Based on the Real-Life Data of Türkiye; Comparison of Anatomical and Functional Outcomes of Phakic and Pseudophakic Patients in Wet Type Age-Related Macular Degeneration.

Objectives: The aim of the study was comparison of wet-type age-related macular degeneration in phakic and pseudophakic patients in terms of anatomical and functional success based on the real-life data of Türkiye. Methods: The multicenter retrospective real-life study data of the. retinal study group were used in this study. Among 867 eyes of 867 patients were included in the study. Patients were divided into two groups according to the status of the lens; phakic group and pseudophakic group. The follow-up period of the two groups, the number of injections at the 1st, 2nd, and 3rd years, and changes in the central macular thickness (CMT, µ) and visual acuity (VA, logMAR) of the patients at the beginning, 6th, 12th, 24th, and 36th months were examined. Results: In our study, the number of injections in the 1st, 2nd, and 3rd years, respectively, was 4.2±2.0, 1.8±1.9, and 1.0±1.7 in the phakic group, and 3.9±2.0, 1.7±1.9, and 0.8±1.4 in the pseudophakic group. When the two groups were compared in terms of the number of injections, there was a statistically significant difference in the 1st year, but there was no significant difference in the 2nd and 3rd years (p=0.001, p=0.350, and p=0.288, respectively). There was no statistically significant difference between the groups in terms of CMT in the baseline, 6th, 12th, 24th, and 36th months (p=0.991, p=0.327, p=0.652, p=0.599, and p=0.873, respectively). Although there was no difference in VA between groups at the beginning (p=0.052), the phakic group showed statistically better VA in controls at 3rd, 6th, 12th, 24th, and 36th months (p=0.001, p=0.001, p=0.000, p=0.000, and p=0.003, respectively). Conclusion: Differences in the number of injections and visual results between phakic and pseudophakic patients in wet type AMD may necessitate the creation of different treatment and follow-up protocols.

Results of anti-VEGF treatment for neovascular AMD in eyes with different baseline visual acuity in Turkish population-based on real life data-Bosphorus retina study group.

BACKGROUND: To investigate the anatomical and visual outcomes of the patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF), according to the baseline best-corrected visual acuity (BCVA) based on the multicenter real-life data. METHODS: Five-hundred-ninety patients who had taken the Pro Re Nata (PRN) treatment regimen with three loading doses and at least one year of follow-up were included. The patients were divided into three groups according to the baseline BCVA: Group 1 (BCVA ≥ 1.3 Logmar), Group 2 (1.3 Logmar > BCVA ≥ 0.3 Logmar), and Group 3 (BCVA ≤ 0.2 Logmar). BCVA, central macular thickness (CMT), and the number of injections and visits were evaluated. RESULTS: There were 175, 322, and 93 patients in Group 1, Group 2, and Group 3, respectively. The number of visits and injections in the 1st year was not different between the groups (p = 0.58 and p = 0.08) and was 7.09 and 4.41 (Group 1), 6.59 and 5.58 (Group 2), 6.77 and 4.08 (Group 3). There was a significant difference in CMT between the baseline and 12th month in Group 1 and Group 2 (p < 0.001, p < 0.001, respectively) but not in Group 3 (p = 0.84). BCVA was significantly better in the 12th month in Group 1 (p < 0.001), slightly worse in Group 2 (p = 0.79), and significantly worse in Group 3 (p < 0.001). CONCLUSION: This study provides evidence that an inadequate number of injections cannot protect vision. Moreover, it can cause vision loss, especially in the eyes with good vision.

Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume in patients with idiopathic epiretinal membrane.

PURPOSE: To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects. METHODS: We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters. RESULTS: Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects. CONCLUSION: The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.

Comparative study of small-incision lenticule extraction and phakic intraocular lens implantation for the correction of high myopia: 6-year results.

