Regional Analysis of Inner Retinal Layer Changes in Multiple Sclerosis with and without Optic Neuritis.

Objectives: The study aimed to investigate inner retinal changes in multiple sclerosis (MS) patients by comparing them with healthy controls. The study also aimed to assess regional differences of inner retinal layer involvement in eyes with and without optic neuritis (ON). Materials and Methods: This retrospective, cross-sectional study consisted of 141 eyes of 74 relapsing-remitting MS patients and 80 eyes of 40 healthy controls. The study group was separated into two subgroups according to the presence of ON history. Peripapillary retinal nerve fiber layer (pRNFL) thickness, total macular thickness, and thicknesses of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer were compared between the MS and healthy control groups and between eyes with and without ON history. Results: Mean pRNFL, total macular, mRNFL, GCL, and IPL thicknesses were significantly thinner in the MS group than in the control group (p<0.001) and in eyes with ON compared to those without ON (p<0.05). Comparison of inner retinal layer thicknesses in the inner 3-mm ring subfields of the ETDRS grid revealed significant thinning in all subfields of the GCL and IPL of eyes with ON (p<0.05). The inferior subfield demonstrated the highest difference. Conclusion: The study demonstrated that GCL and IPL thinning is a robust and reliable biomarker in all MS patients. The thinning was significantly greater in eyes with ON than in eyes without ON. The study also documented that the inferior region showed significantly greater GCL and IPL thinning in eyes with previous ON attacks.

Electrophysiological effects of hyperbaric oxygen treatment on the healthy retina.

PURPOSE: The study aimed to investigate the electrophysiological effects of hyperbaric oxygen treatment (HBOT) on the retina after ten sessions in healthy eyes. METHODS: This prospective, interventional study evaluated forty eyes of twenty patients who were treated with HBOT of ten sessions with the diagnosis of an extraocular health problem. All patients underwent a complete ophthalmologic examination, including assessments of best-corrected visual acuity (BCVA), slit-lamp and pupil-dilated fundus examinations, full-field electroretinography (ffERG) measurements before and after HBOT within 24 h of the 10th session. The ffERG was recorded according to the International Society for Clinical Electrophysiology of Vision protocol using the RETI-port system. RESULTS: The mean age of patients was 40.5 years ranging from 20 to 59 years. Thirteen patients were administered HBOT for avascular necrosis, six patients for sudden hearing loss, and one patient for chronic osteomyelitis of the vertebra. BCVA acuity was 20/20 in all eyes. The mean spherical refractive was 0.56 dioptre (D), and the mean cylindrical refractive error was 0.75 D. Dark-adapted b-wave amplitude in 3.0 ERG was the only variable for the b-wave that showed a statistically significant decrease (p = 0.017). The amplitude of the a-waves in dark-adapted 10.0 ERG and light-adapted 3.0 ERG reduced significantly (p = 0.024, p = 0.025). The amplitude of N 1-P 1 in light-adapted 30 Hz Flicker ERG also demonstrated a statistically significant decrease (p = 0.011). Implicit times did not differ significantly in any of the ffERG data (p > 0.05). CONCLUSIONS: HBOT caused the deterioration of a-wave and b-wave amplitudes in ffERG after ten treatment sessions. The results showed that photoreceptors were adversely affected in the short term after HBOT treatment.

Electrophysiological and anatomical outcomes of subthreshold micropulse laser therapy in chronic central serous chorioretinopathy.

BACKGROUND: To evaluate short-term efficacy of subthreshold micropulse laser therapy on chronic central serous chorioretinopathy (CSC) electrophysiologically and anatomically. METHODS: This prospective study included 18 eyes with chronic CSC. Subthreshold micropulse laser therapy was applied to the eyes using Endpoint Management System (EpM). The efficacy of the treatment was evaluated with optical coherence tomography (OCT) and multifocal electroretinography (mfERG) measurements before and after one month of the treatment. RESULTS: The mean patient age was 47.3 ± 5.7 years (ranged between 36 and 56). The mean symptomatic time of the disease was 12.7 ± 3.33 months. Central macular thickness, choroidal thickness, subretinal fluid height and width showed statistically significant decreases after EpM treatment (p < 0.05). P 1 amplitude of ring 1, 3, 4, and 5 in mfERG increased significantly (p <  0.05). CONCLUSIONS: The study demonstrated that, in both OCT and electrophysiological evaluations, EpM subthreshold laser therapy resulted in anatomical and functional improvements in chronic CSC.

Clinical, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment implantations in duck-type keratoconus.

