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.

Intraocular pressure effect of anti-vascular endothelial growth factor injection for aggressive posterior retinopathy of prematurity.

PURPOSE: To compare the effect of 0.0125 mL and 0.025 mL doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection on intraocular pressure (IOP) in eyes with aggressive posterior retinopathy of prematurity (ROP). METHODS: In this retrospective cohort study, charts of 52 eyes of 26 consecutive infants were reviewed. The patients received 0.0125 mL (Group 1) or 0.025 mL (Group 2) anti-VEGF agents' intravitreally. The IOP was measured before injection, on the first day, during the first week, and in the first month. After each injection, optic nerve head perfusion was evaluated by a binocular indirect ophthalmoscope. IOP values, complications, use of antiglaucomatous drops, and the effects of anti-VEGF drugs were recorded. RESULTS: The mean baseline IOP before injection was 16.0 ± 3.7 mmHg for Group 1 and 15.5 ± 4.5 mmHg for Group 2 (p = 0.365). The mean value of IOP on the first day was statistically increased in Group 2 (29.2 ± 6.1 mmHg) compared with Group 1 (24.1 ± 6.8 mmHg) (p = 0.013). Moreover, antiglaucomatous drops were needed in 12 eyes for Group 2 compared with seven eyes for Group 1. Anterior chamber paracentesis was not performed after any of the injections. CONCLUSION: This study found that IOP increases after intravitreal injections of anti-VEGF agents for the treatment of ROP. The injection of 0.025 mL anti-VEGF agents increases IOP more than the 0.0125 mL injection in the treatment of infants with aggressive posterior ROP.

Can IL-33 and Endocan be New Markers for Retinopathy of Prematurity?

BACKGROUND: Retinopathy of Prematurity (ROP) is a pathophysiologic condition of the retina due to abnormal proliferation of retinal vessels. OBJECTIVE: The study aimed too ascertain the importance of vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), interleukin-33 (IL-33) and endocan in the diagnosis and follow-up of ROP. METHODS: This prospective cohort study was conducted in the neonatal intensive care unit (NICU) of Health Science University, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey, between February 2017 and August 2018. Preterm infants (gestational age (GA) of ≤32 weeks and birth weight of ≤1500 gr), diagnosed ROP were included in the study. VEGF, IGF-1, IL-33 and endocan levels were evaluated in the cord blood and in the serum before and after treatment of infants in the ROP and control groups. RESULTS: A final number of 146 infants were included in the study. During the study period, 73 infants were identified as the ROP group, and 73 infants were allocated as the control group. In the ROP group, the cord blood VEGF value was higher than the control group (p <0.05). However, IGF-1 levels in the cord blood were lower in the ROP group than control (P<0.05). IL-33 and endocan values in the cord blood were similar in both control and ROP groups (p>0.05). Although serum levels of IL-33, VEGF and endocan were higher before laser treatment, these biomarkers decreased significantly after laser treatment (p <0.05). CONCLUSION: We determined that serum IL-33 and endocan levels might be suggested as sensitive novel markers for the prediction of severe ROP.

Short- and long-term effects of zinc treatment on lacrimal gland histopathology and tear functions tests in radioiodine-administered rats.

PURPOSE:: To investigate the short-term (1 week) and long-term (8 weeks) protective effects of zinc administration on radioiodine (RAI)-induced lacrimal gland damage of rats. METHODS:: A total of 40 rats were divided into two groups: an RAI group (n=20), which was administrated a single dose of 3 mCi of 131I and 1 mL physiologic saline for 7 days by gastric gavage, and a zinc group (n=20), which received a single dose of 3 mCi of 131I and 1 mL of physiologic saline containing zinc sulfate at a concentration of 10 mg/kg concentration for 7 days by gastric gavage. All rats underwent tear function tests before and 1 week after RAI administration. About 1 week after irradiation, half of the animals in each group were sacrificed and the extraorbital lacrimal glands were removed for histopathological examination. The remaining animals of the groups underwent the same procedures at 8 weeks after irradiation. RESULTS:: In the RAI and zinc groups, the mean tear production was 3.75 ± 1.55 and 3.65 ± 1.53 mm at baseline, 2.10 ± 1.07 and 3.30 ± 1.34 mm at week 1 (p=0.004), and 3.22 ± 1.48 and 3.50 ± 1.78 mm at week 8, respectively; further, the mean corneal fluorescein staining scores were 4.65 ± 2.16 and 4.80 ± 2.21 points at baseline, 7.85 ± 1.90 and 5.45 ± 2.06 points at week 1 (p=0.001), and 5.44 ± 2.13 and 4.90 ± 2.08 at week 8, respectively. The histopathological changes in rat lacrimal glands at weeks 1 and 8 were consistent with the tear function test results. CONCLUSIONS:: Zinc treatment seems to be protective against RAI-induced lacrimal gland damage of rats, particularly in the acute period.

