evaluate the corneal effects of the intravitreal dexamethasone implantation using corneal topography and specular microscopy. MATERIAL AND METHODS: 27 eyes of the 27 patients who received a single intravitreal dexamethasone implantation dose for diabetic macular edema were enrolled in this study. Sirius topography and EM-3000 specular microscopic examinations were performed at the initial examination (baseline), and then on the first day, during the first week, and 1 month after IDI. Changes in corneal parameters were investigated. RESULTS: The mean age was 58.66 ± 6.59 years. 15 patients were men, and 12 were women. The mean disease duration was 12.2 ± 2.4 months, and mean glycosylated hemoglobin (HbA1c) was 7.2 ± 1.1. After dexamethasone injection, the mean central corneal thickness, endothelial cell density, and coefficient variation of cell area presented a statistically significant decrease (p < 0.05). Anterior segment parameters, such as anterior chamber depth, iridocorneal angle, sim K1 and K2 keratometry, pupillary diameter, horizontal visible iris diameter, and corneal astigmatism did not change (p > 0.05). CONCLUSION: Intravitreal dexamethasone implantation affects corneal endothelial cell structure but does not appear to affect corneal topography parameters.

The Effects of Epiretinal Membranes on the Treatment Outcomes of Dexamethasone Implants in Diabetic Macular Edema: A Real-Life Study.

Purpose: To evaluate the effects of a coexisting epiretinal membrane (ERM) on the treatment outcomes of a dexamethasone implant (DI) in diabetic macular edema (DME) patients. Methods: One hundred five eyes of 78 DME patients (44 F, 34 M; mean age: 65.7) treated with minimum 2 DIs were enrolled into this retrospective study. The study population was divided into the ERM (+) study group and the ERM (-) control group. The best corrected visual acuity (BCVA), intraocular pressure, and central macular thicknesses (CMTs) were evaluated at baseline and months 1, 2, and 3 after each DI treatment. Results: Both groups were comparable in baseline BCVA, CMT, HbA1c levels, and age. In the study group (n: 49), BCVA changed following the first DI from 0.83 to 0.76 and from 0.97 to 0.80 following the second DI. CMT decreased after the first DI from 465 to 377 µ (P < 0.001) and from 477 to 356 µ (P < 0.001) after the second DI. In the control group (n: 56), BCVA changed following the first DI from 0.81 to 0.77 and from 0.86 to 0.83 following the second DI. After the first DI, CMT decreased from 483 to 280 µ (P < 0.001) and from 468 to 301 µ (P < 0.001) after the second DI. The inter-group comparison revealed no significant difference in visual or anatomical gain (P = 0.46, P = 0.05, respectively). Conclusion: The presence of an epiretinal membrane did not change the treatment response to DI therapy.

Three versus five intravitreal aflibercept injections as the initial loading phase in the treatment of diabetic macular edema: one-year results.

PURPOSE: To compare the efficacy of three initial monthly intravitreal aflibercept injections followed by pro re nata (3+PRN) dosing versus five initial monthly intravitreal aflibercept injections followed by pro re nata (5+PRN) dosing in patients with diabetic macular edema. METHODS: A total of 60 treatment-naïve patients with macular edema who underwent intravitreal aflibercept injections (2 mg/0.05 mL) with at least one year of follow-up were analyzed in this retrospective and comparative study. The patients were divided into two groups according to the number of intravitreal aflibercept injections administered in the loading phase. The 3+PRN group comprised 27 patients, whereas the 5+PRN group comprised 33 patients. The visual and anatomical outcomes were compared between the two groups at baseline and at 3, 6, 9, and 12 months. RESULTS: Both 3+PRN and 5+PRN, showed statistically significant improvements in the best-corrected visual acuity and central macular thicknesse throughout the study period (p<0.001 and, p<0.001, respectively). There were no significant differences between the two groups in terms of changes in the best-corrected visual acuity and central macular thickness (p=0.453 and, p=0.784, respectively). The mean number of intravitreal aflibercept injections was significantly greater in the 5+PRN group (6.1 ± 0.8) than in the 3+PRN group (3.9 ± 0.8) (p<0.001). CONCLUSION: The 3+PRN and 5+PRN regimens showed similar 12-month visual and anatomical outcomes following treatment with intravitreal aflibercept injections in patients with macular edema.