PURPOSE: To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. SETTING: University of Health Science Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective comparative case series. METHODS: Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from -6.00 to -10.00 diopters (D) were included in the study. RESULTS: There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. CONCLUSIONS: In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

Evaluation of Macular Microcirculation in Healthy Children Using Optical Coherence Tomography Angiography.

OBJECTIVES: This study was designed to evaluate macular perfusion in a healthy pediatric population using optical coherence tomography angiography (OCTA). METHODS: Fifty-three eyes of 30 healthy children (20 boys and 10 girls) were included in this prospective, cross-sectional study. Age, gender, foveal thickness (FT), superficial foveal avascular zone area (FAZs), deep foveal avascular zone area (FAZd), superficial capillary plexus flow area (SCP), deep capillary plexus flow area (DCP), choriocapillaris flow area (CC), vascular density in the SCP (VDs), vascular density in the DCP (VDd), and subfoveal choroidal thickness (SFCT) were evaluated. RESULTS: The mean age was 12.0±4.0 years (range: 6-15 years). Gender did not have a statistically significant influence on the FAZs or FAZd. However, there was a positive correlation between the CC and age (r=0.31; p=0.025). The FAZs and FAZd were negatively correlated with the FT (p<0.001). The VDd was positively correlated with the FT (p=0.03) and was negatively correlated with the FAZd (p=0.019). CONCLUSION: The present study determined normative data of OCTA parameters in healthy children and provides useful insight into the relationship between age, macular microvascular networks, and the FAZ.

Rotational Stability of a New Posterior Chamber Toric Phakic Intraocular Lens.

PURPOSE: To evaluate the refractive results and rotational stability of Eyecryl toric phakic intraocular lens (pIOL). METHODS: In this retrospective single-surgeon case series, manifest refraction, visual acuities, endothelial cell density (ECD), and pIOL rotation were evaluated over 6 months. RESULTS: 43 eyes from 23 patients were included. At 6 months, the SE was within ±0.50 D of emmetropia in 30 (70%) eyes and within ±1.00 D of emmetropia in 39 (91%) eyes. The efficacy and safety indices were 1.25 ± 0.38 and 1.41 ± 0.34, respectively. Mean ECD was 2719 ± 296 cells/mm2 at the preoperative visit and 2779.42 ± 422 cells/mm2 at the 6-month visit (p > 0.05). The mean value of absolute axis orientation error was 4.95 ± 5.28°. Mean absolute change in axis orientation between visits was less than 3° for all visit intervals. Ninety percent or more of lenses were found to rotate 5° or less between all visit intervals. None of the patients experienced a vision-threatening complication, and no patient required secondary IOL repositioning. CONCLUSION: The pIOL appears to effectively reduce subjective manifest astigmatism and provide good visual acuity. Its position was found to be stable throughout the follow-up.

Intraocular lens power calculation in a posterior chamber phakic intraocular lens implanted eye.

PURPOSE: To evaluate the effect of Eyecryl posterior chamber phakic intraocular lens (pIOL) on axial length measurement and intraocular lens power calculation. METHODS: Axial length (AL), keratometry (K), and IOL power calculations were compared at monthly preoperative and postoperative visits (preoperative vs 1-month). Preoperative IOL power (calculated using preoperative K and AL) was compared with a re-calculation where the pIOL was assumed to be in the posterior chamber (calculated using preoperative K value and postoperative AL). RESULTS: Thirty-nine eyes of 39 patients were included. The mean preoperative AL and postoperative AL were 27.02 ± 1.50 and 27.17 ± 1.52 mm (p < 0.001), respectively. The mean preoperative and recalculated IOL powers to achieve emmetropia were 9.40 ± 3.35 and 8.98 ± 3.37 D (p < 0.001) with SRK-T formula, 8.82 ± 3.54 and 8.47 ± 3.60 (p = 0.02) with Holladay I formula, and 9.78 ± 3.43 and 9.44 ± 3.50 (p = 0.013) with Hoffer Q formula. CONCLUSION: The presence of Eyecryl pIOL in the posterior chamber results in a small increase in the AL measurement, and this might result in a corresponding hypermetropic shift in the desired refraction.