Short- and long-term effects of zinc treatment on lacrimal gland histopathology and tear functions tests in radioiodine-administered rats / Efeitos de curto e longo prazo do tratamento com zinco na histopatologia da glândula lacrimal e funções lacrimais em ratos que receberam iodo radioativo

ABSTRACT Purpose: To investigate the short-term (1 week) and long-term (8 weeks) protective effects of zinc administration on radioiodine (RAI)-induced lacrimal gland damage of rats. Methods: A total of 40 rats were divided into two groups: an RAI group (n=20), which was administrated a single dose of 3 mCi of 131I and 1 mL physiologic saline for 7 days by gastric gavage, and a zinc group (n=20), which received a single dose of 3 mCi of 131I and 1 mL of physiologic saline containing zinc sulfate at a concentration of 10 mg/kg concentration for 7 days by gastric gavage. All rats underwent tear function tests before and 1 week after RAI administration. About 1 week after irradiation, half of the animals in each group were sacrificed and the extraorbital lacrimal glands were removed for histopathological examination. The remaining animals of the groups underwent the same procedures at 8 weeks after irradiation. Results: In the RAI and zinc groups, the mean tear production was 3.75 ± 1.55 and 3.65 ± 1.53 mm at baseline, 2.10 ± 1.07 and 3.30 ± 1.34 mm at week 1 (p=0.004), and 3.22 ± 1.48 and 3.50 ± 1.78 mm at week 8, respectively; further, the mean corneal fluorescein staining scores were 4.65 ± 2.16 and 4.80 ± 2.21 points at baseline, 7.85 ± 1.90 and 5.45 ± 2.06 points at week 1 (p=0.001), and 5.44 ± 2.13 and 4.90 ± 2.08 at week 8, respectively. The histopathological changes in rat lacrimal glands at weeks 1 and 8 were consistent with the tear function test results. Conclusions: Zinc treatment seems to be protective against RAI-induced lacrimal gland damage of rats, particularly in the acute period.

RESUMO Objetivo: Investigar se o tratamento com zinco tem efeito protetor, no curto prazo (1 semana) e longo prazo (8 semanas), sobre os danos induzidos na glândula lacrimal por iodo radiotativo (RAI) em ratos. Métodos: Quarenta ratos foram divididos em dois grupos. No grupo RAI (n=20) foi administrada uma única dose de 3 mCi 131I e 1 cc de solução salina fisiológica durante 7 dias, por gavagem gástrica. O grupo zinco (n=20) recebeu uma dose única de 3 mCi 131I e 1 cc de solução salina fisiológica contendo sulfato de zinco na concentração de 10 mg/kg durante 7 dias por gavagem gástrica. Os testes de função lacrimal foram realizadas para todos os animais antes e após uma semana da administração da RAI. Em seguida, após 1 semana da administração, metade dos animais de cada grupo foi sacrificada e as glândulas lacrimais extraorbitais foram removidas para exame histopatológico. Os animais remanescentes dos grupos foram submetidos aos mesmos procedimentos após 8 semanas a radiação. Resultados: As médias de produção lacrimal foram de 3,75 ± 1,55 e 3,65 ± 1,53 mm na linha de base, 2,10 ± 1,07 e 3,30 ± 1,34 mm na 1a semana (p=0,004), e 3,22 ± 1,48 e 3,50 ± 1,78 mm na 8a semana, para os grupos RAI e zinco, respectivamente. As pontuações médias de coloração fluoresceína foram 4,65 ± 2,16 e 4,80 ± 2,21 no início do estudo, 7,85 ± 1,90 e 5,45 ± 2,06 na primeira semana (p=0,001), 5,44 ± 2,13 e 4,90 ± 2,08 pontos na 8a semana, para os grupos RAI e zinco, respectivamente. As alterações histopatológicas das glândulas lacrimais em 1 e 8 semanas foram consistentes com os testes de função lacrimal resultados. Conclusões: O tratamento de zinco parece ser protetor sobre os danos glândula lacrimal induzidos por RAI em ratos, especialmente no período agudo.

The effects of smoking on dry eye parameters in healthy women.

