Quantitative Analysis of the Activity in Choroidal Neovascularizations after a Single Anti-VEGF Injection: OCT Versus OCT Angiography.

PURPOSE: To analyze early quantitative changes in the choroidal neovascularization (CNV) area observed with optical coherence tomography angiography (OCTA) after single anti-vascular endothelial growth factor (anti-VEGF) injection. MATERIALS AND METHODS: Treatment-naive patients with CNV secondary to neovascular age-related macular degeneration were analyzed immediately before and ~4 weeks after anti-VEGF injection. The primary endpoints of the study included changes in CNV total and vascular area. Secondary endpoints were best-corrected visual acuity (BCVA), central macular thickness (cMT), central total macular thickness (cTMT), and subfoveal choroidal thickness (SFCT). RESULTS: A total of 27 patients (69.19 ± 5.91 years, 21 men/6 women, 14 type 1 NV, 11 type 2 NV, and 2 type 3 NV) were included in the study. There was a significant increase in BCVA and decreases in cMT, cTMT, and SFCT after treatment (p<0.05 for all). CNV total and vascular area changed by -11.55 ± 44.26% (95% confidence interval [CI]: -29.06 and 5.95; p=0.269) and -21.06 ± 41.2% (95% CI: -36.45/-5.67; p=0.786), respectively. The cases with decreased cTMT were accompanied by a decrease in CNV area only in 37% of the cases. No significant correlation was detected between cTMT and CNV total and vascular area percentage changes (r = -0.06, p=0.74; r = 0.02, p=0.9, respectively). CONCLUSIONS: Changes in CNV total and vascular area seem to have limited sensitivity as a biomarker in terms of activation, as wide variability was observed in CNV area after anti-VEGF injection.

Unintentional Staining of the Anterior Vitreous with Trypan Blue During Cataract Surgery.

During phacoemulsification and intraocular lens (IOL) implantation surgery, the trypan blue dye used to stain the anterior capsule passed into vitreous cavity and stained the anterior capsule and anterior vitreous in 6 patients. There was history of trauma in 2 patients, uveitis in 1 patient, mature cataract in 1 patient, and no risk factors in the other patients. IOL was implanted in-the-bag without problem in 5 patients. In the patient with iris and zonular defects due to trauma, a sutured IOL was implanted in the same session. The migration of trypan blue into the vitreous cavity through damaged or intact lens zonules is a rare but important complication that makes subsequent surgical steps substantially more difficult.

Anterior Chamber Migration of Ozurdex Implants.

We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases was vitrectomized eyes. Four of the patients had sutured intraocular lens (IOL) implantation due to complicated cataract surgery, one had combined retinal detachment surgery with sutured IOL implantation, and one had vitrectomy for diabetic intravitreal hemorrhage cleaning and uncomplicated cataract surgery. Anterior chamber implant migration caused corneal edema in all cases and elevated intraocular pressure in three cases. In two cases, the dexamethasone implant was directed into the vitreous cavity after maximum pupillary dilation and corneal manipulation with cotton tip applicator with the patient in reverse Trendelenburg position. There was no other complication until dexamethasone implant degradation, with clear cornea at final examination. In two cases, the implant was removed from the anterior chamber by aspiration, but keratoplasty surgery was planned due to endothelial cell loss and persistent corneal edema during follow-up. In the last two cases, the dexamethasone implant was redirected into the vitreous chamber with a 23-gauge catheter and anterior chamber maintainer but they migrated into the anterior chamber again. In one of these patients, the implant was aspirated by catheter and corneal transplantation was performed due to corneal edema, while the other patient's implant was redirected into the vitreous chamber with no further anterior migration. The risk of dexamethasone implants migrating into the anterior chamber of vitrectomized eyes and those with sutured IOL implantation should be kept in mind and the patient should be informed and advised to see an ophthalmologist immediately before permanent corneal endothelial damage occurs.

Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis

Objectives: To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK). Materials and Methods: From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results: Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143). Conclusion: Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.

Comparison of Icare Pro Tonometry and Icare One Tonometry Measurements in Healthy Eyes

Objectives: To compare intraocular pressure (IOP) measurements obtained with the Icare Pro tonometer used in clinical practice and the Icare One self-tonometer. Materials and Methods: Fifty-two eyes of 52 healthy, right-handed individuals with no prior intraocular surgery or ocular trauma, structural ocular pathology, or systemic disease were evaluated. IOP was first measured using the Icare Pro tonometer. The participants were then told how to use the Icare One tonometer and asked to measure their own IOP. The results were analyzed statistically using SPSS v.24. Results: Of the 52 healthy participants, 16 (30.7%) were male and 36 (69.3%) were female. Their mean age was 31.6±6.3 (23-47) years. Mean IOP measured with the Icare Pro was 17.10±6.2 (11.5-25.2) mmHg, and the mean self-measured IOP with Icare One was 14.01±3.4 (7-24) mmHg. When the two methods were compared using Levene's t-test, there was a significant mean difference of -3.08±0.6 (95% confidence interval: -4.39 -1.78; p<0.001). Conclusion: In this study, there was a significant difference between the IOP measurements we made using the Icare Pro and the participants' self-measured IOP using the Icare One, with the latter being relatively lower. This may be related to the fact that the participants were unfamiliar with using the Icare One. Although the Icare One is a promising tool for glaucoma patients to self-monitor their IOP, further studies are needed.

INTRAVITREAL DEXAMETHASONE IMPLANT IN RETINITIS PIGMENTOSA-RELATED CYSTOID MACULAR EDEMA.

PURPOSE: To report the clinical outcome after intravitreal dexamethasone implant in patients with retinitis pigmentosa and cystoid macular edema. METHODS: Multicenter retrospective case series of eyes with retinitis pigmentosa and cystoid macular edema that underwent intravitreal dexamethasone implant. Primary outcome measures were best-corrected visual acuity in LogMAR and central macular thickness. Statistical analyses used two-tailed comparison with Wilcoxon signed-rank test. RESULTS: There were a total of 45 eyes from 34 patients with a mean age of 32.7 years (range 16-57) and mean follow-up of 15.5 ± 13.0 months. At Month 3 after the first injection, mean initial best-corrected visual acuity improved from 0.61 ± 0.38 (20/81) to 0.37 ± 0.16 (20/47) (P = 0.012), whereas mean central macular thickness (µm) decreased from 506 ± 288 µm to 311.7 ± 71.6 µm (P < 0.001) and mean intraocular pressure increased from 15.7 ± 2.3 mmHg to 19.8 ± 11.0 mmHg (P = 0.01). Fourteen eyes had multiple injections (1-7 reinjections) at a mean interval of 6 months. Treatment effect was durable with multiple injections, but with seven eyes developing visually significant cataracts. CONCLUSION: Best-corrected visual acuity improved up to 4 months in around half of the eyes. Eyes that benefited the most were pseudophakic, steroid nonresponsive, with large initial central macular thickness, and profuse fluorescein dye leakage.

Trabeculectomy combined with deep sclerectomy and scleral flap suture tension adjustment under an anterior chamber maintainer: a new modification of trabeculectomy.

The objective of this study was to investigate the efficacy and safety of trabeculectomy combined with deep sclerectomy in patients with primary open angled glaucoma (POAG) and to compare the results with those from conventional trabeculectomy. In the study 12 eyes of 10 patients operated with trabeculectomy combined with deep sclerectomy (Group I) and 16 eyes of 16 patients operated with conventional trabeculectomy surgery (Group II) were included. In the described form of combined deep sclerectomy with the trabeculectomy technique the superficial scleral flap was sutured with 10/0 monofilament, the number and tension of sutures were adjusted according to the outflow dynamics, under the scleral flap, of balanced salt solution (BSS) provided by an anterior chamber maintainer. In groups I and II all the patients were male POAG cases with mean ages of 60.0 +/- 19.4 and 67.0 +/- 7.1 years, respectively. The mean follow-up periods were 8.3 +/- 3.5 months for group I and 16.6 +/- 7.0 months for group II. Preoperative mean IOP were 29.7 +/- 8.3 and 29.1 +/- 12.8 mmHg mmHg, and average topical antiglaucomatous medications were 2.9 +/- 0.7 and 2.7 +/- 1.1 for groups I and II, respectively. Postoperatively mean IOP measurements were reduced in groups I and II to 10.5 +/- 2.9 vs. 9.6 +/- 4.8 mmHg at 1 week, 13.7 +/- 5.6 vs. 16.0 +/- 9.8 at 1st month, 12.3 +/- 6.4 vs. 17.3 +/- 8.0 at 3rd month, 11.0 +/- 4.1 vs. 15.3 +/- 5.8 at 6th month, 10.8 +/- 1.6 vs. 16.1 +/- 4.4 at 12th month, and 11.0 +/- 1.0 vs. 16.7 +/- 5.0 at 18th month. Statistical analysis revealed that mean postoperative IOP measurements for group I were significantly lower than for group II for all measurements except the first week (P < 0.05). At 12th month, the complete (IOP <22 mmHg without medication) and qualified (IOP <22 mmHg with medication) success rates were 83.3 and 100% for group I and 63.6 and 90.9% for group II. Postoperatively at 12th month, the mean number of antiglaucoma medications had fallen to 0.0 +/- 0.0 in group I and 0.81 +/- 1.1 in group II. Trabeculectomy surgery combined with deep sclerectomy and suture adjustment under an anterior chamber maintainer provided sufficient IOP decrease and diffuse bleb morphology. This technique could be used as a safe method for management of glaucoma.

Therapy with ribozyme to the proliferating cell nuclear antigen-ribozyme and 5-fluorouracil of experimental choroidal neovascularization in rats.

PURPOSE: The aim of this study was to evaluate the efficacy of hammerhead ribozyme to the proliferating cell nuclear antigen (PCNA-Rz) and 5-fluorouracil (5-FU) in experimental choroidal neovascularization (CNV) model in rats. METHODS: Laser was used to induce CNV in each eye of 44 rats. For angiography studies, injections of either a mixture of PCNA-Rz 10 microg/microL and 5-FU 1.5 microg/microL, versus the same dose of either drug alone versus a control injection of Hanks' Balanced Salt Solution (HBSS) were performed. We also studied this regimen to evaluate scar size and volume. RESULTS: There was significantly less angiographic leakage for the treated eyes compared to the controls by 3.53 grading points (P = 0.0005); CNV leakage was reduced in the combination group compared to 5-FU alone by 1.75 grading units (P = 0.04) and compared to PCNARz by 2.22 grading units (P = 0.07). The scar size and volume were smaller (diameter 354.6 +/- 174.2 microm vs 477.3 +/- 157.0 microm), (thickness 52.7 +/- 43.0 microm versus 79.6 +/- 46.2 microm) with a reduction in scar volume of 44.8%. CONCLUSIONS: Subretinal injection of PCNA-Rz and 5-FU mixture is more effective as treatment of laser-induced CNV, than either drug alone. The majority of the antiangiogenic effect is a result of 5-FU activity with a contribution by the PCNA ribozyme.

Human cataractous lens nucleus implanted in a sheep eye lens as a model for phacoemulsification training.

We describe a realistic and inexpensive experimental cataract model for phacoemulsification training. After a capsulorhexis is performed, a deep cavity in the lens of an enucleated sheep eye is formed by phacoemulsification through a lateral incision. An undamaged human cataractous lens nucleus obtained by extracapsular cataract extraction is inserted in the preformed cavity, resting in the center of a cortex cushion. Phacoemulsification training is performed through a corneal tunnel incision. The experimental model is prepared with a human cataractous lens nucleus of the preferred hardness, simulating nuclear phacoemulsification in humans.