The difference in clinical characteristics between patients with rhegmatogenous retinal detachment during partial and complete lock-down periods related to COVID-19 pandemics 2-year long follow-up results.

BACKGROUND: We aimed to compare results of clinical presentation of rhegmatogenous retinal detachment (RRD), and the surgical approach during partial or complete lock-down periods (LP), and non-COVID periods in a tertiary ophthalmology clinic. METHODS: The medical data of the patients who were diagnosed with RRD in a tertiary hospital. The demographic data of patients, the duration from the beginning of the visual symptoms to hospital admission, the status of lens, the anatomical quadrant of retinal break, best-corrected visual acuity (BCVA) at presentation, the type of intraocular tamponade, and final BCVA were recorded. The exclusion criteria were RD other than rhegmatogenous (tractional or exudative), and incomplete follow-up until 2nd-year. RESULTS: The study included 20 eyes of 20 RRD cases in partial LP, 20 eyes of 20 RRD cases in complete LP, and 23 eyes of 23 RRD cases in non-COVID period. The ratio of perfluoropropane (C3F8) gas to silicone oil which was applied as intraocular tamponade at the end of the surgery for RRD was 15/8 in non-COVID period, 11/9 in partial LP, and 11/9 in complete LP (p = 0.730). In final visit at postoperative 2nd-year, the BCVA was logMAR 0.613 ± 0.425 in non-COVID period, logMAR 0.668 ± 0.348 in partial LP, and logMAR 0.730 ± 0.368 in complete LP (p = 0.612). In both inferior and superior quadrant RD, there was significant difference between baseline and final BCVA after surgery. (Baseline and final BCVA in inferior RD: logMAR 1.71 ± 0.40, and logMAR 0.950 ± 0.30 (p = 0.011) and, in superior RD: logMAR 1.35 ± 0.59, and logMAR 0.505 ± 0.321 (p = 0.0001), respectively.) CONCLUSIONS: As a result, it seems that both partial and complete LP did not modify the typology of RRD surgeries. TRIAL REGISTRATION: Retrospectively registered. The study followed the tenets of the Declaration of Helsinki, and it was approved by the local ethical committee (2023-088).

Posterior vitreous attachment as a risk factor for endophthalmitis following intravitreal antivascular endothelial growth factor injection.

PURPOSE: To evaluate the importance of the status of posterior vitreous in eyes with endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF). METHODS: The absence or existence of posterior vitreous detachment (PVD) was elicited in 23 eyes of 23 patients with injection related endophthalmitis, during pars plana vitrectomy (PPV) and compared with 24 control eyes of 24 patients who received intravitreal anti-VEGF without any complication. RESULTS: Thirtten (54.2%) out of 24 patients in the control group had full PVD, whereas only 2 (9.5%) out of 23 eyes in endophthalmitis group (p < 0.001) had full PVD. In all eyes without PVD, posterior vitreous was inducted to be detached at least from optic nerve and macular area without any iatrogenic tear. CONCLUSION: The absence of PVD is a factor that increases the risk of endophthalmitis after intravitreal injections. Uncomplicated separation of the posterior vitreous from the retina in PPV contributes to better prognosis.

PARS PLANA VITRECTOMY WITH AND WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR DIABETIC PATIENTS WITH MACULA INVOLVED TRACTIONAL RETINAL DETACHMENT.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on anatomical and functional results in pars plana vitrectomy performed eyes with tractional retinal detachment affecting the macula because of diabetes mellitus. METHODS: Patients without ILM peeling were considered as Group 1, and patients with ILM peeling were considered as Group 2. The main outcomes were the best-corrected visual acuity at 6 months and the rate of epiretinal membrane formation within 6 months. The rate and the indications for resurgery were determined. Parameters affecting the final best-corrected visual acuity were determined by regression analysis. RESULTS: Final best-corrected visual acuity was significantly better in eyes with ILM peeled off than in eyes with no peel-off ( P = 0.012). Less secondary epiretinal membrane was formed in Group 1 ( P = 0.009). There was no difference between groups in resurgery rates ( P = 0.143). The need for resurgery because of epiretinal membrane was higher in Group 1 rather than Group 2 ( P = 0.001). The only factor affecting the final best-corrected visual acuity was ILM peeling. CONCLUSION: In patients with tractional retinal detachment affecting the macula because of diabetes, ILM peeling in addition to pars plana vitrectomy and membrane excision does not affect the need for resurgery but contributes positively to anatomical and functional outcomes.