AIM: To investigate the effects of chronic smoking on dry eye parameters. METHODS: Ocular surface disease index (OSDI) and tear function tests such as Schirmer's test, tear break-up-time (TBUT) test and impression cytology of 63 female chronic smokers and 40 age-matched female non-smokers were analyzed statistically. RESULTS: The mean OSDI scores, Schirmer test results and TBUT levels were 35.85 ± 24.01 point, 14.25 ± 5.94 mm and 5.17 ± 2.85 s in chronic smokers and 15.20 ± 12.93 point, 15.48 ± 7.01 mm and 10.03 ± 3.44 s in non-smokers, respectively. Differences in OSDI scores, TBUT levels and impression cytology grades among the chronic smokers and non-smokers were statistically significant. CONCLUSION: Smoking behavior seems to affect the dry eye parameters negatively.

Intravitreal bevacizumab for retinopathy of prematurity in infants ineligible for laser therapy.

BACKGROUND/AIM: To evaluate refractive and strabismic results and the efficacy of intravitreal bevacizumab in retinopathy of prematurity (ROP) ineligible for laser therapy. MATERIALS AND METHODS: Thirty-nine eyes of 20 consecutive infants with high-risk prethreshold ROP (11 infants with Zone I and 9 infants with Zone II disease) who were ineligible for laser therapy due to systemic and/or ocular conditions were treated with intravitreal bevacizumab. Recurrent retinopathy was treated with laser ablation. The final follow-up examination was performed at 29.8 ± 6.0 months of corrected age. RESULTS: All eyes responded to the initial treatment with intravitreal bevacizumab. ROP recurred in 8 eyes (36%) with initial Zone I disease and in only 2 eyes (11%) with initial Zone II disease, which were successfully treated with laser ablation. No eye developed myopia higher than 5.0 diopters. At 2.5 years, the Zone I eyes that had received laser treatment appeared to be more myopic than the Zone I eyes treated only with intravitreal bevacizumab (P = 0.038). A tendency for a higher incidence of strabismus after additional laser therapy was also noted, but was not significant (P = 0.22). CONCLUSION: Avoidance or even deferral of laser ablation with intravitreal bevacizumab may lead to less myopization in ROP compared with conventional laser treatment.

Effects of commonly used intravitreal anti-vascular endothelial growth factor drugs on mesenchymal stem cells derived from the limbus and ciliary body.

BACKGROUND: To investigate the effects of commonly used intravitreal anti-vascular endothelial growth factor (anti-VEGF) antibodies on proliferation index and viability of mesenchymal stem cells derived from ciliary body and limbus (CB-MSC and LMSC). METHODS: CB-MSCs and LMSCs were isolated from newborn rats' eyes, and they were expanded in medium by the explant method. Intravitreally used anti-VEGF drugs, aflibercept, bevacizumab and ranibizumab were tested into the 16-well plates, respectively, at four different concentrations. After keeping them for 48 h, the proliferation indexes and viabilities of CB-MSCs and LMSCs were compared separately by Real-Time Cell Analyzer and Methylthiazoltetrazoli (MTT) test. RESULTS: Anti-VEGFs used at 5-times and 10-times of the standard clinical dosage caused statistically significant negative effects on proliferation indexes of CB-MSCs and LMSCs at the 24th hour compared to control group. Only the anti-VEGF group that had 10-times dosage of those used clinically had a statistically significant negative effect on the viabilties of CB-MSCs and LMSCs. CONCLUSION: Administrations of high doses or repeated standard doses of intravitreal anti-VEGF agents may affect the proliferation indexes and viabilities of CB-MSCs and LMSCs adversely. These novel findings deserve further in vivo investigations.

CHOROIDAL THICKNESS IN INFANTS WITH RETINOPATHY OF PREMATURITY.

PURPOSE: To evaluate choroidal thickness in premature infants and its relationship with stage of retinopathy of prematurity (ROP) using spectral domain optical coherence tomography (SD-OCT). METHODS: Spectral domain optical coherence tomography imaging for measuring subfoveal choroidal thickness was performed for 80 premature infants. Subfoveal choroidal thickness was defined as the distance from the hyperreflective line of the outermost retinal pigment epithelium (RPE) to the innermost hyperreflective line of the choroidoscleral junction. Each measurement was performed at the central fovea (CF) and 0.75 mm to 1.5 mm nasal (N1 and N2) and temporal (T1 and T2) to the fovea. Subfoveal choroidal thickness and grading of cystoid macular edema (CME) were analyzed statistically. RESULTS: Choroidal thickness of CF was found to be significantly greater than nasal (N1 and N2) and temporal (T1 and T2) choroidal thickness (P < 0.05). There was no significant relationship between stage of ROP and nasal (N1 and N2) choroidal thickness (P = 0.057, P = 0.282, respectively). However, CF and temporal (T1 and T2) choroidal thickness was found to be significantly lower at a higher stage of ROP (P = 0.005, P = 0.01 and P = 0.001). No significant relationship was found between subfoveal choroidal thickness and the grades of cystoid macular edema (P > 0.05). The choroidal thickness of CF was found to be correlated with birth weight (r = 0.267, P = 0.017) but not birth week (r = 0.140, P = 0.217). Maximum stage of ROP was found to be negatively correlated with choroidal thickness, at N1, T1, and T2 (r < -0.250, P < 0.02). CONCLUSION: The subfoveal choroid in premature infants can be effectively evaluated using a portable SD-OCT device. Choroidal thickness gets thinner with the severity of ROP and the decrease is more prominent at the central and temporal location. Cystoid macular edema is not correlated with choroidal thickness in premature infants.

Comparison of intravitreal ranibizumab and bevacizumab treatment for retinopathy of prematurity.

PURPOSE: To compare the efficacy of intravitreal ranibizumab and bevacizumab treatment for type 1 retinopathy of prematurity (ROP). METHODS: 36 eyes of 20 patients with type 1 ROP who received anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections between August 2011 and February 2013 were retrospectively evaluated. Fifteen eyes of 8 patients received 0.25 mg ranibizumab (group 1), and 21 eyes of 12 patients received 0.625 mg bevacizumab (group 2). Eyes were examined by indirect ophthalmoscopy on the first day, third day, first week, and first month and as required after injections. Laser photocoagulation was performed in cases with progression of ROP. RESULTS: The mean gestation time was 26.2 ± 2.7 weeks in group 1 patients and 27.1 ± 2.5 weeks in group 2 patients. No statistical difference in the time of gestation was observed between the two groups. The mean follow-up period was 20 ± 4.5 months. Laser photocoagulation was performed in 6 of 15 eyes from group 1 and 2 of 21 eyes from group 2. No eyes developed retinal detachment during the follow-up period. CONCLUSION: Ranibizumab and bevacizumab showed an efficacy in the treatment of type 1 ROP. The incidence of disease relapse was higher in eyes which received ranibizumab. Further randomized, controlled clinical trials are required to compare the efficacy of ranibizumab and bevacizumab.

Comparison of intravitreal ranibizumab and bevacizumab treatment for retinopathy of prematurity / Comparação de ranibizumab e bevacizumab intravítreos no tratamento da retinopatia da prematuridade

ABSTRACT Purpose: To compare the efficacy of intravitreal ranibizumab and bevacizumab treatment for type 1 retinopathy of prematurity (ROP). Methods: 36 eyes of 20 patients with type 1 ROP who received anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections between August 2011 and February 2013 were retrospectively evaluated. Fifteen eyes of 8 patients received 0.25 mg ranibizumab (group 1), and 21 eyes of 12 patients received 0.625 mg bevacizumab (group 2). Eyes were examined by indirect ophthalmoscopy on the first day, third day, first week, and first month and as required after injections. Laser photocoagulation was performed in cases with progression of ROP. Results: The mean gestation time was 26.2 ± 2.7 weeks in group 1 patients and 27.1 ± 2.5 weeks in group 2 patients. No statistical difference in the time of gestation was observed between the two groups. The mean follow-up period was 20 ± 4.5 months. Laser photocoagulation was performed in 6 of 15 eyes from group 1 and 2 of 21 eyes from group 2. No eyes developed retinal detachment during the follow-up period. Conclusion: Ranibizumab and bevacizumab showed an efficacy in the treatment of type 1 ROP. The incidence of disease relapse was higher in eyes which received ranibizumab. Further randomized, controlled clinical trials are required to compare the efficacy of ranibizumab and bevacizumab.

RESUMO Objetivo: Comparar a eficácia de ranibizumab e bevacizumab intravítreos no tratamento da retinopatia da prematuridade (ROP) tipo 1. Método: Foram avaliados retrospectivamente 36 olhos de 20 pacientes com retinopatia da prematuridade tipo 1 que receberam injeções intravítreas anti fator de crescimento endotelial vascular (anti VEGF) entre agosto de 2011 e fevereiro 2013. Quinze olhos de 8 pacientes receberam 0,25 mg ranibizumab (grupo 1) e 21 olhos de 12 pacientes receberam 0,625 mg bevacizumab (grupo 2). Os olhos foram examinados por oftalmoscopia indireta no primeiro dia, terceiro dia, primeira semana, e primeiro mês e conforme necessário após a injeção. Fotocoagulação com laser foi realizada quando foi detectada progressão da retinopatia da prematuridade. Resultados: Média do tempo de gestação para os pacientes do grupo 1 foi de 26,2 ± 2,7 semanas, enquanto para o grupo 2 foi de 27,1 ± 2,5 semanas. Não houve diferença estatística em relação ao tempo de gestação entre os grupos. A média de acompanhamento foi de 20 ± 4,5 meses. Fotocoagulação a laser foi realizada a 6 dos 15 olhos do grupo 1 e 2 dos 21 olhos do grupo 2. Nenhum dos olhos desenvolveu descolamento de retina no período de acompanhamento. Conclusão: O ranibizumab e bevacizumab são eficazes no tratamento da retinopatia da prematuridade tipo 1. Incidência de progressão foi maior nos olhos que receberam ranibizumab. Ensaios clínicos controlados futuros são necessários para comparar esses dois medicamentos.

