Effectiveness of selective laser trabeculoplasty and its safety on corneal endothelium in patients with primary open angle glaucoma and ocular hypertension.

Background and Aim: The aim of this study was to evaluate the effectiveness of selective laser trabeculoplasty (SLT) in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT), and to assess its effects and safety on corneal endothelial cell morphology. Patients and Methods: Forty patients with POAG (15 cases, 23 eyes) and OHT (25 cases, 48 eyes) were prospectively evaluated. All cases underwent pachymetry, goniolens examination, Humphrey Visual Field Test, Optical Coherence Tomography, and Corneal Confocal Microscopy measurements. Patients whose intraocular pressure (IOP) was more than 21 mmHg in POAG and OHT, underwent SLT. SLT treatment was applied to the inferior 180° region of the trabecular meshwork. Central corneal thickness (CCT), IOP, and specular microscopy examinations were taken at the visits before and after the first day, first week, first month, third and sixth months of the SLT procedure. Retinal nerve fiber layer (RNFL) thickness measurements and visual field tests were performed before and six month post-SLT. Results of the pre-SLT and post-SLT measurements were compared and a P value of lower than 0.05 was considered statistically significant. Results: The results of IOP measurements at first week, first month, third, and sixth month post-SLT were significantly lower than the results before and post-SLT first day. No significant difference was found between the results of initial and final measurements of CCT and specular microscopic corneal endothelial cell morphology evaluation. There was no statistically significant difference between the results of initial and final measurements for RNFL thickness and the results of the visual field tests. Conclusion: SLT is an effective treatment modality for reducing IOP in patients with POAG and OHT and is also a safe procedure in terms of the entirety of corneal endothelial cell morphology.

Analysis of the Peripapillary Choroidal Vascular Characteristics in Papilledema Associated with Pseudotumor Cerebri.

SIGNIFICANCE: Choroidal vascularity index measured by image binarization method from peripapillary optical coherence tomography sections has been found significantly lower in papilledema patients than healthy controls. PURPOSE: The purpose of this study was to compare peripapillary choroidal parameters in papilledema patients with control subjects. METHODS: Peripapillary spectral domain optical coherence tomography scans of 34 patients with papilledema and 34 healthy controls are acquired for the study. Images are binarized with the ImageJ software (National Institutes of Health, Bethesda, MD) to calculate total choroidal area, stromal area, luminal area, and choroidal vascularity index. RESULTS: Total choroidal area, luminal area, and choroidal vascularity were significantly lower in papilledema patients compared with healthy controls on right (1.343 ± 0.286 vs. 1.694 ± 0.344, P < .001; 0.880 ± 0.209 vs. 1.167 ± 0.255, P < .001; 65.28 ± 2.99% vs. 68.68 ± 2.81%, P < .001, respectively) and left eyes (1.376 ± 0.308 vs. 1.647 ± 0.339, P < .001; 0.899 ± 0.231 vs. 1.134 ± 0.237, P < .001; 64.92 ± 3.44 vs. 68.84 ± 3.23, P < .001, respectively). No difference was found between active and remitted stages of papilledema in terms of choroidal parameters. CONCLUSIONS: Peripapillary total choroidal area, luminal area, and choroidal vascularity index are significantly reduced in patients with papilledema. These parameters might be beneficial tools for evaluating choroidal vascularity in papilledema quantitatively and differential diagnosis for optic disc edema.

The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema.

OBJECTIVE: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema. MATERIALS AND METHODS: A total of 60 eyes from 60 consecutive patients who received 0.5 mg/0.05 ml IVIs of bevacizumab (n = 30, IVB group) or 1.25 mg/0.05 ml ranibizumab (n = 30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared. RESULTS: The groups were matched for age (p = 0.11) and gender (p = 0.32). There was no significant difference in endothelial cell count (IVB group, p = 0.66; IVR group, p = 0.74), pleomorphism (IVB group, p = 0.44; IVR group, p = 0.88) and polymegathism (IVB group, p = 0.21; IVR group, p = 0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p = 0.15; IVR group, p = 0.58) before injection or 1 month after the first and third injections. CONCLUSION: Monthly 1.25 mg/0.05 ml IVIs of bevacizumab or 0.5 mg/0.05 ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.

Evaluation of Choroidal Thickness in Non-arteritic Anterior Ischaemic Optic Neuropathy at the Acute and Chronic Stages.