Laser in situ keratomileusis (LASIK) in patients with superior steepening on corneal topography: Is it safe and predictable?

BACKGROUND: Attention is usually given to inferior steepening on corneal topography in the evaluation of a patient's suitability for LASIK surgery. The aim of this study is to investigate long-term refractive results with superior steepening. METHODS: Patients who underwent LASIK surgery between 2015 and 2019 in our refractive surgery department were retrospectively reviewed. The patients with a ≥ 1.0 D superior-inferior (S-I) quadrant difference in the tangential map, using a Scheimpflug camera with a Placido disc topographer (Sirius), were included in the study. Preoperative and postoperative best-corrected and uncorrected visual acuity (Snellen), cylindrical refraction values, and spherical equivalent (SE) values were compared. Adverse events were recorded. RESULTS: Fifty eyes of 28 patients participated in the study. The mean age of the patients was 27.5 ± 8.0 (19-59). Sixteen patients were female (57.1%), and 12 (42.8%) patients were male. The average follow-up time was 29.8 ± 11.1 months (12-61). Average central corneal thickness was 549.4 ± 26.0 (498-602) µm. Average minimal corneal thickness was 549.1 ± 26.9 (497-598) µm. Preoperative S-I quadrant difference (D) was 1.87 ± 0.7 (1.0-3.99). Posterior elevation (Kvb) was 11.2 ± 1.9 (9-17) µm. The preoperative SE value was - 1.7 ± 2.1 (- 6.25-3.25) and improved to - 0.3 ± 0.44 D (- 1.25-0.75) (p < 0.001). Preoperative cylindrical refraction values were - 2.04 ± 1.7 (- 6.25-0), and postoperative values were - 0.47 ± 0.4 (- 2-0) D (p < 0.001). Uncorrected visual acuity was median 1.0 (0.4-1.0) with 38 eyes (76%) having 20/20 postoperative uncorrected visual acuity. No sight threatening complications or ectasia findings were observed during the 2 years postoperative follow-up time. CONCLUSIONS: Abnormal corneal topographies with (S-I) asymmetry result in predictable results after LASIK.

Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols.

PURPOSE: To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. SETTING: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case-control study. METHODS: Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm, and Group 2 received 5 minutes of illumination at 18 mW/cm. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. RESULTS: A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively). CONCLUSIONS: Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group.

AIM: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS: Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3th, 6th and 12th months, and in central macular thickness (CMT) at 6th and 12th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS: The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6th (44 vs 72) and 12th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6th month; 85 vs 97, 12th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits. CONCLUSION: The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Evaluation of Clinical Findings, Optical Coherence Tomography, Fundus Fluorescein Angiography, and Indocyanine Green Angiography Imaging in Patients with Polypoidal Choroidal Vasculopathy.

OBJECTIVES: The aim of this study was to describe clinical findings as well as spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings of polypoidal choroidal vasculopathy (PCV). METHODS: This retrospective, observational case series included 144 eyes of 103 patients who were diagnosed with PCV between January 2014 and August 2016. Best corrected visual acuity, 90-diopter lens slit-lamp fundus biomicroscopy examination findings, color fundus photography, SD-OCT, FA, and ICGA findings were evaluated at the time of diagnosis. RESULTS: Sixty-six patients (93 eyes, 64.1%) were male and 37 (51 eyes, 35.9%) were female. Sixty-two (60.2%) patients had unilateral involvement. The most common SD-OCT finding was retinal pigment epithelial detachment (PED). Red-orange subretinal lesions were seen in 20 eyes (13.9%). There was a single polyp in 21 (14.6%) eyes, and more than 1 polyp in 123 (85.4%) eyes observed with ICGA imaging. The polyps were located in the peripapillary area in 10 (6.9%) eyes, the macular area in 91 (63.2%) eyes, and the extramacular area in 1 (0.7%) eye. A significant branching vascular network was seen in the ICGA images of 112 (77.8%) eyes. CONCLUSION: In this study, the majority of patients were male, with unilateral macular polyps. A serous PED and an exudative pattern were the most common clinical manifestations. SD-OCT showed specific findings for PCV, but ICGA was the most useful test for diagnosis.

