Evaluation of subclinical changes in recently diagnosed pediatric hypertension patients without hypertensive retinopathy: an OCT study.

PURPOSE: To investigate subclinical choroidal and retinal changes in recently diagnosed pediatric hypertension (HT) patients. METHODS: This prospective case-control study consisted of 62 treatment naive HT patients (34 essential HT and 28 renal-induced HT) and 62 control subjects aged 10-16 years. All demographic data and ocular parameters were noted. Macula and choroid measurements were acquired by spectral domain optical coherence tomography (SD-OCT). Choroidal measurements were obtained by taking the mean of the measurements taken from 3 nasal and 3 temporal locations at 500µ intervals (mean nasal, mean temporal) in addition to the subfoveal area. RESULTS: All choroidal thickness (ChT) values in HT subjects were significantly lower than in the healthy group (p < 0.001 for all). Also, there was no statistically significant difference between central macular thickness (CMT) and mean macular thickness (MMT) between the two groups. Subfoveal ChT, mean ChT, and CMT values were statistically lower in patients with renal-induced HT compared to essential HT subjects (p < 0.001, p = 0.04, p = 0.014, respectively). No significant correlation was observed between choroidal thicknesses and blood pressure values in essential and renal HT groups except weak correlation between mean temporal ChT and systolic blood pressure (SBP) in renal HT group (r = - 0.464, p = 0.013). CONCLUSION: This study demonstrated that choroidal thickness decreased even during the subclinical period in treatment naive pediatric HT subjects. In addition, it has been shown that the choroid is more affected in renal-induced HT compared to essential HT group.

Evaluation of subclinical retinopathy and angiopathy with OCT and OCTA in patients with systemic lupus erythematosus.

PURPOSE: To evaluate the choroidal and retinal layers with optical coherence tomography (OCT) and retinal microvascular structures with optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE) patients. METHOD: In this prospective, cross-sectional and comparative study, a total of 35 SLE patients and 35 healthy control participants were included. SLE patients who were using hydroxychloroquine (HCQ) and/or immunosuppressive agents are evaluated with OCT and OCTA. SLE patients who have no HCQ maculopathy observed in OCT were included in the patient group. RESULTS: Mean macular thickness and ganglion cell inner plexiform layer (GC-IPL) thicknesses were thinner in the patient group. When the parameters obtained with OCTA were evaluated, vessel (VD) and perfusion density (PD) were significantly lower in the patient group. Central foveal thickness and foveal avascular zone parameters were negatively correlated. In addition, VD and PD, and GC-IPL thicknesses were positively correlated. CONCLUSION: Application of OCTA for the evaluation of microvasculature in SLE patients may be useful in subclinical changes.

The long-term effect of human immunodeficiency virus infection on retinal microvasculature and the ganglion cell-inner plexiform layer: an OCT angiography study.

PURPOSE: To investigate the long-term effect of HIV infection on the ganglion cell-inner plexiform layer and retinal capillary network. METHODS: This prospective, cross-sectional case-control study included 45 HIV-infected patients and 45 healthy individuals. Optical coherence tomography angiography (OCTA) was used for the assessment of macular, peripapillary retinal nerve fiber layer (RNFL) thicknesses, ganglion cell-inner plexiform layer, vessel density, perfusion density, and foveal avascular zone. RESULTS: The mean disease duration was 7.3 ± 1.9 years (range, 5-12 years) in the HIV group. The mean CD4 count (nadir) for all the patients was 147.09 ± 122 cells/mm3 and the mean RNA was 173.6 ± 913.8 copies/ml. No statistically significant difference was determined between the groups in respect of the average and foveal MT (p = 0.05). A significant difference was found between the two groups in respect of the mean VD and PD parameters (p < 0.05). Peripapillary PD was significantly decreased in the HIV group. There was a significant difference between the average and superior and inferior half-region of GC-IPL values. Using Pearson's correlation analysis, no significant correlation was determined between the duration of HIV infection and mean GC-IPL, MT and VD, and PD values (r - 0.223, p 0.141; r - 0.223, p 0.141; r - 0.169, p 0.268; r - 0.105, p 0.491; r - 0.095, p 0.535 respectively). CONCLUSIONS: The results of this study provide evidence of microvascular and neuroretinal loss in individuals with well-suppressed HIV infection, compared with healthy control subjects. OCTA is an important test for the screening of retinal microvascular changes over time in HIV-infected cases.

