Examination of the Corneal Endothelium in Pediatric Patients With COVID-19.

PURPOSE: To investigate the effects of coronavirus disease 2019 (COVID-19) infection on the corneal endothelium in children. METHODS: This retrospective study included 46 pediatric patients with COVID-19 infection and 38 healthy controls. Specular microscopy measurements were analyzed, and measurements were obtained from images showing at least 100 cells with clear borders. Mean endothelial cell density, mean hexagonal cell percentage (HEX), mean coefficient of variation (CV), central corneal thickness, and mean cell area were evaluated. RESULTS: Specular microscopy data showed that the CV values were 2.442±6.517 in the healthy control group (HCG) and 2.659±5.119 in the COVID-19-affected group (CAG) ( P =0.003). The hexagonality of the HCG and CAG were 6.916±8.271 and 6.683±5.885, respectively ( P =0.011). CONCLUSION: A decrease in the HEX and an increase in the CV were observed in the corneal specular microscopic examination of children with COVID-19 infection. These results are important in demonstrating the corneal effects of COVID-19 infection in children.

Effect of Irrigation Solution Temperature on the Corneal Endothelial Functions in Posterior Vitrectomy: Room Temperature Versus Cooled.

PURPOSE: To compare the effects of cooled and room temperature irrigation on the preoperative and early postoperative corneal endothelial parameter values in posterior vitrectomy. MATERIALS AND METHODS: In this prospective, randomized, comparative study, 68 patients underwent a standard 3-port, 23-G posterior vitrectomy operation by a single surgeon. Cooled irrigation solution was applied to 36 patients during surgery (group 1), and room temperature irrigation solution was applied to 32 patients (group 2). The patients were also divided into four groups according to their history of noncomplicated cataract surgery (phakic or pseudophakic) and the types of tamponade used (silicone or gas). The central corneal thickness (CCT), endothelial cell density (ECD), mean cell area (MCA), hexagonal cell percent, and coefficient of variation of cell area (CV) parameter values of the groups at preoperative and postoperative 1 month were compared. RESULTS: There were no statistically significant differences between the preoperative and postoperative corneal parameter values in groups 1 and 2 ( P >0.05). However, it was remarkable that the percentage of preoperative-postoperative change in all the corneal parameter values was higher in group 2. When the results of the subgroup analyses of the patients who were pseudophakic and used gas tamponade (Group D) in group 2 were examined, it was determined that the negative effects were significantly higher in the postoperative values for the ECD, MCA, CV, and CCT parameters compared with the preoperative values ( P <0.05). CONCLUSION: In patients with pseudophakia and gas tamponade, cooled irrigation was found to be more advantageous for corneal parameters.

Ocular findings and their correlation with disease severity in Fabry disease in South-East Anatolia.

PURPOSE: To evaluate the ocular findings and the relationship between these findings and the disease severity of patients with Fabry disease (FD) in South-East Anatolia. METHODS: We enrolled the 24 eyes of 24 patients with FD and the disease severity scores were obtained with FD severity scoring system (DS3). The relationship between the presence of any ocular findings and DS3 scores was evaluated. RESULTS: The mean age of the patients was 35.2 ± 8.6 years. The mean DS3 score and α-galactosidase A enzyme activity of the patients was 7.04 ± 3.71 and 1.93 ± 0.84 µmol/l/h, respectively. Of the 24 patients, 20 (83.3%) had cornea verticillate (CV), 18 (75%) had tortuous conjunctival vessels, 15 (62.5%) had tortuous retinal vessels and 3 (12.5%) had lens opacities. The ocular vascular abnormalities were associated with disease severity (p < 0.05); however, the presence of CV did not affect the DS3 scores (p > 0.05). CONCLUSIONS: According to our study, the patients with ocular vascular abnormalities associated with FD had more severe disease than those who did not have an abnormality. CV was the most common ocular finding in FD, but it has no association with disease severity.

Challenges in pediatric cataract surgery: comparison of intraocular lens power calculation formulas using optical biometry.