The objective of this study was to evaluate the measurements of choroidal thickness (CT) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION) at the acute and chronic stages. This case-control study compares three groups: Group 1 included 23 eyes of 23 patients with chronic NAION, Group 2 consisted of 24 eyes of 24 patients with acute NAION, and Group 3 included 24 eyes of 24 age-matched control subjects. The average CTs for Group 1, Group 2, and Group 3 were 261.24 ± 50.04, 280.05 ± 74.94, and 254.74 ± 50.11 µm, respectively. For all measurements, no statistical significance was found between the groups (p = 0.319, 0.357, 0.680, and 0.178 for the CTs as average, foveal, superior, and inferior, respectively). Similarly, there was no difference between the CT measurements of the affected and unaffected eyes in Group 1 and Group 2 (p = 0.571, 0.741 for average, respectively). The amount of time after the onset of the disease ranged from 6.0 to 48 months (23.86 ± 16.70 months) in Group 1 and from 1 to 30 days (7.45 ± 8.86 days) in Group 2. There was no correlation between the CTs and follow-up times in Group 1 (p = 0.768 for average) and no association between the CTs and the thicknesses of the retinal nerve fibre layers in Group 2 (p = 0.453 for average). CT is not directly influenced by NAION at either the acute or the chronic stage of the disease. These results may also demonstrate that the changes of CT do not increase the risk of experiencing a NAION attack.

Effect of religious fasting on tear osmolarity and ocular surface.

OBJECTIVE: To evaluate the effects of religious fasting on tear secretion, tear osmolarity, corneal topography, and ocular aberrations. METHODS: This prospective controlled study comprised 29 eyes of 29 healthy men. Before ophthalmologic examination, all subjects underwent corneal topography by a placido disc corneal topography and aberrometry device (OPD Scan II). Tear osmolarity was measured using OcuSense TearLab osmometer. Ocular surface disease index (OSDI) scores, tear break-up time (BUT), Schirmer I test, and lissamine green staining were evaluated. The measurements taken before and during Ramadan at the same hours between 4.00 and 5.00 PM were compared using paired sample t test, and a P value less than 0.05 was accepted as statistically significant. RESULTS: The mean age of the study group was 27.8 ± 5.9 years (range, 20-47 years). The mean tear osmolarity values were measured as 285.6 ± 8.2 mOsm/L and 293.3 ± 16.0 mOsm/L, whereas the mean Schirmer I values were 14.8 ± 6.0 mm and 10.6 ± 5.3 mm in nonfasting and fasting periods, respectively. Tear osmolarity, OSDI, and Oxford grading scores significantly increased (P=0.02, P=0.002, P=0.003, respectively), whereas Schirmer I values and intraocular pressure decreased (both, P<0.001) during the fasting period compared with the nonfasting period. There were no significant differences in tear BUT, keratometry values, and corneal aberration measurements between nonfasting and fasting periods (P>0.05, for all). CONCLUSION: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.

The effect of room illumination on the measurement of anterior segment parameters.

OBJECTIVE: To evaluate the effect of room illumination on the measurement of anterior segment parameters. METHODS: In this comparative study, measurements of anterior segment parameters of 25 eyes of 25 healthy patients were performed by optical low-coherence reflectometry (OLCR). Measurements were taken under photopic conditions (150 lux) and under mesopic conditions (3 lux). Paired t test by SPSS 16.0 was used to compare the anterior segment measurements performed in both conditions. A P value lower than 0.05 was accepted as statistically significant. RESULTS: The mean age of the patients was 27.09±1.72 years (range, 20-40 years). Of the anterior segment parameters, axial length and keratometry did not show significant difference between photopic and mesopic conditions (P=0.541 and P=0.812, respectively). The mean anterior chamber depth measurements was 3.04±0.35 mm and 3.06±0.35 mm, whereas the mean lens thickness was 3.75±0.36 mm and 3.77±0.36 mm in the mesopic and photopic conditions, respectively. The mean pupil diameter measurement was 4.86±0.70 mm under photopic conditions and 6.36±0.94 mm under mesopic conditions. The anterior chamber depth, lens thickness, and pupil diameter showed significant difference between photopic and mesopic conditions (P=0.01, P=0.006, and P=0.0001, respectively). CONCLUSION: Anterior chamber depth, lens thickness, and pupil diameter were affected by the changes in luminance while performing measurements with OLCR. Considering the age of the study group, further studies are needed to test the measurement of accommodation amplitude.

Extensive bone formation in a painful blind eye.

Osseous metaplasia may occur in phthisis bulbi, usually caused by long-standing retinal detachment, ocular trauma, or inflammation. However, extensive intraocular bone formation is a rare phenomenon. We report a case with long-standing phthisis bulbi demonstrating subretinal extensive bone formation. Results of histopathologic examination revealed extensive bone formation overlying the choroid with accompanying bone marrow without hematopoiesis.