Purpose: To evaluate the visual, refractive, tomographic, and topometric outcomes of progressive thickness intracorneal ring segment (PT-ICRS) implantation in duck-type keratoconus. Methods: This retrospective study included eyes with oval (duck-type) keratoconus treated with PT-ICRS implantation. After the femtosecond laser tunnel creation, one PT-ICRS (Keraring AS 5 with 160° arc length) was implanted along the ectatic, inferior half of the cornea. Data of uncorrected and corrected distance visual acuity (UDVA and CDVA), refraction, asphericity (Q value), and keratometry (K) were compared pre- and postoperatively. Additionally, changes in the topometric indices of corneal irregularity were also evaluated after PT-ICRS implantation. Results: Thirty-one eyes of 30 patients were included in the study with a mean follow-up time of 9.06 months (ranging between 6 and 18 months). UDVA improved from 0.85 ± 0.36 to 0.27 ± 0.14 logMAR (P = 0.001), and CDVA improved from 0.37 ± 0.22 to 0.13 ± 0.11 logMAR (P = 0.001). The mean spherical error decreased from -3.66 ± 2.60 to -1.60 ± 1.42 D (P = 0.001), and the mean cylindrical error decreased from -4.91 ± 2.65 to - 1.41 ± 1.31 D (P = 0.001). All topographic parameters measured from the anterior cornea demonstrated statistically significant improvements after PT-ICRS implantation (P = 0.001). K mean, K maximum, corneal astigmatism, and Q value showed a significant decrease. Besides the index of height asymmetry, all topometric indices were significantly reduced after PT-ICRS implantation. There were no loss of lines and no complications. Conclusion: PT-ICRS implantation in duck-type keratoconus is an effective and safe treatment. This intervention improves the visual acuity, refractive error, topographical, and topometric parameters significantly by decreasing both eccentricity and steepness of the cone.

Tuck-and-pull technique for posterior chamber phakic intraocular lens explantation.

The tuck-and-pull technique was developed for practical and safe explantations of posterior chamber phakic intraocular lenses (PCPIOLs). In this technique, after the creation of a side port, viscoelastic (or OVD [ophthalmic viscosurgical device]) is initially injected behind the PCPIOL to widen the space between PCPIOL and the crystalline lens. The old incisions can be used after recent implantations rendering the enlargement of the main incision unnecessary. After additional OVD over and under the PCPIOL, the haptic is tucked by a chopper and pulled through the main incision with a single maneuver. The haptic is grasped by two suture forceps and explanted with a "hand-to-hand" maneuver. The tuck-and-pull technique provided high protection of the corneal endothelium, crystalline lens, anterior chamber structures, and the PCPIOL itself. This technique is a practical, easy, and safe approach for explantations of all PCPIOL types, whatever the reason for its explantation may be.

Does conventional laser photocoagulation still have a place in the treatment of diabetic macular edema?

Objective: The study aimed to investigate the long-term efficacy of conventional laser photocoagulation in the treatment of diabetic macular edema. Methods: In this retrospective study, the records of patients presented with diabetic macular edema (DME) and non-proliferative diabetic retinopathy were reviewed. DME defined as clinically significant macular edema was treated by using argon green or yellow dye laser with focal, grid, and modified grid techniques according to Early Treatment Diabetic Retinopathy Study parameters. Best-corrected visual acuity (BCVA) was measured. BCVA change after the treatment and its relationship with other factors were evaluated. Results: The study included 133 eyes of 81 patients. The mean follow-up was 28.26 months. BCVA demonstrated the increase of 2 lines or more in 20.7% of the eyes, stabilization within 2 lines in 60.7% of the eyes, and loss of 2 lines or more in 18.3% of the eyes. The eyes with baseline BCVA lower than or equal to 0.50 showed a statistically significant increase (p=0.001) whereas the eyes with baseline BCVA of more than 0.50 did not show a statistically significant change (p=0.070) after laser photocoagulation treatment. Conclusions: Conventional laser photocoagulation is an effective treatment in diabetic macular edema including center-involved type and stabilizes visual acuity in the majority of the patients. Improvement in BCVA is significant in the group with lower baseline BCVA. Abbreviations: DM = diabetes mellitus, DME = diabetic macular edema, ETDRS = early treatment diabetic retinopathy study, CSME = clinically significant macular edema, CLP = conventional laser photocoagulation, VEGF = vascular endothelial growth factor, BCVA = best-corrected visual acuity, ANOVA = analysis of variance, VA = visual acuity.

Anatomical effects of intravitreal anti-vascular endothelial growth factor injections on inner layers of the lesion-free retina.