Long-term (5 years) follow-up of small-incision lenticule extraction in mild-to-moderate myopia.

PURPOSE: To report long-term efficacy and safety of small-incision lenticule extraction (SMILE) in patients with mild-to-moderate myopia. SETTING: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case series. METHODS: Medical records of patients who had SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Patients with a preoperative spherical equivalent (SE) of manifest refraction of 6.00 D or less and a 5-year follow-up period were included in the study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities and SE were analyzed preoperatively and at 1 year, 3 years, and 5 years postoperatively. RESULTS: The study comprised 54 eyes (34 patients). The mean SE of the intended correction was -4.11 diopters (D) ± 0.98 (SD) and ranged from -1.38 to -5.88 D. The mean preoperative UDVA and CDVA were 1.08 ± 0.29 logarithm of the minimum angle of resolution (logMAR) and 0.02 ± 0.08 logMAR, respectively. At the 5-year follow-up, the mean difference between the intended and achieved SE was -0.13 ± 0.29 D. The mean postoperative UDVA and CDVA were 0.04 ± 0.09 logMAR and 0.00 ± 0.04 logMAR, respectively. At the 5-year follow-up, the SE was within ±0.50 D of the intended correction in 32 (93%) of the 34 patients and within ±1.00 D of intended correction in all patients. The SE at the 5-year follow-up was within ±0.50 D of the 1-year visit in 33 (98%) of all patients. No patient lost CDVA lines, and no vision-threatening events occurred during the surgery or the postoperative period. CONCLUSIONS: SMILE in mild-to-moderate myopia offers predictable correction of SE refractive error. Refractive results were stable at the long-term follow-up.

Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm.

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.

Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm.

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.

Foveal avascular zone area measurements with optical coherence tomography angiography in patients with nanophthalmos.

PURPOSE: To compare the area of the superficial foveal avascular zone (SFAZ) and deep foveal avascular zone (DFAZ) between patients with nanophthalmos and age matched controls. METHODS: This prospective and comparative study included 19 eyes from 11 patients with nanophthalmos (study group) and 19 eyes from 19 healthy subjects (control group). SFAZ and DFAZ were measured with optical coherence tomography angiography (OCT-A). All participants underwent a standardised ocular examination including best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) anterior chamber depth (ACD), axial length (AL), and refractive error (RE) measurements. RESULTS: Mean SFAZ and DFAZ area in the nanophthalmic eyes and in the control eyes were 0.09 ± 0.12 mm2, 0.10 ± 0.10 mm2 and 0.37 ± 0.10 mm2, 0.37 ± 0.10 mm2 respectively (p < 0.001 and p < 0.001). Mean BCVA, RE, AL, ACD CMT, SFCT, were 0.40 ± 0.34 logMAR Unit, 10.0 ± 2.2 18.1 ± 1.5 mm, 2.15 ± 0.28 mm, 367.1 ± 87.4 µm, 489.2 ± 85.2 µm respectively, in nanophthalmic eyes and there was a statistically significant difference between groups (p < 0.001 for each). There were negative correlations for both SFAZ and DFAZ with RE (r = -0.733 and r = -0.758, p < 0.001), CMT (r = -0.823 and r = -0.82, p < 0.001), SFCT (r = -0.647 and r = -0.717 p < 0.001) for the entire study population. SFAZ and DFAZ area were significantly correlated with AL (r = 0.732 and r = 0.745, p < 0.001) and ACD (r = 0.614 and r = 0.654, p < 0.001). In study group, 5 eyes did not have neither SFAZ nor DFAZ, 3 eyes had only DFAZ and 1 eye had only SFAZ in the OCT-A images. CONCLUSIONS: SFAZ and DFAZ area were significantly smaller in nanophthalmic eyes than control eyes.