Assessment of ocular neurotoxicity in patients treated with systemic cancer chemotherapeutics.

PURPOSE: Cisplatin and Paclitaxel are two chemotherapeutic agents known to produce neurotoxicity when used for cumulative dose regimens. In this study we aim to assess their toxicity in the optic nerve, and to evaluate the retinal nerve fibre layer (RNFL) thickness and visual field changes in lung cancer patients treated with Cisplatin and Paclitaxel. METHODS: Fifteen patients who were treated intravenously with 75 mg/m(2) cisplatin and 175 mg/m(2) paclitaxel every 3 weeks, up to a maximum of six courses, were enrolled in this prospective clinical trial. All patients underwent complete ophthalmological assessments before their treatments began, as well as three months after the completion of their treatments. The RNFL thickness measurements were performed using optical coherence tomography (OCT). Functional testing included the use of frequency-doubling technology (FDT) perimetry and the Humphrey visual field analyser (HFA). The main outcome measurements included the average RNFL thicknesses and visual field indices (mean deviation [MD] and pattern standard deviation [PSD]). RESULTS: The median age of the 15 patients (nine male and six female) was 63.49 years old (range: 53-77). The average RNFL thickness measurement during the baseline examination was 103.73 µm (range: 97-111). Three months after the cessation of treatment the RNFL thickness declined to 97.4 µm (range: 91-102). Statistical analysis showed a significant thinning between the two measurements (p = 0.032). The MD and PSD values recorded by the HFA demonstrated no statistically significant changes 3 months after the cessation of treatment (p > 0.207 and p > 0.186, respectively). There were statistically significant decreases in both the MD (0.48 to -1.13 dB) and PSD (2.13 to 0.65 dB) indices measured by the FDT perimetry (p = 0.041 and p = 0.025, respectively). CONCLUSIONS: In our study, the systemic administration of Cisplatin and Paclitaxel affected the peripapillary RNFL thicknesses and visual field indices as revealed by FDT perimetry. OCT and FDT perimetry may be adjunctive tools for the screening of ocular toxicity in patients treated with these agents.

Ocular effects of pegylated interferon-α in patients with chronic hepatitis B.

PURPOSE: To evaluate the early retinal changes and its reflection on the visual field examination in chronic hepatitis B (CHB) patients using pegylated interferon-α (PEGIFN-α) monotherapy. PATIENTS AND METHODS: Thirty eyes of fifteen patients with CHB were examined prospectively for changes in the fundus examination and visual field examination (both Humphrey Perimetry and Frequency Doubling Perimetry). The patients were examined before and in 3 months intervals after starting the PEGIFN-α treatment. The changes in the fundus examination were noted and the visual field examinations, retinal nerve fiber thickness, Schirmer scores and color vision before and at 3 months of the treatment were compared. The statistical evaluation was performed with paired-t test, using SPSS 16.0 Inc. (Chicago, IL). RESULTS: The mean age of the 15 patients (seven male, eight female) was 52.5 ± 12.4 years. There was no significant retinal change in none of the patients. Neither the visual field examination with Humphrey Field Analyzer nor the Frequency Doubling Perimetry results has demonstrated any significant change during 3 months follow-up. There was a statistically significant increase in the retinal nerve fiber layer (RNFL) thickness; while Schirmer test scores for dry eye assessment was significantly decreased. CONCLUSION: PEGIFN-α monotherapy, which is used for treatment of CHB, may cause some changes in the thickness of RNFL that may necessitate the close follow-up for further morphological changes of the optic disc in these patients.

Structural and Functional Assessment in Patients Treated with Systemic Isotretinoin Using Optical Coherence Tomography and Frequency-Doubling Technology Perimetry.

A causal association between central nervous system neuropathy and oral isotretinoin has been reported. In this study we aimed to assess retinal nerve fibre layer (RNFL) thickness and visual field changes in patients treated with systemic isotretinoin. Thirty-nine patients treated with 1 mg/kg daily oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent complete ophthalmologic assessment before treatment, on day 60, and 3 months after completion of treatment. RNFL thickness measurements were performed with Stratus optical coherence tomography. Functional testing included frequency-doubling technology perimetry and Humphrey field analyser. Main outcome measures were average RNFL thicknesses and visual field indices (mean deviation, pattern standard deviation). Measurements of RNFL thickness showed no statistically significant change between the three measurements (p = 0.180). No statistically significant differences were observed in the frequency-doubling technology indices (mean deviation and pattern standard deviation, p = 0.066 and p = 0.103, respectively) and in the Humphrey field analyser indices (mean deviation and pattern standard deviation, p = 0.091 and p = 0.087, respectively) at day 60 of treatment or 3 months after the cessation of treatment. In this study of 39 patients, systemic use of isotretinoin (1 mg/kg daily) does not cause a statistically significant change in peripapillary RNFL thickness or visual field findings within the usage period, and within 3 months after cessation.