Corneal endothelial morphology and anterior segment parameters in children with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: To compare the corneal endothelial morphology and anterior segment parameters in type 1 diabetes mellitus children (T1DM) and healthy controls. METHODS: This cross-sectional prospective study included 56 patients with T1DM and 50 eyes of 50 age-matched controls. Endothelial morphology was analyzed with EM-3000 specular microscopy, and anterior parameters were analyzed with Sirius Scheimpflug topography. Endothelial cell density (ECD), coefficient of variation (CV) of cell area, central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), K1 and K2, pupillary diameter (PD), horizontal visible iris diameter (HVID), duration of T1DM, and HbA1c levels were noted. RESULTS: The mean age of the T1DM group was 14.3 ± 3.2 years, compared to 13.2 ± 3.7 years in the healthy group (p = 0.140). The mean duration of diabetes mellitus was 4.5 ± 3.5 years. The mean HbA1c was 9.5 ± 1.9% (minimum 6%, maximum 14%). The mean values of CCT were 556 ± 30 µm and 536 ± 36 µm in T1DM and healthy groups, respectively (p = 0.003). The mean values of ACD were 3.69 ± 0.31 mm and 3.83 ± 0.27 mm in T1DM and healthy groups, respectively (p = 0.02). The mean values of PD were 4.29 ± 1.2 mm and 5.17 ± 1.36 mm in T1DM and healthy groups, respectively (p = 0.001). There was no statistically significant difference between groups in terms of ECD, CV, ICA, K1, K2, and HVID (p > 0.05). CONCLUSION: Type 1 diabetes mellitus children have thicker corneas, shallower anterior chamber depth, and smaller pupillary diameter than healthy subjects.

Direct transretinal removal of subfoveal perfluorocarbon liquid combined with internal limiting membrane peeling.

A 65-year-old woman was referred to our institution with a 5-day history of visual impairment in her right eye and macula-off retinal detachment. A successful 23 G pars plana vitrectomy was performed with a 1000 cs silicone oil injection, and the silicone oil tamponade was extracted 2 months later. During the fundoscopic and optical coherence tomography examinations, three subfoveal perfluorocarbon liquid bubbles were detected, and her best corrected visual acuity was limited to 20/400. Brilliant blue staining was used for the internal limiting membrane peeling, and the direct transretinal aspiration of the perfluorocarbon liquid bubbles was performed with a 23 G silicone-tip Flute cannula. This patient's best corrected visual acuity increased to 20/200 at the 1 month follow-up and then to 20/100 at the 1-year follow-up.

The Efficacy of Posterior Subtenon Triamcinolone Acetonide Injection in Treatment of Irvine-Gass Syndrome.

Purpose: To evaluate the efficacy and safety of posterior 40 mg subtenon triamcinolone acetonide (PST) injection in treating Irvine-Gass syndrome.Methods: The retrospective study included 21 patients (mean age: 76 ± 8.2) with a treatment-naïve eye subjected to topical anesthesia and injection of 40 mg/ml triamcinolone via a blunt tip SubTenon cannula through a single inferonasal peritomy. Best corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), biomicroscopic and funduscopic findings, and optical coherence tomography (OCT) measurements were recorded.Results: Baseline central macular thickness decreased from 431 ± 136 µm to 300 ± 67 µm (1st month; p = .002), to 292 ± 56 µm (3rd month; p = .002), and to 299 ± 66 µm (6th month; p = .005). Mean BCVA increased from 0.71 ± 0.23 to 0.27 ± 0.11, 0.19 ± 0.06, and 0.24 ± 0.17, respectively (all visits; p < 0.001). Mean IOP values did not change significantly (p = .12).Conclusion: PST injection is an effective and safe treatment for Irvine-Gass syndrome.