Comparision of Optical Low Coherence Reflectometry Versus Ultrasonic Biometry in High Hypermetropia.

PURPOSE: To compare anterior chamber depth (ACD), axial length (AL), and lens thickness (LT) measurements obtained by the Lenstar LS 900 (Haag-Streit AG) optical low-coherence reflectometry with those obtained by the A-scan contact ultrasound among patients with moderate and high hypermetropia. METHODS: Fifty-two eyes of 52 patients with moderate and high hypermetropia (spherical equivalent of +4 D or more) were examined in this study measurements of ACD, AL, and LT obtained by Lenstar were compared with those obtained by applanation A-scan ultrasound. All measurements were obtained by two independent examiners. The interdevice agreements were evaluated with Bland-Altman analyses. RESULTS: The mean age of the patients was 54.78±12.77 years (range 18-74 years). The mean spherical equivalent refractive power was +5.16±1.12 D (+4.0 to +8.75). The mean values of ACD, AL, and LT with A-scan were 3.05±0.34, 21.55±0.75, and 4.33±0.49 mm, respectively, whereas these values were 2.99±0.45, 21.58±0.78, and 4.20±0.44 mm, respectively, with Lenstar. There was statistically significant difference of LT between the two methods (P=0.02). The mean differences (lower/upper limit of agreement) of the ACD, AL, and LT values for A-scan ultrasound and Lenstar were -0.06 (-0.594/0.474), 0.04 (-0.380/0.459), and -0.12 (-0.739/0.502), respectively. CONCLUSION: Among patients with moderate and high hypermetropia, the biometric measurements of ACD, AL, and LT by ultrasound and optical biometry were determined to be correlated and there was a high degree of agreement between contact A-scan ultrasonic biometry and Lenstar.

Evaluation of the effect of daily activities on intraocular pressure in healthy people: is the 20 mmHg border safe?

PURPOSE: The aim of this prospective study was to evaluate the intraocular pressure (IOP) variations during daily activities such as reading, speaking and carrying in regard to investigating whether an elevation or decrease exists. SUBJECTS AND METHODS: Forty-four eyes of 44 healthy subjects were evaluated. The IOP was measured in relaxation and after reading, speaking and carrying a shopping bag for 5 min on different days, respectively. The subjects rested for 15 min between the activities. Mean initial IOP levels were compared with mean IOP levels after reading, speaking and carrying a shopping bag with paired t test. A p value of 0.05 was considered as statistically significant. RESULTS: We observed no changes in mean IOP after reading (p = 0.188). Mean IOP was increased after speaking and carrying compared with mean basic IOP (p = 0.001 and p = 0.001, very significant, respectively). The mean IOP began to decrease 15 min after speaking and carrying and came back to the baseline values one hour later. CONCLUSIONS: The IOP is not stable during daily activities. Simple actions such as carrying or speaking have an increasing effect on IOP. This should be taken into consideration in glaucoma patients during control measurements, especially in patients in whom the IOP was near to the 20 mmHg border.

Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.

PURPOSE: To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. MATERIALS AND METHODS: Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. RESULTS: Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. CONCLUSION: Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.