Comparison of outcomes for traumatic retinal detachment surgery using 1000- or 5000-centistoke silicone oil.

PURPOSE: To compare the efficacy and complications associated with higher viscosity (5000-centistoke) versus lower viscosity (1000-centistoke) silicone oil in traumatic retinal detachment surgery. MATERIAL AND METHODS: Patients who underwent 23-gauge pars plana vitrectomy using 1000- or 5000-centistoke silicone oil to treat retinal detachment associated with traumatic globe injury were retrospectively analysed. Anatomical and visual outcomes were compared. RESULTS: Forty-four eyes of 44 patients were included in the study, which included 22 eyes in each group. Patients were significantly younger in the 5000-centistoke group compared to the 1000-centistoke group (median: 22 vs. 54 years old, respectively, p < 0.001) and open trauma was more common (77% vs. 36%, respectively, p = 0.006). Anatomical success was similar in both groups (73% and 77%, 5000- and 1000-centistoke groups, respectively; p = 0.73). Although ambulatory vision (>5/200) at the final follow-up visit was more common in the 1000-centistoke group compared to the 5000-centistoke group (55% vs. 9%, respectively, p < 0.001), there was no significant difference between the groups with respect to change in visual acuity postoperatively compared with preoperatively. CONCLUSION: Surgeons prefer 5000-centistoke silicone oil for use in more complicated cases. Anatomical outcomes were similar using 1000- and 5000-centistoke silicone oil.

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1.

OBJECTIVES: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. MATERIALS AND METHODS: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. RESULTS: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 µm (range: 91-1582), 330±115 µm (range: 99-975), and 332±114 µm (range: 106-1191), respectively. CONCLUSION: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Simultaneous Transepithelial Topography-Guided Photorefractive Keratectomy and Accelerated Cross-Linking in Keratoconus: 2-Year Follow-Up.

PURPOSE: To evaluate the visual, refractive, and topographic outcomes after simultaneous topography-guided transepithelial photorefractive keratectomy (transepithelial TG-PRK) using the Amaris Excimer laser platform and accelerated corneal cross-linking (CXL) in eyes with keratoconus. MATERIALS AND METHODS: Patients with 2 years of follow-up were included in this retrospective case series. Manifest refraction (MR), uncorrected (UDVA) and corrected (CDVA) distance visual acuity, corneal topography, and pachymetry were evaluated at 1, 3, 6, 12, and 24 months after surgery. The root-mean-square of total higher-order aberrations (total HOA-RMS), coma (Coma-RMS), and spherical aberration (SA-RMS) were calculated for 4- and 6-mm diameters. RESULTS: Forty-six eyes of 46 patients were included in the study. Stromal ablation was ≤50 µ in all patients. MR was -3.78±3.26 preoperatively and -1.39±1.82 postoperatively. Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels. UDVA values further improved after 2 years, compared to the 1-year values. No patient lost two or more lines and keratoconus progression was not observed in any patient. CONCLUSION: Simultaneous transepithelial TG-PRK and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy.

Visual and Refractive Outcomes of Small-Incision Lenticule Extraction in High Myopia: 5-Year Results.

PURPOSE: To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. MATERIALS AND METHODS: Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. RESULTS: Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was -7.47 ± 1.10 D (range -6.00 to -10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was -0.43 ± 0.47 (0.50 to -1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. CONCLUSION: SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up.

Verisyse versus Veriflex Phakic Intraocular Lenses: Refractive Outcomes and Endothelial Cell Density 5 Years after Surgery.

PURPOSE: To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years. METHODS: We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively. RESULTS: The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (-0.25 ± 0.30 D and -0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group, p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed. CONCLUSION: Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile.