Comparison of intravitreal bevacizumab monotherapy and combined laser photocoagulation and intravitreal bevacizumab therapy in the same session in the treatment of aggressive retinopathy of prematurity.

PURPOSE: To compare the results of intravitreal bevacizumab (IVB) monotherapy and combined intravitreal bevacizumab and laser photocoagulation (LPC) therapies applied in the same session to patients with aggressive retinopathy of prematurity (A-ROP) in our clinic. METHODS: The study included 67 eyes of 37 patients diagnosed with A-ROP and treated. Forty-nine eyes treated with anti-vascular endothelial growth factor agent injection monotherapy for A-ROP treatment were included in the first group. The second group consisted of 18 eyes that received injection therapy and LPC treatment. The clinical findings of the two groups were investigated, and their treatment results were compared. RESULTS: Recurrence was observed in 19 of the 49 (38%) eyes in the first group, but there was no recurrence in any of the cases in the second group. While only IVB was applied to eight cases with recurrence, the combination of LPC and IVB treatment was applied to 11 cases. A second recurrence was detected in two of the eight cases that had received IVB monotherapy as a treatment for recurrence and in three of the 11 cases that had received LPC and IVB. The treatment outcomes of the two groups did not statistically significantly differ (P = 0.181). CONCLUSION: We consider that the combined simultaneous LPC and IVB treatment we applied in A-ROP cases is an effective approach, particularly for cases where there are concerns about the patient's ability to attend follow-up appointments.

OCT-A evaluation of the retinal and choroidal structures of patients with a history of radiotherapy due to nasopharyngeal carcinoma.

BACKGROUND: To perform the optical coherence tomography angiography (OCT-A) evaluation of the microvascular structures of the retina and choroidal tissue in asymptomatic patients who received radiotherapy for nasopharyngeal carcinoma and to compare the results to those of healthy individuals. METHODS: Ophthalmological examinations were performed in all asymptomatic patients without vascular or systemic diseases, or fundus findings who had received radiotherapy at least two years earlier. Then, OCT-A scans were obtained. Foveal, parafoveal, and whole retinal thicknesses, vessel densities in the superficial and deep capillary plexuses, subfoveal choroidal thickness, the non-flow area in the superficial capillary plexus, and the choriocapillaris flow area were measured and compared to the values of the healthy control group. RESULTS: The radiotherapy group had significantly lower deep capillary plexus vascular density and subfoveal choroidal thickness values and significantly higher choriocapillaris flow area values compared to the control group. CONCLUSIONS: We consider that OCT-A is useful in the early diagnosis of radiation retinopathy that may develop during follow-up in patients with nasopharyngeal carcinoma who have received radiotherapy.

Evaluation of retinal and optic disc vascular structures in individuals before and after Pfizer-BioNTech vaccination.

INTRODUCTION: We conducted this study to detect possible changes in posterior segment structures using the optical coherence tomography angiography (OCTA) in individuals vaccinated with the Pfizer-BioNTech vaccine. MATERIALS AND METHODS: The study included healthcare professionals who presented to the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital, who were scheduled to receive the first dose of the Pfizer-BioNTech vaccine. The exclusion criteria were any eye pathology (e.g., glaucoma, uveitis, diabetic retinopathy, amblyopia), myopia with the absolute value of refractive error >6, axial length >26 mm, history of eye surgery, and presence of systemic disease.OCTA was performed to 40 healthcare professionals before vaccination and on the third day after vaccination. RESULTS: After Pfizer-BioNTech vaccination, there was a statistically significant decrease in the total vascular, foveal vascular, parafoveal vascular and perifoveal vascular density of the superficial capillary plexus and the perifoveal vascular density of the deep capillary plexus and a statistically significant increase in the retinal foveal thickness and total retinal parafoveal thickness compared to the pre-vaccination values (p < 0.0001, p = 0.009, p < 0.0001, p = 0.001, p = 0.04, p = 0.03, and p = 0.05, respectively). CONCLUSION: We consider that the decrease in the retinal vascular density may be due to vascular endothelial damage and inflammation in vaccinated people. It can be suggested that increased inflammation plays a role in the retinal thickness in vaccinated people similar to patients with a history of COVID-19. We also consider that spike protein may be effective in these processes.

Analysis of optical coherence tomography angiographic findings of prematurely born children and its relationship with macular edema of prematurity.

PURPOSE: To compare foveal avascular zone (FAZ) area, foveal vascular density (VD), and foveal thickness in pre- and full-term children and to evaluate their relationship with cystoid macular edema (CME) in the prematurity period using spectral domain optical coherence tomography angiography (SD-OCTA). METHODS: OCTA imaging was performed at 4-6 years of age in 90 eyes of 45 prematurely born children and 50 eyes of 25 term children. Subjects were divided into three groups: prematurely born with CME (group 1); prematurely born without CME (group 2); healthy, term children (group 3). Imaging results in the three groups were compared. RESULTS: FAZ area was significantly larger in group 3 than in groups 1 and 2 (P < 0.001 [ANOVA]). FAZ area was found to be correlated with birth weight (r = 0.511; P < 0.001) and gestational age (r = 0.532; P < 0.001). No significant relationship was found between history of CME and FAZ area. CONCLUSIONS: In our study cohort, FAZ area was smaller in prematurely born children and was correlated with older gestational age and higher birth weight. CME in the neonatal period did not seem to affect retinal microvascular development in premature infants.

Comparison of bevacizumab, ranibizumab and aflibercept in retinopathy of prematurity treatment.

PURPOSE: To compare the efficacy and refractive outcomes of intravitreal bevacizumab, ranibizumab and aflibercept in retinopathy of prematurity (ROP) treatment. METHODS: We analyzed the files of patients treated with intravitreal bevacizumab, ranibizumab and aflibercept for ROP, retrospectively. A total of 187 eyes of 111 patients were included. Recurrence time after initial treatment, recurrence rate, age and rate of additional treatment, refractive outcomes in age 1, 2 and 3 were evaluated and compared between the groups. RESULTS: Fifty-four eyes of 30 patients formed bevacizumab group (Group-1), 77 eyes of 47 patients formed ranibizumab group (Group-2) and 56 eyes of 34 patients formed aflibercept group (Group-3). No significant difference was found in gender, gestational age, birth weight and risk factors between the groups (p>0.05). Success rate was higher in group 3, but the difference was not significant (p = 0.174) (74.1% in group-1, 62.4% in group-2 and 76.8% in group-3). Recurrence rate was higher in group 2, but the difference was not significant (p = 0.158) (25.9% in group-1, 37.6% in group-2 and 23.2% in group-3). Recurrence time after initial treatment was significantly shorter in group 2 (p < 0.01). Additional treatment rate was also higher, and the age of additional treatment was lower in group-2 (p < 0.05 and p < 0.01, respectively). We found refractive values more myopic in ages of 1, 2 and 3 in group 1. CONCLUSIONS: Bevacizumab, ranibizumab and aflibercept are effective treatment alternatives for ROP. We observed more frequent and much earlier recurrence in eyes treated with ranibizumab. A myopic shift was found in bevacizumab group. We also emphasize the necessity of longer follow-ups for infants treated with anti-VEGF drugs.

Calculation of an Optic Nerve Injury Risk Profile Before Sphenoid Sinus Surgery.

OBJECTIVES: Our objective was to analyze variations in the optic nerve (ON) course and surrounding structures in an effort to construct an optic nerve injury risk profile before endoscopic intranasal sphenoidal, or endoscopic endonasal transphenoidal, skull-base surgery, and eventually to construct and formulate a common classification by combining the known classes. The authors used computed tomography (CT) toward this end. METHODS: The authors retrospectively reviewed 200 consecutive CT scans (400 sides) of the paranasal sinuses. The pneumatization of the anterior clinoid process, the relationships of the ONs to the sphenoidal sinuses, and ON dehiscence were evaluated. The authors then created a formula by which risk profiles can be constructed for patients for whom sphenoid or parasellar surgery is planned. RESULTS: Pneumatization of the anterior clinoid process was evident in 28.25%. Dehiscence of the bony wall of the ON was evident in 9.5%. The ON course lay adjacent to the sphenoidal sinus, causing sinus wall indentation, in 23%. Cumulative optic nerve injury risk scoring showed that, radiologically, surgery on 8.5% and 1.5% of sphenoid sinuses described here carried severe or critical risk of ON injury, respectively. CONCLUSIONS: Head-and-neck surgeons and neurosurgeons should be aware of variations in ON course. The authors composed an optic nerve injury risk classification category based on the sum of individual weights of each of these classes. Reductions in ON injuries require careful evaluation of potential variant anatomies. Preoperative CT scans must be meticulously reviewed to avoid ON injury.