Retinal and choroidal vascular structures are affected in axial spondyloarthritis: an optical coherence tomography study.

PURPOSE: The aim of this study is to evaluate the retinal and choroidal structures in r- and nr-axSpA patients using spectral domain optical coherence tomography (SD-OCT) and to compare changes with healthy controls. METHODS: In this cross-sectional study, 70 axSpA patients (50 radiographic- and 20 nr-axSpA) and 50 healthy control subjects were included. Choroidal thickness (ChT), macular thickness, retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) were measured by SD-OCT. For ChT values, seven lines at nasal and temporal were drawn at 500-µm intervals, centering the subfoveal sclerochoroidal junction. Analysis of the data was performed with the SPSS program. Mann-Whitney U test was performed for comparison of non-normally distributed continuous data; Student's t test was used for normal distributed data. RESULTS: No significant difference was observed between 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects (p 0.417). R-axSpA and nr-axSpA groups and control group were similar in terms of spherical equivalent, intraocular pressure, axial length, and body mass index (p 0.574, p 0.874, p 0.918, p 0.344, respectively). While mean macular and GCC thicknesses were significantly lower in the patient group than in the healthy group, there was no significant difference between the two groups in terms of RNFL thickness. CONCLUSION: The present study showed that there was no significant relationship between markers and scores indicating disease activity and ChT, MT, RNFL, and GCC thicknesses. However, an increase in choroidal thickness and involvement of the retinal layers has also been demonstrated in patients with spondyloarthritis. In addition, the relationship between disease activity and retinal layer involvement is remarkable in the r-axSpA group.

Evaluation of the anterior segment parameters after Nd: YAG laser Capsulotomy: Effect the design of intraocular lens Haptic.

OBJECTIVE: To evaluate the changes in anterior segment parameters after neodymium-yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy in 1-piece and 3-piece IOLs. METHODS: In an institution, 65 eyes of 65 consecutive pseudophakic patients with posterior capsule opacification underwent Nd:YAG laser capsulotomy. The patients were divided into two groups according to the IOL type. Group-1 consisted of 35 subjects with 1-piece IOL and Group-2 consisted of 30 subjects with 3-piece IOL. Anterior segment parameters were measured with the Sirius rotating camera before, one week and one month after Nd:YAG laser capsulotomy. RESULTS: Mean age was 72.3±5.2 years in 1-piece IOL and 72.3±6.8 years in 3-piece IOL. There were no statistically significant differences before capsulotomy for IOP, axial length, spherical equivalent, anterior chamber depth, central corneal thickness, anterior chamber angle and anterior chamber volume between two IOL groups. BCVA improved after capsulotomy in both groups (p=0.001). Both IOL groups had statistically significant myopic shift compared with the baseline values (P= 0.03 and P=0.01 resp.). Both IOL groups had statistically significant decrease in ACD, from baseline to the 1st week and 1st month (p=0.04 and 0.03 resp.). CONCLUSION: To achieve the highest percentage of refractive and anterior segment stability surgeons may prefer to implant the 1-piece IOL design.

Choroidal Thickness Changes in the Acute Attack Period in Patients with Familial Mediterranean Fever.

PURPOSE: The aim of this study was to evaluate choroidal thickness changes during acute attacks of familial Mediterranean fever (FMF). METHODS: Fifty patients with FMF and 50 healthy controls were included. Choroidal thickness of each participant was measured at the foveola and horizontal nasal and temporal quadrants at 500-µm intervals to 1,500 µm from the foveola using spectral-domain optical coherence tomography. White blood cell count, erythrocyte sedimentation rate (ESR) and serum levels of fibrinogen and C-reactive protein (CRP) were evaluated. The clinical findings (peritonitis, arthritis and pleuritis) were noted. RESULTS: Choroidal thickness was significantly thicker at all measurement points in FMF patients compared to healthy controls during an acute attack (p < 0.05). There were positive correlations between the choroidal thickness and ESR, fibrinogen and, particularly, CRP levels. Clinical findings did not change the choroidal thickness significantly (p > 0.05). CONCLUSIONS: Increased choroidal thickness in the acute phase of FMF is possibly related to the inflammatory edematous changes in the choroid.

Early Neurodegeneration of the Inner Retinal Layers in Type 1 Diabetes Mellitus.

PURPOSE: This study explores retinal structural changes in type 1 diabetes without clinically diagnosed diabetic retinopathy (DR). METHODS: Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, and macular thickness (MT) were measured in 90 type 1 diabetic patients by using spectral domain optical coherence tomography. The values were compared with 100 sex- and age-matched healthy controls. The independent t test was used to assess differences in the mean age, mean diabetic and ocular parameters, and the thickness values between the diabetic and control groups. Multiple linear regression analysis was performed to investigate the correlation between the thickness values and diabetic and ocular parameters. RESULTS: Whole-RNFL, the superior and inferior quadrants, and the superior half of the peripapillary RNFL thicknesses were significantly thinner in diabetic patients compared with controls (p < 0.05). GCC thicknesses in the average macular, outer temporal superior and outer temporal inferior sectors were significantly thinner in diabetic patients (p < 0.05). Central and average MTs were similar in both groups (p > 0.05). There were significant negative correlations of the duration of type 1 diabetes with the inner nasal MT, inner temporal superior GCC thickness, inner nasal inferior GCC thickness, and outer nasal superior GCC thickness (p < 0.05). Similarly, there were significant negative correlations of the level of HbA1c with the whole-RNFL thickness, superior-half-RNFL thickness, and superior-quadrant-RNFL thickness (p < 0.05). CONCLUSIONS: Type 1 diabetic patients without clinically diagnosed DR had neurodegeneration in the inner retinal layers compared with healthy controls.

Delayed visual loss due to radiation retinopathy.

Radiation retinopathy remains a devastating cause of visual morbidity in patients undergoing radiation for globe, orbit, and head and neck malignancies. A 65-year-old female was admitted with the complaint of low vision in the right eye for two months. Best corrected visual acuity was 20/32 in the right eye and 20/25 in the left eye. Slit lamp examination was normal in both eyes. Fundoscopic examination revealed perifoveolar hard exudates, paramacular microhemorrhages, telangiectasias, and macular degeneration in both eyes. Fundus florescein angiography showed enlargement of the foveal avascular zone, perifoveal capillary telangiectasia, and widespread venous beading bilaterally. Optical coherence tomography revealed bilateral cystoid macular edema. The prediagnosis of diabetic retinopathy was not confirmed because of the absence of diabetes mellitus after endocrinologic evaluation. Detailed medical history explored external beam radiotherapy to the head and neck region for nasopharyngeal cancer 10 years ago. The ultimate diagnosis was radiation retinopathy.

Diabetic Macular Edema.

Diabetic macular edema (DME), one the most prevalent causes of visual loss in industrialized countries, may be diagnosed at any stage of diabetic retinopathy. The diagnosis, treatment, and follow up of DME have become straightforward with recent developments in fundus imaging, such as optical coherence tomography. Laser photocoagulation, intravitreal injections, and pars plana vitrectomy surgery are the current treatment modalities; however, the positive effects of currently available intravitreally injected agents are temporary. At this point, further treatment choices are needed for a permanent effect. SOURCES OF DATA SELECTION: The articles published between 1985-2015 years on major databases were searched and most appropriate 40 papers were used to write this review article.

Primary transcanalicular diode laser-assisted dacryocystorhinostomy: long-term success rates and risk factors for recurrence.

OBJECTIVE: The aim of the study was to investigate the long-term success rates of transcanalicular endolaser dacryocystorhinostomy (TC-DCR) surgery along with the factors that possibly affect surgical success. METHODS: Patients (n = 300) who underwent unilateral TC-DCR operations in the department of ophthalmology of our university hospital between January 2011 and June 2021 were included in the study. The subjects were divided into 2 groups, with group 1 showing no recurrence (n = 205) and group 2 showing recurrence (n = 95). RESULTS: The mean follow-up period for the 300 patients was 26.7 ± 7.0 months (range, 11-33 months). The overall success rate was 205 of 300 (∼68%). Although, based on the univariate risk analysis, age, operative time, total laser power, tube removal time, septum deviation, fistulisation, and intraoperative hemorrhage were found to be risk factors, in multivariate risk analysis, only total laser power, septum deviation, and intraoperative bleeding were determined to be the main risk factors. CONCLUSION: The success rate of TC-DCR was lower than that of traditional external DCR, but because TC-DCR is a minimally invasive aesthetic surgery with a short operative time, it may become a preferred option by more ophthalmologists, especially for young patients without intranasal pathology and coagulation disorders and elderly patients at risk for general anaesthesia. It should be taken into account that the chances of success are relatively lower among patients with total laser power applied during surgery, intraoperative hemorrhage, fistulization, and septum deviation. In TC-DCR, bleeding control, short operative time, and low laser power are important to achieve a high success rate. Also, 1 year after TC-DCR, even the presence of anatomic drainage may lower the functional success of patients, so follow-up should be continued.

Subclinical Alterations in Retinal Layers and Microvascular Structures with OCTA in ANCA-Associated Vasculitides.

PURPOSE: Using OCTA, investigate the capillary network and retinal layers in granulomatosis with ANCA associated vasculitis (AAV) patients who did not manifest apparent ocular involvement and compare the findings with healthy subjects. METHOD: The present study, which is designed as a prospective and case-control study, includes 22 AAV patients and 35 control participants. OCTA parameters were noted. RESULTS: In most of the regions, AMT, RNFL and GC-IPL thicknesses were significantly lower in the AAV group than in the control group. While the vascular indices were lower in the AAV group, except for the center 1 mm region, the FAZ parameters were similar between the two groups. CONCLUSION: In AAV patients, subclinical changes in the retinal layers and superficial vascular plexus have been shown. In the future maybe a non-invasive method such as OCTA will become available in scoring systems for prognosis determination in AAV.

Evaluation of retinal microvascular network in patients with systemic sclerosis: An optical cohorence tomography angiography study.

PURPOSE: To investigate the long-term effect of systemic sclerosis on the optic disk and retinal capillary network and to see whether the drugs used in the treatment of SSc affected optical coherence tomography angiography (OCTA) parameters. MATERIALS AND METHODS: This cross-sectional case-control study included 40 systemic sclerosis patients and 40 healthy individuals. We included only one eye of each patient in the study. Macular layers and angiography scanning were performed with a Zeiss Cirrus 5000 OCTA system. Such values as macular thickness, retinal nerve fiber layer (RNFL), ganglion cell inner plexiform layer (GC-IPL) were obtained. For central vessel and perfusion density (VD, PD), central 6 mm were obtained and were evaluated by dividing it into 3 groups as inner, outer, and full. The FAZ was evaluated through 3 parameters: area, perimeter, circularity index. RESULTS: Statistically significant difference was found between the groups in terms of the mean and foveal macular thickness values (p=0.008, p=0.033). Significant differences were also found between the two groups in terms of the VD and PD parameters in all regions except for 1 mm center (p<0.05). There were no significant differences in RNFL and GC-IPL values between two groups. Also, a positive correlation was observed between parapapillary perfusion density values and RNFL and GC-IPL thicknesses in SSc group. When the subgroups were compared in terms of vasodilator drug use, the subgroup using vasodilators was seen to have higher mean RNFL and inferior RNFL thicknesses (p=0.045 and p=0.035, respectively). In addition, there was a significant positive correlation between parapapillary VD and RNFL values in the SSc subgroup treated with vasodilators. CONCLUSIONS: The results of this study demonstrate microvascular loss in individuals with systemic sclerosis, compared with healthy subjects. Also, it has been determined that OCTA is an important test for screening retinal and optic disk microvascular changes over time in cases of systemic sclerosis and may be used to evaluate the response to vasodilator drugs used in the treatment of SSc disease.