Chemokine CXCR-4 and cyclooxygenase-2 in the pathogenesis of pterygium

Background/aim: This study aimed to investigate the expression of chemokine receptor 4 (CXCR-4) and cyclooxygenase-2 (COX-2) in the epithelium and stroma of pterygium tissue in comparison with healthy conjunctiva. Materials and methods: The expression of CXCR4 and COX-2 was investigated by immunohistochemistry in the epithelium and stroma of the pterygium tissue of 29 eyes and compared with healthy conjunctival tissues. The correlation between CXCR4 and COX-2 expression as well as the correlation of these markers with the area of pterygium were evaluated statistically. Results: COX-2 staining scores were 1.75 ± 0.63 in the epithelium and 1.20 ± 0.62 in the stroma of the pterygium tissue. Mean CXCR-4 staining in the epithelium was 0.069 ± 0.37, whereas it was 5.0 ± 2.84 cells in the stroma. There was almost no staining of COX-2 and CXCR4 in the control samples. There was a strong positive correlation between the expression of CXCR-4 and COX-2 in the stroma of the pterygium. Conclusion: CXCR-4 and COX-2 may play important roles in the pathogenesis of pterygium.

The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage.

This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO) in infants treated with conservative management within the first year of age. Other purpose of the study is to emphasize the relationship between spontaneous resolution time and effective lacrimal sac massage. Thirty-one infants were diagnosed to have CNLDO by an ophthalmologist prior to 3 months of age. In this study, 36 eyes of 31 patients were included with CNLDO. The patients were divided into two groups. Group 1 (28 eyes of 24 patients) was consisted of the patients who were applied effective lacrimal sac massage regularly during the follow-up period, and patients whose parents did not apply a regular lacrimal passage regularly were accepted as group 2 (8 eyes of 7 patients). Thirty-three eyes of 31 patients (18 rights and 15 left) successfully resolved with only conservative management (91.6 %). In these thirty-three eyes, one eye (3 %) resolved between 0 and 3 months, fourteen eyes (42.5 %) resolved between 4 and 6 months, eleven eyes (33.3 %) resolved between 7 and 9 months, and seven eyes (21.2 %) resolved between 10 and 12 months. CNLDO was resolved in 27 (96.2 %) of 28 eyes in group 1, and in group 2, six eyes (77.7 %) had resolvement. This difference was statistically significant (p = 0.001). The mean age of resolution was 6.8 ± 1.88 months in group 1, 10.3 ± 1.5 months in group 2 (p < 0.001). In light of our study, we believe that conservative management of CNLDO is highly successful. Our study provided a possible objective explanation for the efficacy of lacrimal sac massage. Emphasizing the importance of the massage to parents and describing in detail can reduce the risk of unnecessary surgical interventions.

The effect of caffeine on choroidal thickness in young healthy subjects.

BACKGROUND: To investigate the effect of oral caffeine intake on choroidal thickness using optical coherence tomography (OCT). METHODS: Eighteen otherwise healthy caffeine users and 18 controls were enrolled. All participants underwent OCT scanning with high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 and 3 h following 200-mg oral caffeine intake in the study and after oral placebo in the control group. The measurements were taken in the morning (10-12 am) to avoid diurnal fluctuation. RESULTS: The median choroidal thickness at the fovea prior to oral caffeine intake was 337.00 (IQR 83.75) µm, which decreased to 311.00 (IQR 79.25) µm at 1 h and 311.00 (IQR 75.00) µm at 3 h following oral caffeine intake (p = 0.001, 0.002, respectively). The median choroidal thickness was also significantly decreased following oral caffeine intake at other five extrafoveal points (p < 0.05 for all). The difference in choroidal thickness was not statistically significant between 1 and 3 h of caffeine intake at all six points. In the control group, the median baseline choroidal thickness at the fovea was 330.00 (IQR 88.75) µm, which was 330.50 (IQR 80.75) µm at 1 h and 330.50 (IQR 90.75) µm at 3 h (p = 0.552, 0.704, respectively). CONCLUSIONS: Caffeine causes a significant decrease in choroidal thickness following oral intake. This decrease might be a result of reduced ocular blood flow due to its vasoconstrictive effect.

Choroidal thickness in relation to sex, age, refractive error, and axial length in healthy Turkish subjects.