Successful treatment of ligneous conjunctivitis with topical fresh frozen plasma in an infant / Sucesso do tratamento da conjuntivite lenhosa com uso tópico de plasma fresco congelado em uma criança

ABSTRACTA 6-month-old female infant presented to our clinic with bilateral eyelid swelling, yellowish-white membranes under both lids, and mucoid ocular discharge. Her aunt had similar ocular problems that were undiagnosed. The conjunctival membranes were excised and histopathological investigation of these membranes showed ligneous conjunctivitis. Further, laboratory examination revealed plasminogen deficiency. A good response was observed to topical fresh frozen plasma (FFP) treatment without systemic therapy, and the membranes did not recur during the treatment. Topical FFP treatment may facilitate rapid rehabilitation and prevent recurrence in patients with ligneous conjunctivitis.

RESUMOUma criança feminina com seis meses de idade se apresentou à nossa clínica com edema palpebral bilateral, membranas brancas amareladas sob as pálpebras de ambos os olhos e descarga mucosa. Sua tia já havia apresentado problemas oculares semelhantes que não foram diagnosticados. As membranas conjuntivais foram excisadas e a investigação histopatológica das membranas demonstraram conjuntivite lenhosa. O diagnóstico de deficiência de plasminogênio foi obtido a partir de um exame laboratorial. Tratamento tópico com plasma fresco congelado (FFP) sem qualquer terapia sistêmica mostrou boa resposta. Não foram observadas recorrências das membranas. O tratamento tópico com FFP pode ajudar a reabilitação rápida e prevenir a recorrência em pacientes com conjuntivite lenhosa.

Anatomical and visual outcomes of ranibizumab injections in retinal pigment epithelium tears.

PURPOSE: To report the anatomical and visual results in patients diagnosed as having retinal pigment epithelium (RPE) tears after receiving ranibizumab injections. METHODS: Eyes diagnosed as having RPE tears with a minimum 6-month follow-up were retrospectively evaluated. Each eye was treated with at least three doses of ranibizumab at monthly intervals. Best-corrected visual acuity (BCVA), anterior segment findings, intraocular pressure, and fundus examination results were evaluated during control visits. Color fundus photography, fundus fluorescein angiographies, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) images were obtained. The height of pigment epithelial detachment (PED) was measured by SD-OCT. RESULTS: Twelve eyes with RPE tears were studied. Nine eyes (75%) developed RPE tears during ranibizumab injections for choroidal neovascularization (eight eyes with vascularized PED and one eye with choroidal osteoma), and tears occurred in three eyes before any injections. The median number of ranibizumab injections after diagnosis of RPE tears was 3 (min 2, max 5). In the most recent follow-up visit, there was no statistically significant correlation between the grade of RPE and logMAR of BCVA (p>0.05, r=0.112). Eight of twelve eyes had PED, and seven of these had irregular PED contours before injection therapy. The mean PED height was 447 ± 122 µm. CONCLUSIONS: In this series, RPE tears developed mostly after intravitreal anti-VEGF injections for vascularized PED. Increased vertical height and irregular contours of the PEDs can be risk factors for the formation of RPE tears. The continuation of anti-VEGF therapy after tear formation is beneficial for vision improvement in eyes with RPE tears.

The relationship of birth weight, gestational age, and postmenstrual age with ocular biometry parameters in premature infants / A relação entre o peso ao nascer, idade gestacional e idade pós-menstrual com a biometria ocular em bebês prematuros

ABSTRACT Purpose: To analyze ocular biometry parameters and evaluate their relationship with gestational age, birth weight, and postmenstrual age in prematurely born infants. Methods: The right eyes of 361 premature infants born before the 36th gestational week were evaluated. Birth weight, gestational week, and gender were recorded. An A-scan Biometer was used for obtaining axial measurements, including anterior chamber depth, lens thickness, vitreous length, and total axial length. Results: Gestational age and birth weight values ranged from 23 to 36 weeks and from 560 to 2,670 g, respectively. The mean gestational age and birth weight were 30.8 ± 2.8 weeks and 1,497.9 ± 483.6 g, respectively. During the first examination (4-5 weeks of postnatal age), birth weight and gestational age of the infants correlated significantly and positively with lens thickness, vitreous length, and axial length (r>0.5, p<0.001), but not with anterior chamber depth (r<0.5). Increased vitreous and axial lengths correlated significantly with increasing postmenstrual age of the infants (r=0.669, p<0.001; r=0.845, p<0.001, respectively). Conclusions: Lens thickness, vitreous length, and axial length, but not anterior chamber depth, were significantly correlated with birth weight and gestational age. All four parameters increased with increasing postmenstrual age, with higher correlations for vitreous and axial lengths than for anterior chamber depth and lens thickness. It was concluded that axial elongation resulted primarily from increasing posterior chamber length. .