Evaluation of acute effects of pulmonary involvement and hypoxia on retina and choroid in coronavirus disease 2019: An optic coherence tomography study.

PURPOSE: We investigated the acute subclinical choroidal and retinal changes caused by Coronavirus Disease 2019 (COVID-19) in patients with and without pulmonary involvement, using spectral domain optic coherence tomography. METHODS: This prospective case-control study included COVID-19 patients: 50 with pulmonary involvement and 118 with non-pulmonary involvement. All patients were examined 1 month after recovering from COVID-19. The changes were followed using optic coherence tomography parameters such as choroidal and macular thickness and retinal nerve fibre layer and ganglion cell complex measurements. RESULTS: All choroidal thicknesses in the pulmonary involvement group were lower than in the non-pulmonary involvement group and the subfoveal choroidal thickness differed significantly (p=0.036). Although there were no significant differences between the central and average macular thicknesses in the two groups, they were slightly thicker in the pulmonary involvement group (p=0.152 and p=0.180, respectively). A significant decrease was detected in the pulmonary involvement group in all ganglion cell complex segments, except for the outer nasal inferior segment (p<0.05). In addition, a thinning tendency was observed in all retinal nerve fibre layer quadrants in the pulmonary involvement group compared to the non-pulmonary involvement group. CONCLUSION: In COVID-19 patients with pulmonary involvement, subclinical choroidal and retinal changes may occur due to hypoxia and ischemia in the acute period. These patients may be predisposed to ischemic retinal and optic nerve diseases in the future. Therefore, COVID-19 patients with pulmonary involvement should be followed for ophthalmological diseases.

Nasal vein occlusion after COVID-19: A case report.

To present a case of nasal vein occlusion that has not been reported after the coronavirus disease 2019 (Covid-19) pandemic. A 53-year-old patient reported a complaint of floaters after a recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. His best corrected visual acuity (BCVA) was 20/20 for both the eyes. On examination, a flame-shaped hemorrhage was observed in the left eye around the infero-nasal area adjacent to the optic disc. Temporal branch vein occlusion has been widely reported in association with SARS-CoV-2 infection. We emphasize that nasal vein occlusions triggered by Covid-19, which do not cause vision loss, should also be considered.

Evaluation of the retinal layers and microvasculature in patients with acromegaly: a case-control OCT angiography study.

BACKGROUND: The aim of study was to evaluate the retinal layers and macular capillary network with OCTA in acromegaly patients, to compare with healthy population. METHODS: In this prospective, observational, and comparative study, 40 acromegaly patients and 40 healthy control participants were included. Serum IGF-1 levels and disease duration of all patients were noted. Macular layers and angiography scanning was performed with a Zeiss Cirrus 5000 OCTA system. Macular thickness, RNFL, and GC-IPL values were obtained. For central vessel and perfusion density, central 6 mm was obtained and was evaluated by dividing into three groups (inner, outer, full). FAZ parameters were evaluated dividing into three groups (area, perimeter, circularity index). Analysis of the data was performed with the SPSS for Windows. RESULTS: There was no significant difference between the patient group and the control group in terms of age, gender, best corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and axial length (AL). The mean follow-up period after diagnosis was 11.0 ± 5.5 years. Central and mean macular thicknesses were also significantly higher in the acromegaly group (p < 0.05). Superior, inferior, and average RNFL thicknesses were also significantly thinner in the acromegaly group (p < 0.05). When OCTA parameters were compared between groups, there was a significant decrease in central vessel density (CVD) and central perfusion density (CPD) values in all regions in acromegaly group compared with controls (p < 0.05). CONCLUSION: Our findings with OCTA show that acromegaly causes a significant capillary network decrease according to the healthy subjects.

Normative Data of Superficial Retinal Vascular Plexus and the Relationship to Retinal Layers.