The aim of this study was to investigate the association between choroidal thickness (CT) and sex, age, refractive error (RE), and axial length in healthy subjects. This is a study of 154 eyes in 154 healthy subjects. CT measurements were performed by the same experienced technician using a spectral domain optical coherence tomography device. CT was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at six more points which are located at, respectively, 500 µm nasal to the fovea, 1,000 µm nasal to the fovea, and 1,500 µm nasal to the fovea, 500 µm temporal to the fovea, 1,000 µm temporal to the fovea, and 1,500 µm temporal to the fovea. The RE was measured by autorefractometry, and the axial length was measured by interferometry. Statistical analysis was performed to evaluate CT at each location, and to the correlations of CT with sex, age, RE, and axial length. The mean subfoveal CT was 265.86 ± 60.32 µm, the mean age was 49.01 ± 19.19 years, the mean RE was -0.17 ± 1.20 diopters (D), and the mean axial length was 23.39 ± 0.76 mm. CT profile indicated that the choroid was thicker at the fovea than at temporal and nasal locations. Univariable linear regression analysis showed that subfoveal CT decreased 3.14 µm for each year of age and decreased 79.33 µm for each mm of axial length (P = 0.000, R(2) = 0.249; P = 0.000, R(2) = 0.487, respectively). In a similar analysis, subfoveal CT was found to decrease by 50.24 µm/D myopia-shifted change in refraction (P = 0.000, R (2) = 0.201). The subfoveal choroid was 99.16 µm (39.22 %) thicker in men than women when adjusting for age and axial length (P = 0.000, R(2) = 0.249). CT decreases with increasing myopia, age, and axial length. Men had thicker choroid than women, and CT varies depending on location.

Choroidal thickness changes in patients with pseudoexfoliation syndrome.

To evaluate the choroidal thickness using spectral-domain optical coherence tomography (OCT) in patients with pseudoexfoliation syndrome (PXS) and to compare them with healthy controls. This observational comparative study consisted of 35 PXS patients and 35 age- and sex-matched control cases. The control cases had neither systemic nor ocular disease. All 70 patients underwent a complete ophthalmic examination as well as choroidal thickness measurement using a high speed and high resolution SD-OCT device (Topcon 3D OCT-2000, Japan). There was no significant difference with respect to mean refractive error and intraocular pressure measurement between patients with PXS and controls (p = 0.237 and 0.433, respectively). The mean choroidal thickness was found as 206.6 ± 37.6 µm in the PXS group and 215.9 ± 47.3 µm in controls, respectively. The mean choroidal thickness was not significant between the PXS patients and the control cases (p = 0.362). Although PXS patients had lower mean choroidal thickness than controls, our results did not reach any statistical significance.

Evaluation of retinal and choroidal vascular structures in patients with anxiety disorder.

PURPOSE: To evaluate the retinal and choroidal vascular structures in patients with anxiety disorders. METHODS: Thirthy-four eyes of 34 patients who were diagnosed with any anxiety disorders were compared with 32 eyes of 32 age- and sex-matched controls. Central macular thickness (CMT), foveal vascular zone (FAZ) area, total retinal vascular densities of superficial and deep capillary plexus (VDSCP, VDDCP), outer retinal and choriocapillary layers (ORL, CCL) blood flow rates, central subfoveal choroidal thickness (SFCT) and choriodal vascularity index (CVI) were evaluated with optical coherence tomography angiography (OCT-A) and enhanced depth imaging optical coherence tomography (EDI-OCT). RESULTS: No statistical differences were found between the study and control groups in terms of CMT, FAZ area, VDSCP, VDDCP, ORL and CCL blood flow rates. The mean SFCT was 346.26 ± 64.26 µm in patients with anxiety disorder and was found to be statistically significantly thicker than the control group (319.56 ± 37.19 µm) (p = 0.042). Besides, CVI was significantly lower in the study group (71.09 ± 2.64 vs 73.13 ± 3.31, p = 0.008). CONCLUSION: In people with anxiety disorders, the SFCT was found to be thicker and CVI was found to be lower than normal subjects. Although anxiety and stress are important factors in central serous chorioretinopathy, multifactorial factors, including ocular factors, play a role in the pathophysiology of the disease. There is a need for prospective studies with larger series on the subject.