RESUMO Objetivo: Medir os comprimentos axiais dos componentes oculares e avaliar a relação com a idade gestacional, peso ao nascer e idade pós-menstrual em crianças nascidas prematuramente. Método: O olho direito de 361 crianças prematuras, que nasceram com menos de 36 semanas de gestação, foram avaliados. O peso ao nascer, semanas de gestação e gênero foram registrados. Um biômetro A-scan foi utilizado para a obtenção das medidas axiais da profundidade da câmara anterior, espessura do cristalino, comprimento vítreo e comprimento axial total. Resultados: A idade gestacional e os valores de peso ao nascimento variaram de 23 a 36 semanas e de 560 a 2.670 g, respectivamente. A idade gestacional e o peso ao nascer foram 30,8 ± 2,8 semanas e 1.497,9 ± 483,6 g. Ao primeiro exame (4 a 5 semanas de idade pós-natal), o peso ao nascimento e a idade gestacional dos recém-nascidos apresentaram correlação positiva, estatisticamente significativa, com a espessura do cristalino, comprimento vítreo e comprimento axial total (r>0,5 p<0,001), mas não com a profundidade da câmara anterior (r<0,5). O alongamento de comprimento vítreo e do comprimento axial total se correlacionaram significativamente com o aumento da idade pós-menstrual dos lactentes (r=0,669; p<0,001 e r=0,845; p<0,001, respectivamente). Conclusões: A espessura do cristalino, o comprimento vítreo e o comprimento axial total, mas não profundidade da câmara anterior, foram significativamente correlacionados com o peso ao nascimento e com a idade gestacional. Todos os quatro componentes aumentaram com a idade pós-menstrual, apresentando correlações mais elevadas do comprimento vítreo e comprimento axial total do que da profundidade da câmara anterior e espessura do cristalino. Concluiu-se que o alongamento axial resultou principalmente do aumento do comprimento da câmara posterior. .

Anatomical and visual outcomes of ranibizumab injections in retinal pigment epithelium tears / Resultados anatômicos e visuais de injeções de ranibizumab em roturas do epitélio pigmentado da retina

ABSTRACT Purpose: To report the anatomical and visual results in patients diagnosed as having retinal pigment epithelium (RPE) tears after receiving ranibizumab injections. Methods: Eyes diagnosed as having RPE tears with a minimum 6-month follow-up were retrospectively evaluated. Each eye was treated with at least three doses of ranibizumab at monthly intervals. Best-corrected visual acuity (BCVA), anterior segment findings, intraocular pressure, and fundus examination results were evaluated during control visits. Color fundus photography, fundus fluorescein angiographies, fundus autofluorescence, and spectral domain optical coherence tomography (SD-OCT) images were obtained. The height of pigment epithelial detachment (PED) was measured by SD-OCT. Results: Twelve eyes with RPE tears were studied. Nine eyes (75%) developed RPE tears during ranibizumab injections for choroidal neovascularization (eight eyes with vascularized PED and one eye with choroidal osteoma), and tears occurred in three eyes before any injections. The median number of ranibizumab injections after diagnosis of RPE tears was 3 (min 2, max 5). In the most recent follow-up visit, there was no statistically significant correlation between the grade of RPE and logMAR of BCVA (p>0.05, r=0.112). Eight of twelve eyes had PED, and seven of these had irregular PED contours before injection therapy. The mean PED height was 447 ± 122 µm. Conclusions: In this series, RPE tears developed mostly after intravitreal anti-VEGF injections for vascularized PED. Increased vertical height and irregular contours of the PEDs can be risk factors for the formation of RPE tears. The continuation of anti-VEGF therapy after tear formation is beneficial for vision improvement in eyes with RPE tears. .