OBJECTIVES: The aim of this study was to evaluate the relationship between optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters in a healthy population and to detect any changes that occur with age. METHODS: A total of 100 healthy participants were included in this prospective, observational, and comparative study. The participants were categorized in 4 groups according to age: Group 1: 21-30 years, Group 2: 31-40 years, Group 3: 41-50 years, Group 4: 51-60 years of age. Mean macular thickness, retinal nerve fiber layer (RNFL), ganglion cell inner plexiform layer (GC-IPL), and the choroidal thickness (ChT), vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and parapapillary perfusion density parameters were recorded and analyzed. RESULTS: In comparisons between groups, no significant difference in OCTA parameters was observed. There were inverse correlations between the outer VD, PD, and intraocular pressure (IOP) (r= -0.307, p=0.006 and r= -0.284, p=0.011, respectively). The correlation between parapapillary perfusion density and IOP was close to being significant (r= -0.213, p=0.059). There were significant relationships between OCTA parameters and macular, RNFL, and GC-IPL thickness. No significant relationship between ChT and OCTA parameters was seen. CONCLUSION: The size and characteristics of superficial VD, PD, parapapillary perfusion density, and FAZ were determined in a population with standardized demographic and ocular clinical features, and the relationship between these parameters and retinal layers was established.

Evaluation of subclinical alterations in retinal layers and microvascular structures with OCT and OCTA in healthy young short-term smokers.

PURPOSE: To detect the changes that can be determined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in young and short-term smokers. METHOD: In this cross-sectional, observational, and comparative study, 45 "healthy" smokers and 45 healthy non-smoker control participants were included. Those with a smoking history between 1 year to 5 years and an average of 10-30 cigarettes per day were included in the study. OCT and OCTA measurements were made at least 60 min after smoking and at least 8 h after caffeine-containing beverages in order to end the effect of nicotine on systemic and retinal blood flow in the smoking group. RESULTS: The mean smoking period was 2.2 ± 0.13 years. Mean macular thickness(MMT), retinal nerve fiber layer(RNFL), and choroidal thickness(Cht) were significantly lower in the smoker group, while ganglion cell-inner plexiform layer(GC-IPL) thickness was higher. Vessel density(VD) values were similar between groups, while perfusion density(PD) values were significantly higher in the smoker group. There were significant correlations between MMT and outer VD, outer PD, foveal avascular zone(FAZ) perimeter and circularity index. FAZ area and central VD and PD were inversely correlated. Also, FAZ circularity index and subfoveal, nasal, and temporal ChTs were positively correlated. CONCLUSION: Despite the short-term smoking, ischemic effects were observed in retinochoroidal and vascular structures.

Changes in anterior segment parameters and presence of dry eye disease in patients with acromegaly: A Sirius topography study combined with meibography.

PURPOSE: To investigate anterior segment parameters (ASPs) and dry eye disease (DED), including the status of the meibomian glands, in patients with acromegaly. METHODS: In this cross-sectional, comparative study, 36 acromegaly patients and 40 healthy sex- and age-matched controls were included. Participants received a comprehensive ophthalmological examination, including intraocular pressure measurements with Goldmann applanation tonometry (IOPGAT) and central corneal thickness corrected intraocular pressure (IOPCCT) measurements, and were evaluated for ASPs and DED. For ASPs, white-to-white (WTW), apical (ACT) and thinnest corneal thickness (TCT), corneal volume (CV), keratometry readings (K1, K2, and Kmean), anterior chamber depth (ACD) and volume (ACV), and iridocorneal angle (ICA) were obtained via Sirius topography. DED was assessed with Schirmer's test, tear breakup time (TBUT), and Ocular Surface Disease Index (OSDI) scores. Meibography scores (MSs) were obtained with the Sirius topography device. RESULTS: Patients had higher mean IOPGAT (P = .006), IOPCCT (P = .01), ACT (P = .024), and TCT (P = .005) but narrower ICA (P = .014) than controls. Although Schirmer's test did not differ between the groups (P = .442), patients had higher OSDI (P < .001), higher MS (P = .001), and shorter TBUT (P = .002). CONCLUSION: Patients with acromegaly have greater IOP, greater corneal thickness, but narrower ICA than healthy individuals, as well as DED with increased MSs, which suggests meibomian gland dysfunction.