Evaluating the effectiveness of inflammatory markers in pediatric open globe injury using a modified pediatric ocular trauma score.

BACKGROUND: This study aims to assess pediatric patients with Open Globe Injury (OGI) using the Modified Pediatric Ocular Trauma Score (MPOTS) and to investigate the correlation between Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lympho-cyte ratio (PLR) parameters with the prognosis determined by MPOTS. METHODS: In this retrospective study, we included pediatric patients with OGI. Recorded data encompassed demographic details, injury type, duration from injury to surgery, complete ophthalmological examinations, initial and final visual acuities, anterior segment and fundus findings, and NLR and PLR values. Patients were categorized into three groups based on their MPOTS scores: Grade I (≤30 points), indicating high risk; Grade II (35-65 points), moderate risk; and Grade III (≥70 points), low risk. Differences between categories were statistically evaluated. RESULTS: The study comprised 22 patients. In Category I, the duration from injury to surgery was longer (p=0.018). The most common injury type in this category was globe rupture, occurring in four (50%) patients, with a significant difference noted between the groups (p=0.041). Category I exhibited lower final visual acuity and higher NLR and PLR values compared to the other categories (p<0.050 for all values). Both NLR and PLR demonstrated significant negative correlations with MPOTS (respectively, r=-0.869, p<0.001; r=-0.809, p<0.001). CONCLUSION: The Modified Pediatric Ocular Trauma Score is an effective and practical method for assessing the prognosis of pediatric patients with Open Globe Injury (OGI). Furthermore, there is evidence indicating a negative correlation between MPOTS and the increase in NLR and PLR values that often follows OGI in this patient population.

Long term outcomes of Yamane technique in various indications.

INTRODUCTION: To describe the clinical and refractive outcomes of Yamane transconjunctival sutureless intrascleral intraocular lens (SIS IOL) fixation technique in aphakic and dislocated IOLs. METHODS: The aphakic and IOL dispositioned patients who underwent Yamane surgery in Bozyaka Research and Training Hospital were evaluated retrospectively. The demographic data, preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), indication for surgery, additional surgical interventions, complications, the final status of retina, and central macular thickness (CMT) through spectral-domain optic coherence tomography (SD-OCT) were recorded. RESULTS: A total of 30 eyes of 30 patients were evaluated. The indication for surgery was aphakia in 24 patients, lens dislocation in 1 patient, and IOL dislocation in 5 patients. The mean age of participants was 64.17 ± 14.69 years, and the mean follow-up was 46.07 ± 7.96 months. The mean BCVA was improved from 0.25 ± 0.22 (-0.94 ± 0.83 log MAR) to 0.49 ± 0.24 in decimals (-0.37 ± 0.27 log MAR) (p:0.041). The mean subjective refraction improved from 10.06 ± 3.10 to -1.45 ± 0.73 D in the final visit (p < 0.05). The mean of cylindrical refraction was -1.22 ± 1.03 D in the postoperative period. At the time surgery, 36.6% of patients required at least one additional surgical procedure. During follow-up period, two (6.7%) out of 30 of patients had retinal detachment, two of the patients (6.7%) occured epiretinal membrane, one of the patients (3.3%) had cystoid macular edema. CONCLUSION: Yamane SIS IOL fixation technique is an effective and reliable surgical option in complicated cases that require additional surgical interventions in long-term follow-up.

Central corneal thickness, axial length, anterior chamber and optic disc structure in patients with central and branch retinal vein occlusion.