PURPOSE: Comparison of the accuracy of intraocular lens (IOL) power calculation formulas (SRK II, SRK/T, Holladay 1, Hoffer Q and Barrett II Universal, Haigis) in pediatric cataract surgery using optical biometry. METHOD: This prospective study included seventy eyes of 70 patients between ages of 3-15 who had undergone cataract surgery with IOL implantation. Anterior segment parameters and axial length (AL) were measured with an optical biometer. Barrett II Universal formula results were used to determine the diopter of implanted IOL. Postoperative refraction was taken at first month, and differences from the estimated refractive value [mean absolute predictive error (APE)] were compared between formulas. Formulas were also compared according to AL. RESULTS: The lowest APE was achieved with Barrett II formula (0.64 ± 0.73D) and the highest with Haigis formula (1.06 ± 0.84D) in the whole study population (p < 0.01). APE values were lowest with Holladay 1 (0.79 ± 0.71D) and highest with Haigis (1.44 ± 0.92D) in patients with an AL ≤ 22 mm; lowest APE was achieved with Barrett II (0.47 ± 0.54D) and highest with Haigis (0.84 ± 0.72D) in patients with an AL > 22 mm. CONCLUSION: Barrett II formula had the best results in eyes with average AL, and SRK/T and Holladay 1 formulas were better in eyes with shorter AL. Haigis formula statistically had the highest predictive error in all formulas.

Outcomes of customized topographic guided epithelial debridement for corneal collagen cross-linking.

PURPOSE: To evaluate the outcomes of corneal collagen cross-linking performed with customized epithelial debridement technique in progressive keratoconic corneas. MATERIALS AND METHODS: Forty eyes of 40 patients were included in the study. We performed an ophthalmologic examination and recorded the uncorrected visual acuity, best corrected visual acuity (BCVA), central corneal thickness at the thinnest point (t-CCT), flat meridian keratometry (K1), steep meridian keratometry (K2), endothelial cell density (ECC), hexagonal cells (HEX), and coefficient of variation of cell areas (CV) measured preoperatively and at the 1st, 3rd, 6th and 12th months postoperatively. RESULTS: The mean UCVA and BCVA were increased (p < 0.05). The mean flattest and steepest K readings were decreased (p < 0.05). The mean t-CCT decreased in the first months after treatment and increased after 6 months. The mean t-CCT was thicker at 12 months compared to pretreatment status (p < 0.05). The mean ECC and CV were not significantly different between follow-up intervals (p > 0.05). The mean HEX was statistically increased (p > 0.05). CONCLUSIONS: Corneal collagen cross-linking performed with customized epithelial debridement technique is a successful alternative method for stopping the progression of keratoconus after 12 months of treatment.

Comparison of Bevacizumab and Ranibizumab in the Treatment of Type 1 Retinopathy of Prematurity Affecting Zone 1.

PURPOSE: To investigate the effects of bevacizumab and ranibizumab in the treatment of type 1 retinopathy of prematurity (ROP) affecting zone 1. METHODS: Files of the patients who received intravitreal bevacizumab (IVB) or ranibizumab (IVR) treatment for ROP affecting zone 1 were evaluated retrospectively. Spherical equivalent (SE) and axial length (AXL) measurements were performed at 1 year of adjusted age. RESULTS: Sixty-eight eyes of 37 patients were included in the study. All patients had initial disease regression but 6 patients (4 in the IVB, 2 in the IVR group) showed reactivation (p = 0.679). The number of eyes with incomplete vascularization were 15 and 12 in the IVB and IVR groups, respectively (p = 0.725). Mean AXL was 20.50 ± 0.99 mm in the IVB group and 19.30 ± 0.48 mm in the IVR group (p < 0.001). Mean SE was -1.49 ± 2.38 dpt in the IVB group and 0.98 ± 2.18 dpt in the IVR group (p < 0.001). CONCLUSION: Bevacizumab and ranibizumab showed similar effectiveness in the treatment of type 1 ROP affecting zone 1. The AXL was longer and SE was more myopic in eyes treated with IVB. This difference might be caused by the longer intravitreal half-life of bevacizumab than ranibizumab.