Giant ethmoido-orbital osteoma presenting with dacryocystitis and metamorphopsia.

Osteoma is the most common benign neoplasm of the paranasal sinuses. Intraorbital extension is rare. Here we report a 16-year-old adolescent boy who presented with epiphora and pain in the medial canthal area. A computed tomographic scan revealed a bone density mass in the left ethmoid cavity extending into the adjacent orbit. The tumor was removed via endoscopic endonasal surgery. The pathologic evaluation was consistent with osteoma. After surgery, all complaints have been resolved and there was not any sign of recurrence in the computed tomographic scan.

Scleral perforation complicating titanium mesh plaque in orbital blowout fracture.

A 27-year-old man who underwent a previous reconstruction surgery for left orbital blowout fracture and recent revision surgery for left cicatricial ectropion was admitted to the ophthalmology outpatient clinic with a 20-mm irregular conjunctival and scleral incision in the left eye at the 6-o'clock position. The scleral and conjunctival incisions were repaired, and during the operation, the anterior end of the titanium mesh plate was visible at the inferior orbital rim. The plastic surgery team removed the irritating end of the plate. Obvious adherence of periocular tissues onto the titanium implant and fibrovascular ingrowth through the implant were seen during this operation. The possible mechanism for the misdirection of the anterior end of the implant might be explained by iatrogenic rotation during the revision of the cicatricial ectropion. To the best of our knowledge, this is the first reported case demonstrating scleral incision caused by an orbital titanium implant.

The Effects of Space Radiation and Microgravity on Ocular Structures

Long-term exposure to microgravity and space radiation leads to physiological and pathological changes in human biology. Pathological neuro-ocular changes are collected under the name spaceflight-associated neuro-ocular syndrome. This review examines studies on the effects of microgravity and space radiation on the ocular structures and their results. In addition, we discuss treatment methods and hypotheses to reduce the effects of microgravity and space radiation on biological structures.

Short-Term Clinical Results of Preferred Retinal Locus Training

Objectives: This study evaluated acoustic biofeedback training using microperimetry in patients with foveal scars and an eligible retinal locus for better fixation. Materials and Methods: A total of 29 eligible patients were enrolled in the study. The acoustic biofeedback training module in the MAIA (Macular Integrity Assessment, CenterVue®, Italy) microperimeter was used for training. To determine the treatment efficacy, the following variables were compared before and after testing: best corrected visual acuity (BCVA); MAIA microperimeter full threshold 4-2 test parameters of average threshold value, fixation parameters P1 and P2, and bivariate contour ellipse area (BCEA) for 63% and 95% of fixation points; contrast sensitivity (CSV 1000E Contrast Sensitivity Test); reading speed using the Minnesota Low-Vision Reading Test (MNREAD reading chart); and quality of life (NEI-VFQ-25). In addition, fixation stability parameters were recorded during each session. Results: The study group consisted of 29 patients with a mean age of 68.72±8.34 years. Median BCVA was initially 0.8 (0.2-1.6) logMAR and was 0.8 (0.1-1.6) logMAR after 8 weeks of preferred retinal locus training (p=0.003). The fixation stability parameter P1 improved from a mean of 21.28±3.08% to 32.69±3.69% (p=0.001) while mean P2 improved from 52.79±4.53% to 68.31±3.89% (p=0.001). Mean BCEA 63% decreased from 16.11±2.27°2 to 13.34±2.26°2 (p=0.127) and mean BCEA 95% decreased from 45.87±6.72°2 to 40.01±6.78°2 (p=0.247) after training. Binocular reading speed was 38.28±6.25 words per minute (wpm) before training and 45.34±7.35 wpm after training (p<0.001). Statistically significant improvement was observed in contrast sensitivity and quality of life questionnaire scores after training. Conclusion: Beginning with the fifth session, biofeedback training for a new trained retinal locus improved average sensitivity, fixation stability, reading speed, contrast sensitivity, and quality of life in patients with macular scarring.

Evaluation of the choroidal thickness and retinal nerve fiber layer and visual fields in morbid obesity: Does bariatric surgery affect retinal structure and function?