PURPOSE: To compare the central corneal thickness (CCT), the structural properties of the anterior chamber and optic disc in patients with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and controls. MATERIAL AND METHODS: In this prospective study, 31 eyes of 31 CRVO patients (group 1) (mean age: 65.7 ± 10.2 male/female:16/15), 42 eyes of 42 BRVO patients (group 2) (mean age: 61.5 ± 9.9, male/female: 21/21), and 41 controls (mean age: 61.2 ± 15.3, male/female:15/26) were enrolled. Intraocular pressure (IOP), corrected IOP (IOPcorr), central corneal thickness (CCT), anterior chamber depth & volume (ACD & ACV), iridocorneal angle (ICA), axial length (AL), retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, cup to disc ratio (C/D), cup & rim volume, the scleral canal diameter (SCD), and mean & pattern deviation in visual field of the eyes with CRVO/BRVO, their fellow eyes and control eyes were evaluated. RESULTS: There was no significant difference in IOP among groups (p:0.239), while IOPcorr was significantly higher in eyes with CRVO compared with eyes with BRVO (p:0.003). Central corneal thickness was significantly thinner in CRVO than both BRVO and controls (p:0.005, p:0.002 respectively). The difference in the RNFL thickness was significant among groups (p:0.019), and it was detected significant between CRVO eyes and controls (p:0.05). Anterior chamber volume was lower in eyes with BRVO than in normal eyes (p:0.009). There was no significant difference in AL, ACD, rim volume, cup volume, GCL thickness, C/D ratio, ICA, and PSD among groups. CONCLUSION: The patients with CRVO tend to have thinner corneas, and the evaluation of IOP and CCT can be overlooked during retinal follow-up. Intraocular pressure values corrected with CCT should always be take into account to prevent possible optic nerve damage.

A Comparative Evaluation of Globe Trauma Features in a Tertiary Care Hospital Before and During the COVID-19 Pandemic

Objectives: To compare the clinical features, preoperative evaluation, and surgical approaches of globe trauma patients presenting to the emergency department before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We retrospectively analyzed 54 eyes of 54 patients with traumatic globe perforation who underwent primary globe repair. The patients were divided into two groups according to the official start of the COVID-19 pandemic in Turkey: Group 1, 1 May 2019-11 March 2020 and Group 2, 11 March 2020-1 January 2021. The demographic features, trauma history, time from trauma to admission and from admission to surgery, COVID-19 serology (polymerase chain reaction [PCR]) result, ophthalmological examination findings at admission, surgical interventions, and postoperative clinical features were obtained from the patients' records. Results: The mean ages of the patients in Group 1 (n=21) and Group 2 (n=33) were 42.76±20.72 and 37.78±23.47 years, respectively (p=0.431). During the pandemic, garden/farm injuries increased while workplace injuries decreased. In Groups 1 and 2 respectively, time from trauma to admission was 461.4±1228.6 and 935.4±2039.6 min (p=0.342), time from admission to surgery was 604.2±679.8 and 392.7±306.9 min (p=0.125), and length of hospital stay was 7.23±4.96, and 3.78±2.28 days (p<0.005). All patients had a COVID-19 PCR test and all resulted negative. There was no significant difference between the groups in terms of the clinical features of the ocular and adnexal injuries, surgical interventions, or postoperative complications (p>0.05). Preoperative visual acuity was found to be an important prognostic factor associated with postoperative visual acuity. Conclusion: Globe injuries require urgent intervention in terms of visual morbidity. Patterns of injury differ during the pandemic due to both restrictions and lifestyle changes. During the pandemic, patients were discharged as soon as possible after emergency treatment to minimize the time spent in the hospital.

The prognostic role of optical coherence tomography in diabetic macular edema patients undergoing early dexamethasone implant shift.