Personalized medicine beyond genomics: alternative futures in big data-proteomics, environtome and the social proteome.

No field in science and medicine today remains untouched by Big Data, and psychiatry is no exception. Proteomics is a Big Data technology and a next generation biomarker, supporting novel system diagnostics and therapeutics in psychiatry. Proteomics technology is, in fact, much older than genomics and dates to the 1970s, well before the launch of the international Human Genome Project. While the genome has long been framed as the master or "elite" executive molecule in cell biology, the proteome by contrast is humble. Yet the proteome is critical for life-it ensures the daily functioning of cells and whole organisms. In short, proteins are the blue-collar workers of biology, the down-to-earth molecules that we cannot live without. Since 2010, proteomics has found renewed meaning and international attention with the launch of the Human Proteome Project and the growing interest in Big Data technologies such as proteomics. This article presents an interdisciplinary technology foresight analysis and conceptualizes the terms "environtome" and "social proteome". We define "environtome" as the entire complement of elements external to the human host, from microbiome, ambient temperature and weather conditions to government innovation policies, stock market dynamics, human values, political power and social norms that collectively shape the human host spatially and temporally. The "social proteome" is the subset of the environtome that influences the transition of proteomics technology to innovative applications in society. The social proteome encompasses, for example, new reimbursement schemes and business innovation models for proteomics diagnostics that depart from the "once-a-life-time" genotypic tests and the anticipated hype attendant to context and time sensitive proteomics tests. Building on the "nesting principle" for governance of complex systems as discussed by Elinor Ostrom, we propose here a 3-tiered organizational architecture for Big Data science such as proteomics. The proposed nested governance structure is comprised of (a) scientists, (b) ethicists, and (c) scholars in the nascent field of "ethics-of-ethics", and aims to cultivate a robust social proteome for personalized medicine. Ostrom often noted that such nested governance designs offer assurance that political power embedded in innovation processes is distributed evenly and is not concentrated disproportionately in a single overbearing stakeholder or person. We agree with this assessment and conclude by underscoring the synergistic value of social and biological proteomes to realize the full potentials of proteomics science for personalized medicine in psychiatry in the present era of Big Data.

Doppler ultrasonographic measurement of short-term effects of valsalva maneuver on retrobulbar blood flow.

BACKGROUND: To investigate the effects of Valsalva maneuver (VM) on retrobulbar blood flow parameters in healthy subjects. METHODS: Participants without any ophthalmologic or systemic pathology were examined in supine position with color and pulsed Doppler imaging for blood flow measurement, via a paraocular approach, in the ophthalmic artery (OA), central retinal artery (CRA), central retinal vein (CRV), nasal posterior ciliary artery (NPCA), and temporal posterior ciliary artery (TPCA), 10 seconds after a 35- to 40-mm Hg expiratory pressure was reached. Peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistivity index (RI) values were recorded for each artery. PSV and EDV values were recorded for CRV. RESULTS: There were significant differences between resting and VM values of PSV and EDV of CRA, RI of NPCA, and PI, RI, and EDV of TPCA. Resting CRA-EDV, CRV-PSV, and CRV-EDV were positively correlated whereas resting OA-PSV and CRA-PI, and OA-PSV, CRA-PSV, and CRA-EDV during VM, were negatively correlated with age. CONCLUSIONS: VM induces a short-term increase in CRA blood flow and a decrease in NPCA and TPCA RI. Additional studies with a longer Doppler recording during VM, in a larger population sample, are required to allow definitive interpretation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:551-555, 2017.

The results of 25-gauge vitreoretinal surgery for optic disc pit-associated maculopathy: a report of three cases and mini-review of the literature.

PURPOSE: We report the outcomes of three consecutive patients with optic disc pit-associated maculopathy who were treated with 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling, fluid-air exchange, barrage endolaser, and sulfur hexafluoride (SF6) gas tamponade. CASE REPORT: Patients with optic disc pit-associated maculopathy were treated with 25-gauge pars plana vitrectomy followed by ILM peeling, fluid-air exchange, barrage endolaser, and gas tamponade with 20 % SF6. All patients were asked to maintain a facedown position for 3 days postoperatively. This technique resulted in complete retinal reattachment after 25-gauge vitrectomy, ILM peeling, fluid-air exchange, barrage endolaser, and 20 % SF6 gas injection. The best-corrected visual acuity (BCVA) improved in all three patients and successful anatomical results were achieved. There wasn't any macular detachment in all cases at 20th week follow-up. CONCLUSIONS: Our outcomes suggest that 25-gauge vitrectomy with ILM peeling, fluid-air exchange, barrage endolaser, and SF6 gas tamponade appears to be an effective treatment option for optic disc pit-associated maculopathy.

Comparison of pain experience during 23-G vitreoretinal surgery under topical and retrobulbar anesthesia.

The objective of this study is to compare pain and discomfort scores of patients during 23-G vitreoretinal surgery under topical and retrobulbar anesthesia without using sedation. A total of 157 patients with various vitreoretinal disorders were included in this study. Patients were randomly divided into two groups: topical (group 1, n = 76) and retrobulbar anesthesia (group 2, n = 81). Patients underwent 23-G vitreoretinal surgery without using sedation. All patients rated the level of experienced pain during the surgical procedure using a visual analogue pain scale. Pain and discomfort scores while performing anesthesia were significantly higher in group 2 than group 1 (p < 0.001). Patients in group 1 experienced more pain than group 2 during trocar insertion, endolaser photocoagulation, and scleral indentation steps of surgery (for all; p < 0.001). There was no significant difference in overall pain and discomfort scores and surgeon comfort scores between groups (p = 0.163, p = 0.097; respectively). None of the patients required additional anesthesia or sedation during or after the procedure. Topical anesthesia without using sedation is a safe and effective, alternative method for 23-G vitreoretinal surgeries in selected patients with various vitreoretinal pathologies.

Comparing the effects of two different contact lenses on corneal re-epithelialization after corneal collagen cross-linking.

OBJECTIVE: To investigate whether keratoconus (KC) patients who applied the corneal collagen cross-linking (CXL) and two different contact lens (CL) showed any differences in complaints and findings following the CXL. METHODS: This prospective, comparative, double-blind clinical study involved 60 eyes of 60 patients (38 female and 22 male). At the end of the CXL procedure, CL (Balafilcon A) was inserted in 29 patients (Group-1) while CL with different material content (Hioxifilcon A) designed for therapeutic/bandage purposes were inserted in 31 patients (Group-2). RESULTS: On the 1st and 3th day after the CXL, there were no statistically significant differences between the groups in terms of the postoperative symptoms. On the 3th day after the CXL, all cases of both two groups were found to complete the corneal re-epithelialization. There was more PE ratio in the patients who had allergic conjunctivitis. CONCLUSIONS: With the use of Balafilcon A and Hioxifilcon A lens materials, KC patients who underwent the CXL were found to have similar symptoms and clinical findings after the CXL. However, epithelial staining and PE were observed more in KC cases accompanied by allergic conjunctivitis.

Intraorbital haematoma during a commercial flight: a case report.

BACKGROUND: Intraorbital haematoma is a rare clinical entity which can be caused by orbital traumas, neoplasms, surgeries nearby sinuses and orbit, vascular malformations, acute sinusitis, systemic abnormalities, barotrauma and valsalva maneuver. CASE PRESENTATION: A 74-year-old male presented with sudden onset of ocular pain, upper eye lid swelling, proptosis and diplopia after a commercial flight. After complete ophthalmic ocular examination including pupillary light reflexes and laboratory examinations; computed tomography and magnetic resonance imaging of orbit revealed a subperiostal mass-like lesion in the right retrobulbar-extraconal region which was compatible with intraorbital haematoma. Visual acuity was not compromised so we planned a conservative approach with close observation. We administered systemic corticosteroid and topical dorzolamide/timolol combination therapy. At the first month follow-up, intraorbital haematoma resolved without significant sequelae. CONCLUSION: Intraorbital haematoma can be managed by conservative approach without any intervention if it does not threat visual acuity or optic nerve. We experienced a case of intraorbital haematoma during a commercial flight. We discussed the rarity of this condition and its management.