Purpose: The study aimed to investigate the changes in choroidal thickness (CT), retinal nerve fiber layer thickness (RNFL), and visual field parameters in morbidly obese patients following bariatric surgery. Methods: The study included 40 morbidly obese patients with body mass indexes (BMI) ≥40 who had undergone bariatric surgery (Group 1) and 40 age-and sex-matched healthy subjects with normal BMI values (Group 2). RNFL and CT measurements by optical coherence tomography (OCT) and visual field test were performed preoperatively and the 1st, 6th, and 12th months postoperatively. CT measurements were obtained from the subfoveal, nasal (N), and temporal (T) regions at distances of 500 µm and 1,000 µm from the fovea. Results: No significant pathology was detected during ophthalmological examinations following bariatric surgery. The BMIs were found to be significantly lower in all of the periods after bariatric surgery (P < 0.0001). The CT measurements decreased significantly in all periods after bariatric surgery (P < 0.0001). No differences were found in terms of the mean RNFL thicknesses in all postoperative periods (P = 0.125). Visual field tests showed no significant changes during scheduled visits. (P = 0.877). No visual field defect was detected in any patient during the follow-up periods after bariatric surgery. Conclusion: These results have suggested that CT is positively correlated with BMI and decreased with a reduction in BMI progressively. Nutritional disorders resulting from malabsorption have not caused any nutritional optic neuropathy and visual field defect for at least the first postoperative year after bariatric surgery.

Clinical factors associated with floppy iris signs: a prospective study from two centers.

BACKGROUND AND OBJECTIVE: To evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, and alpha-1 adrenergic blocker (A1AB) use. PATIENTS AND METHODS: Five hundred patients were included in this prospective study. Intraoperative adverse events, such as pupillary constriction, iris billowing, and iris prolapse from the wound, were noted. Multinomial regression analysis was used to evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, pupil diameter, and A1AB use. RESULTS: Pupil constriction was significantly associated with pseudoexfoliation (P < .001). Diabetes mellitus was associated with pupil constriction and iris billowing (P = .005 and .003, respectively). Hypertension was associated with pupil constriction (P = .021). Intraoperative floppy iris syndrome was strongly associated with A1AB use and male gender (P < .001 and .039, respectively). CONCLUSION: Intraoperative floppy iris syndrome was observed in 2.8% of patients and was strongly related to A1AB use, particularly in smaller pupil diameters. Pseudoexfoliation, diabetes mellitus, and hypertension were not associated with intraoperative floppy iris syndrome.

Efficiency of Rarebit perimetry in the evaluation of homonymous hemianopia in stroke patients.

AIMS: To compare the efficiency of Rarebit perimetry and the Humphrey field analyser (HFA) in detecting the homonymous hemianopia in stroke patients with occipital lobe infarcts. METHODS: 40 patients who suffered from visual complaints caused by acute occipital lobe infarcts underwent visual field analysis on the same day, in random order-first with either Humphrey perimetry 30-2, SITA standard program (Zeiss Humphrey Systems) or Rarebit perimetry. A visual field was classified into four quadrants for right and left eyes: superior temporal, superior nasal, inferior temporal, and inferior nasal. The entire mean hit rate numbers (MHR) and mean deviation and pattern standard deviation (PSD) values were compared for each quadrant of each eye. RESULTS: The results of Rarebit MHR and HFA mean deviation values for each quadrant of the right and left eyes were highly correlated in all patients with homonymous hemianopia (Pearson's r correlation coefficients for superior temporal, superior nasal, inferior temporal and inferior nasal quadrants of right and left eyes were 0.827, 0.833, 0.843, 0851 and 0.746, 0821, 0882, 0.824, respectively (p<0.001 for all quadrants)). There was a strong correlation between Rarebit MHR and HFA PSD for each quadrant of both eyes. CONCLUSIONS: Rarebit perimetry is rapid, reliable, and easily performed in patients with homonymous hemianopia. It can be done using a simple software program and simple hardware and it readily detects severe visual loss in patients with occipital lobe lesions.

Retinal arterial macroaneurysm rupture following fundus fluorescein angiography and treatment with Nd:YAG laser membranectomy.

A 60-year-old woman with hypertension was seen for a routine examination. Her best-corrected visual acuity was 20/20 bilaterally. Intraretinal hemorrhages were found in the parafoveal region of the right eye. A fundus fluorescein angiography evaluation identified the hemorrhages as arterial macroaneurysms. The following day, the patient returned complaining of blurred vision that had developed the previous evening. Best-corrected visual acuity was counting fingers in the right eye. A subhyaloid hemorrhage approximately three optic disks in size was found in the macular region. The hemorrhage was drained with an Nd:YAG laser.