PURPOSE: To determine the prognostic characteristics of optical coherence tomography (OCT) parameters by evaluating diabetic macular edema (DME) patients with early dexamethasone (DEX) shift after three doses of intravitreal ranibizumab (RNB) injection. METHODS: Fifty-four eyes of 34 patients who had DEX implant after three doses of RNB were included in this retrospective study. Early DEX shift includes patients who received direct DEX implant replacement after three doses of RNB load. Baseline OCT values and factors affecting best corrected visual acuity (BCVA) and central macular thickness (CMT) response were analyzed with logistic regression analyses. RESULTS: The presence of subretinal fluid and hyperreflective spot (HRS) >20 were found to be a negative predictive factor for anatomical response. (p = 0.009, p = 0.001, respectively) Low initial BCVA creates a positive effect on visual gain.( p = 0.041) Giant outer nuclear layer cysts, completely disrupted inner segment-outer segment and HRS > 20 have a negative effect on visual gain. (p = 0.025, p = 0.043, p = 0.023, respectively) According to the receiver operating characteristic analysis, the subretinal fluid volume threshold at which >20% reduction in CMT occurs was determined to be 0.85 mm3. (sensitivity 70%, specificity 84% area under the curve 0.817, p = 0.021). CONCLUSION: The presence of high number of HRS and high subretinal fluid volume at the baseline negatively affect prognosis even in patient groups with early DEX shift.

Predictive value of the characteristics of intraretinal cystoid spaces on early response to antivascular endothelial growth factor treatment in patients with cystoid diabetic macular edema.

PURPOSE: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. METHODS: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. RESULTS: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). CONCLUSION: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.

Relief of Cystoid Macular Edema-Induced Focal Axonal Compression with Anti-Vascular Endothelial Growth Factor Treatment.

Purpose: To evaluate the mechanical compression of retinal nerve fiber layer (RNFL) by intraretinal cysts in macular edema and its relief with anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: Optical coherence tomography scans were used to measure RNFL thickness and reflectance at seven preselected points at and around the peak of the edema before and after anti-VEGF treatment in 10 patients (11 eyes) with branch retina vein occlusion (BRVO) and diabetic macular edema (DME). Scans through nonedematous retina and from the fellow eyes were taken as controls. Correlations were sought between the changes in retinal and RNFL thickness, RNFL reflectance, and the size of the intraretinal cysts. Results: Postinjection RNFL thickness decreased significantly only at peak point of the edema (18.1 ± 2.7 vs. 13.8 ± 1.2 µm; P = 0.038), at its nasal edge (20.1 ± 2.7 vs. 15.5 ± 1.4 µm; P = 0.026), and 500 µm away from its nasal border (35.7 ± 6.0 vs. 20.1 ± 2.7 µm; P = 0.006) suggesting focal stagnation of the axoplasmic flow owing to compression at its peak point. Significant postinjection decreases in RNFL reflectivity were also noted at peak point of the cyst (164.9 ± 10.3 vs. 141.5 ± 12.6 arbitrary units [AU]; P = 0.037), at its nasal edge (166.8 ± 7.8 vs. 135.1 ± 10.2 AU; P = 0.02), and 1500 µm away from temporal edge (160.2 ± 6.2 vs. 141.1 ± 6.4 AU; P = 0.022). Cyst proximity to RNFL (D50 = 50 µm) was the only determinant significantly affecting the magnitude of the RNFL thickness change after anti-VEGF treatment (P = 0.001). Conclusions: Intraretinal cysts due to BRVO and DME locally compress overlying axons and induce anatomic changes suggestive of axoplasmic stagnation. This compression can be relieved with anti-VEGF treatment. Translational Relevance: Focal compression of RFNL by retinal cysts may indicate a need for early treatment of macular edema to prevent axonal loss, especially in patients with low axonal reserve.

Acute vitreomacular traction syndrome after uneventful phacoemulsification.

We prospectively evaluated 59 eyes following uneventful phacoemulsification and intraocular lens implantation with optic coherence tomography at one and seven postoperative days (POD). Acute vitreomacular traction was observed in two eyes (3.3%) at the first POD. Spontaneous resolution occurred in both eyes within one week. The temporary visual loss associated with acute vitreomacular traction syndrome may go unnoticed as visual acuity rapidly improves.