RESUMO Objetivo: Apresentar os resultados anatômicos e visuais de injeções de ranibizumab em pacientes que foram diagnosticados com roturas do epitélio pigmentado da retina (RPE). Métodos: Olhos com um mínimo de seis meses de acompanhamento após diagnóstico de roturas do RPE foram avaliados retrospectivamente. Cada olho foi tratado com, pelo menos, três doses de ranibizumab em intervalos mensais. Acuidade visual com a melhor correção (BCVA), achados do segmento anterior, pressão intraocular e exames de fundo de olho foram avaliados nas visitas de controle. Retinografia colorida, angiografias fluoresceínicas, autofluorescência de polo posterior e tomografia de coerência óptica imagens de domínio espectral (SD-OCT) foram obtidos. A altura do descolamento do epitélio pigmentado (PED) foi medida com SD-OCT. Resultados: Doze olhos com roturas do epitélio pigmentado da retina foram incluídos no estudo. Nove olhos (75%) desenvolveram roturas do epitélio pigmentado da retina durante as injeções ranibizumab para neovascularização de coroide (oito olhos com descolamento do epitélio pigmentado vascularizado e um olho com osteoma de coroide), a rotura ocorreu em três olhos antes de quaisquer injeções. A mediana do número de injeções de ranibizumab após o diagnóstico da rotura do RPE foi de 3 (mínimo 2, máximo 5). Na visita de acompanhamento mais recente, não houve correlação estatisticamente significante entre o grau de RPE e logMAR de BCVA (p>0,05, r=0,112). Oito dos doze olhos tinham descolamento do epitélio pigmentado, desses, 7 olhos tinham PEDs com contornos irregulares antes da injeção. A altura média do PED foi 447 ± 122 µm. Conclusões: Nesta série, as roturas de epitélio pigmentado da retina aconteceram principalmente após a injeção intravítrea anti-VEGF para descolamento do epitélio pigmentado vascularizado. O aumento da altura vertical e contornos irregulares dos PEDs podem ser considerados fatores de risco para a formação da rotura ...

Spectral-Domain OCT Analyses of Macular Changes After Ranibizumab Therapy for Type 1 Retinopathy of Prematurity.

PURPOSE: To investigate the clinical and macular spectral-domain optical coherence tomography (SD-OCT) findings after intravitreal ranibizumab treatment for type 1 retinopathy of prematurity (ROP). METHODS: Eighteen eyes of 10 premature infants with type 1 ROP were retrospectively studied. All eyes were treated with intravitreal ranibizumab as monotherapy. Macular SD-OCT was performed before and after intravitreal ranibizumab therapy using a portable SD-OCT machine; the follow-up images were taken 1 day, 1 week, 1 month, and 2 months after therapy. RESULTS: Among the 10 infants, there were six males and four females. Mean central foveal thickness before and 2 months after intravitreal ranibizumab was 292.5 ± 61.4 and 171.6 ± 21.7 µm, respectively. Differences were statistically significant (P = .01). Sixteen eyes of eight patients had macular edema before treatment. Two eyes of two patients developed a crack in the outer hyperreflective line on SD-OCT corresponding with retinal pigment epithelium with serous retinal detachment 1 day after treatment. Macular edema regressed in all patients 2 months after intravitreal ranibizumab therapy. Mean follow-up time was 11.4 ± 1.5 months. No recurrence was seen except in both eyes of one patient treated with intravitreal ranibizumab monotherapy. CONCLUSIONS: Intravitreal ranibizumab injection is effective for the treatment of type 1 ROP as a monotherapy agent; however, macular changes not seen with indirect ophthalmoscope may develop.

Povidone iodine in the treatment of adenoviral conjunctivitis in infants.

CONTEXT: Adenoviral conjunctivitis. OBJECTIVE: To examine the effects of conjunctival irrigation with povidone iodine in infants with adenoviral conjunctivitis. MATERIAL AND METHODS: An outbreak of adenovirus conjunctivitis occurred between September and December 2012 at the neonatal intensive care unit of our hospital. Forty-three infants with adenoviral conjunctivitis were examined in this study. Thirty-five eyes of 35 infants who had detailed ophthalmological examination and clinical scoring were included. The conjunctiva of 15 infants (Group 1) were irrigated with povidone iodine 2.5% solution and then treated with preservative-free artificial tears and preservative-free antibiotic drops. Twenty infants (Group 2) were treated only with the same drops with the same posology, without conjunctival irrigation with povidone iodine. Patients were examined two times a week until the complete recovery. Lid edema, conjunctival chemosis, fragility of conjunctival vasculature, pseudomembrane formation, and corneal involvement were scored clinically. RESULTS: Twenty patients (57%) were female and 15 patients (43%) were male and mean age was 3.1 months (ranged from 1 to 4 months). No relation was found between gender and clinical scores. Statistically significant lower clinical scores were obtained from Group 1. The median recovery time was earlier in Group 1 (7 d) than Group 2 (12 d) (p = 0.001). CONCLUSION: Conjunctival irrigation with 2.5% povidone iodine is effective in the treatment of adenoviral conjunctivitis in infants.