PURPOSE: The primary aim of the study was to investigate the effects of anti-vascular endothelial growth factor (VEGF) injections on the inner retinal layer anatomy of the lesion-free retina in eyes treated for neovascular age-related macular degeneration (nAMD). The secondary aim was to compare the changes of inner retinal layers in the lesion-free region of treated eyes with the same region of the untreated, fellow eyes and, thus, to elucidate any adverse effect of anti-VEGF treatments independently of 1-year aging changes. METHODS: This was a retrospective, longitudinal, case-control study of 50 eyes of 25 patients. Twenty-five eyes with nAMD comprised the study group (16 eyes treated with aflibercept and 9 eyes treated with ranibizumab) and 25 fellow eyes with dry AMD (16 eyes in AREDS 2 and 9 eyes in AREDS 3) comprised the fellow eye group. Spectral-domain optical coherence tomography (SD-OCT) measurements were done at pre-treatment, 1 month after three loading anti-VEGF injections and at the end of 1 year. The retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL) thicknesses and total retinal thickness in the macula were measured. Thicknesses of inner retinal layers which were lesion-free in the outer nasal subfield of ETDRS grid were analysed and the changes in thicknesses during the follow-up period were compared between study and fellow eye groups. Paired t-test for normally distributed variables was applied for analyses of differences for the comparison of the results across the pre-and the post-. A p value of less than 0.05 was considered statistically significant. RESULTS: The mean number of injections was 5.76 ± 1.26 in the study group in 1 year. The mean decrease in total retinal thickness was significant with 6.08 ± 9.05 µm (p= 0.003) in nAMD group and was insignificant with 0.32 ± 1.03 µm (p> 0.05) in fellow eye group with dry AMD. Most of the retinal thickness decrease was during first three injections in nAMD group. Total retinal thickness and GCL thickness were thinner in the study group at every follow-up examination, but the difference between groups was not statistically significant (p> 0.05). RNFL, GCL, IPL, and INL thicknesses did not demonstrate a statistically significant change in both study and fellow eye groups during 1 year follow-up period (p> 0.05). CONCLUSIONS: Repeated anti-VEGF injections in nAMD appear to have no significant effect on the RNFL, GCL, IPL, and INL thicknesses of the lesion-free retina. Additionally, there was no significant difference in inner retinal layer changes between in eyes treated with anti-VEGF injections for nAMD and fellow eye group during 1-year follow-up.

The effects of implantable collamer lens implantation on higher order aberrations.

AIM: To evaluate the changes in higher order aberrations (HOAs) after implantable collamer lens (ICL; Staar Surgical, Nidau, Switzerland) implantation. METHODS: Totally 30 eyes of 18 patients with myopia were included in this study with an average age of 25.77y (min: 21, max: 40). Refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), HOAs (entire, corneal and internal) were evaluated preoperatively and three months postoperatively. Ocular aberrations were measured by using iTrace (Tracey Technology, Houston, Texas, USA). SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) was used for the statistical analysis and the interpretation of the data. P values of less than 0.05 were considered statistically significant. RESULTS: The preoperative mean spherical power was -9.01 D (min: -5.00, max: -13.00) and the mean cylindrical error was -2.40 D (min: -0.50, max: -4.75). The postoperative mean residual spherical power was -0.73 D (min: -0.20, max: -1.75) and the mean cylindrical error was -0.89 D (min: -0.18, max: -2.09). Analyses were made on root mean square (RMS) values of total HOAs (tHOAs), spherical aberration, coma and trefoil as entire, corneal and internal components. The differences in entire tHOAs and in internal tHOAs were significant. There was no significant change found in spherical aberrations. The differences in entire coma and in internal coma were significant. There was no significant change found in corneal coma. With respect to trefoil, the only significant difference was in internal trefoil. CONCLUSION: The ICL implantation corrects the refractive error successfully and changes entire and internal HOAs of the eye.

Refractive Outcomes of 20 Eyes Undergoing ICL Implantation for Correction of Hyperopic Astigmatism.

PURPOSE: To analyze 1-week, 1-month, and 12-month postoperative refractive outcomes of eyes that under-went ICL implantation to correct hyperopic astigmatism. METHODS: The study enrolled 20 eyes of patients with an average age of 32 years (range: 21 to 40 years). The outcomes of spherical and cylindrical refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), vault, and angle parameters were evaluated 1 week, 1 month, and 12 months postoperatively. RESULTS: The preoperative mean UDVA was 0.15 ± 0.11 (decimal) (20/133 Snellen) and increased to 0.74 ± 0.25 (20/27 Snellen) postoperatively, with a change of 0.59 (decimal) (20/33.9 Snellen) (P < .0001), which was statistically significant. The preoperative mean CDVA was 0.74 ± 0.25 (decimal) (20/27 Snellen) and increased to 0.78 ± 0.21 (20/25 Snellen), with a change of 0.03 (decimal) (20/666 Snellen) (P < .052), which was not statistically significant. The mean preoperative sphere was 6.86 ± 1.77 diopters (D) and the mean preoperative cylinder was -1.44 ± 0.88 D. The mean 12-month postoperative sphere decreased to 0.46 ± 0.89 D (P < .001) and cylinder decreased to -0.61 ± 0.46 D (P < .001), with a change of 6.40 D, both of which were statistically significant. The mean 1-month postoperative vault was 0.65 ± 0.13 mm and decreased to 0.613 ± 0.10 mm at 1 year postoperatively, with a change of 0.44 mm (P < .003). The preoperative/12-month and 1-month/12-month trabecular-iris angle (TIA), trabecular-iris space area 500 mm from the scleral spur (TISA500), and angle opening distance 500 mm from the scleral spur (AOD500) values were analyzed nasally, temporally, and inferiorly. All differences were statistically significant between preoperative/12-month analysis. The only differences between 1- and 12-month analysis were on TISA500 inferior (P < .002) and AOD500 nasal (0.031) values. CONCLUSIONS: ICL hyperopic toric implantation is a safe method and provides stable refractive outcomes in patients with high hyperopia (up to 10.00 D) and astigmatism (up to 6.00 D). [J Refract Surg. 2017;33(9):604-609.].