Does ranibizumab (Lucentis®) change retrobulbar blood flow in patients with neovascular age-related macular degeneration?

PURPOSE: To investigate the effects of intravitreal ranibizumab on retrobulbar blood flow in patients with neovascular age-related macular degeneration (AMD). METHODS: Thirty-one eyes of 30 patients with neovascular AMD were examined prospectively by both color Doppler imaging and fundus fluorescein angiography. Color Doppler imaging was used to measure the maximum and minimum velocities of the central retinal vein, peak systolic/end-diastolic velocities of blood flows, and pulsatility index and resistivity index values in the central retinal artery, nasal/temporal posterior ciliary arteries (NPCA/TPCA) and ophthalmic artery. The t test for paired samples was used for comparing retrobulbar blood flow values before and after intravitreal ranibizumab (Lucentis®) injection in the study and control groups. RESULTS: There was a statistically significant (p < 0.05) difference between the pre-injection and post-injection end-diastolic velocities of the NPCA and TPCA and resistivity index values of TPCA. The other parameters showed no statistically significant difference. CONCLUSION: Our results show that intravitreal ranibizumab injection increases retrobulbar blood flow.

Does phacoemulsification under topical anesthesia affect retrobulbar blood flow?

PURPOSE: To investigate with color Doppler imaging the effects of phacoemulsification surgery under topical anesthesia on retrobulbar vessels hemodynamics. METHODS: In this prospective study, color Doppler imaging was used to measure the maximum (Vmax) and minimum flow velocity (Vmin) of the central retinal vein, and the Vmax and Vmin, pulsatility index and resistance index of the central retinal artery, nasal, and temporal posterior ciliary arteries, and ophthalmic artery blood flow before and 1 day after phacoemulsification surgery under topical anesthesia. RESULTS: After phacoemulsification surgery under topical anesthesia, Vmin of the central retinal artery increased (p ≤ 0.05), whereas the other variables showed no significant change. CONCLUSIONS: Phacoemulsification surgery under topical anesthesia has a minor effect on retrobulbar blood flow. Therefore topical anesthesia should be suitable for patients with ocular perfusion disorders (eg, glaucoma).

Effects of intravitreal bevacizumab (Avastin) therapy on retrobulbar blood flow parameters in patients with neovascular age-related macular degeneration.

BACKGROUND: To investigate the effects of intravitreal bevacizumab on retrobulbar circulation in patients with neovascular age-related macular degeneration (AMD). METHOD: Thirty patients with neovascular age-related macular degeneration were assessed prospectively by both color Doppler imaging and fundus fluorescein angiography. Spectral Doppler analysis allowed the measurement of the maximum velocity (Vmax) and minimum velocity (Vmin) of the central retinal vein (CRV), and peak systolic (PSV), end-diastolic (EDV) velocities of blood flows, and pulsatility index (PI) and resistance index (RI) values in the central retinal artery (CRA), nasal and temporal posterior ciliary arteries (NPCA, TPCA), and ophthalmic artery (OA). The t test for paired samples was used to compare retrobulbar blood flow values before and after intravitreal bevacizumab injection. RESULT: PSV and EDV of the NPCA and PSV of the TPCA were significantly decreased after intravitreal bevacizumab injection (p < 0.05). There was no statistically significant difference in the other parameters. CONCLUSION: Our results suggest that intravitreal bevacizumab therapy has a measurable effect on retrobulbar blood flow.

Isolated Superior Ophthalmic Vein Thrombosis Associated with Orbital Cellulitis: Case Report.

Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity that may be associated with sino-orbital disease. The clinical presentation of SOVT may include signs of venous congestion, such as unilateral ptosis, chemosis, ophthalmoplegia, and eyelid swelling, with or without fundus findings. This case report describes a case of SOVT associated with orbital cellulitis diagnosed with magnetic resonance imaging and treated using anticoagulant therapy, antibiotherapy, and a corticosteroid. In the presence of orbital cellulitis, clinicians should always keep the possibility of SOVT in mind, as it may result in mortality and visual loss if not diagnosed early and given appropriate treatment without delay.

Comparison of retinopathy of prematurity incidence between Turkish citizens and Syrian refugees.

Purpose: More than 3.5 million Syrians came to Turkey seeking refuge and over 470,000 Syrian infants were born since the start of the civil war in 2011. Our aim is to compare the incidence of retinopathy of prematurity (ROP) between Syrian refugees and Turkish citizens. Methods: This multicenter, retrospective study was conducted in Gaziantep University, Faculty of Medicine and Gaziantep Children's Hospital in Turkey. We included the data of patients who were screened for ROP between July 2015 and June 2017. Results: The above-mentioned data of 906 Turkish infants and 199 Syrian infants were included in this study. Mean gestational ages (GAs) were (32.9 ± 2.7) and (32.1 ± 2.8) weeks as well as mean birth weights (BWs) were (1937.5 ± 582.9) and (1696.8 ± 485.5) g, in Turkish and Syrian infants, respectively. GA and BW were significantly lower in Syrian infants while time spent in neonatal intensive care unit was significantly higher. The zone of ROP was lower in the Syrian infants in the first examination and for the most advanced ROP (P = 0.001). Any stage ROP was present in 392 (43.3%) and 81 (40.7%) patients in Turkish and Syrian population, respectively (P = 0.490). The number of patients who required treatment for ROP were 95 (10.5%) and 20 (10.1%) in Turkish and Syrian groups, respectively (P = 0.882). Conclusion: Our findings showed that refugee infants had lower BW and GA than native population but the incidence of ROP did not differ between them. Psychosocial stress is an important risk factor for women at reproductive age as it increases the incidence of prematurity. Additional care and psychological support must be given to refugees during perinatal period to decrease the risk of premature birth.

Increased Expressions of ICAM-2 and ICAM-3 in Pterygium.

Purpose: Pterygium, one of the most common ocular surface diseases, is characterized by inflammatory infiltrates, proliferation, angiogenesis, fibrosis, and extracellular matrix breakdown. The objective of this study was to elucidate the levels of the intercellular adhesion molecule (ICAM)-2, and ICAM-3 gene and protein expressions in pterygium. Methods: A total of 59 patients with pterygium were included in this study. mRNA from pterygial and conjunctival autograft tissues were extracted, and real-time polymerase chain reaction on the BioMark HD dynamic array system was performed for the ICAM-2 and ICAM-3 gene expressions. ICAM-2 and ICAM-3 protein expressions using western blot and immunohistochemistry methods were also investigated in pterygial and conjunctival autograft tissues. Results: ICAM-2 and ICAM-3 gene expressions were markedly augmented in pterygial tissues (P = 0.0018 and P = 0.0023, respectively). Significant increases in protein expressions in pterygial tissues were also detected for ICAM-2 and ICAM-3 (P = 0.0116 and P = 0.0252, respectively). In the immunohistochemical studies, there was a marked increase in ICAM-3 (P = 0.0152), but not in ICAM-2 (P = 0.1041), protein expressions in pterygial tissues. Significant positive correlations between pterygia grading with ICAM-2 protein expression (P = 0.0398) and ICAM-3 immunohistochemical scores (P = 0.0138) were observed. Conclusion: These results demonstrate, for the first time, the expressions of ICAM-2 and ICAM-3 in the pterygium. These findings may help to understand the signal transduction mechanisms in the pterygium formation and provide a new therapy strategy for pterygium treatment.

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction.

PURPOSE: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. METHODS: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. RESULTS: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. CONCLUSIONS: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.