Macular findings obtained by spectral domain optical coherence tomography in retinopathy of prematurity.

Purpose. To examine the macular findings obtained with spectral domain optical coherence tomography (SD OCT) in infants with retinopathy of prematurity (ROP). Materials and Methods. The macular SD OCT images of 190 premature infants were analyzed. Data regarding central foveal thickness (CFT), cystoid macular edema (CME), and cyst grading were compared. The relationships of CFT with gestational age and birth weight were investigated. Results. The results were obtained from 358 eyes of 179 infants (81 females and 98 males) of a mean gestational age of 30.9 ± 2.7 weeks and a mean birth weight of 1609 ± 477 g. ROP was diagnosed in 126 eyes and CME in 139 eyes. A significantly greater percentage of eyes with ROP were found to have CME (54%) compared to eyes without ROP (31%; P = 0.001). The incidence of CME was 46.3% for stage 1 ROP, 57.1% for stage 2, and 87.5% for stage 3. There was a weakly inverse correlation between CFT, gestational age, and birth weight (P = 0.025, r = -0.227; P = 0.002, r = -0.182, resp., Spearman correlation test). Conclusions. High-quality SD OCT images can be obtained from premature infants using the iVue system. Severity and frequency of CME in premature infants increase as stage of ROP increases.

Comparison of the effects of subconjunctival and topical anti-VEGF therapy (bevacizumab) on experimental corneal neovascularization / Comparação do efeito da terapia anti-VEGF (bevacizumab) subconjuntival e tópica na neovascularização corneana experimental

Purpose: To compare the effects of bevacizumab applied either subconjunctivally or topically, in a rat model of corneal neovascularization induced by alkali burn. Methods: The right corneas of 24 Wistar-Albino rats were cauterized with silver nitrate sticks. The rats were divided randomly and equally into three groups: no treatment control (n=8), subconjunctival bevacizumab treatment (n=8), and topical bevacizumab treatment (n=8). Immediately following cauterization, the subconjunctival group was treated with a 0.05 ml (1.25 mg) bevacizumab subconjunctival injection. The topical group was treated with 10 mg/ml bevacizumab twice daily, and the control group received subconjunctival saline injections twice daily. The burn stimulus and neovascularization scores were evaluated using a technique previously described by Mahoney and Waterbury. Digital photographs were obtained before the eyes were enucleated and corneal sections were then analyzed by histopathology. Results: The mean burn stimulus score was 1.86 ± 0.6 and there was no statistical difference between the groups (p=0.730). The mean neovascularization scores in the subconjunctival and topical bevacizumab groups were statistically lower than the control group (p<0.05). The mean percentage area of corneal neovascularization was 82.5 ± 22.1 in the control group, 42.7 ± 15.0 in the subconjunctival group, and 55.8 ± 18.2 in the topical group. The differences between the control and treatment groups were statistically significant (p<0.05). Histopathology showed that the treatment groups presented less neovascularization, inflammation, and fibroblast activity than the control group (p<0.05). Conclusions: This study demonstrates that both subconjunctival and topical administrations of bevacizumab inhibit corneal neovascularization and decrease inflammation and fibroblast activity in a rat model of corneal neovascularization induced by alkali burn. .

Objetivo: Comparar o efeito de bevacizumab aplicado subconjuntival e topicamente em um modelo de neovascularização de córnea de ratos induzida por queimadura alcalina. Métodos: Córneas direitas de 24 ratos Wistar-Albino foram cauterizados por nitrato de prata. Os indivíduos foram divididos aleatoriamente e igualmente em três grupos: controle (n=8), o bevacizumab subconjuntival (n=8), o bevacizumab tópico (n=8). Imediatamente após a cauterização, 0,05 ml (1,25 mg) de bevacizumab foi injetado no grupo subconjuntival. Grupo tópico foi inculcado com 10 mg/ml de bevacizumab duas vezes por dia. O grupo controle recebeu solução salina normal, topicamente, duas vezes ao dia. A graduação do estímulo da queimadura e a graduação da neovascularização foram avaliados utilizando a técnica descrita por Mahoney e Waterbury. Fotografias digitais foram obtidas dos olhos serem enucleados. Seções da córnea foram analisadas por histopatologia. Resultados: A média da graduação do estímulo da queimadura foi de 1,86 ± 0,6 e não houve diferença estatisticamente entre os grupos (p=0,730). As médias das graduações da neovascularização no grupo bevacizumab subconjuntival e no grupo bevacizumab tópico foram estatisticamente menores do que o grupo controle (p<0,05). A percentagem média de área de neovascularização da córnea foi de 82,5 ± 22,1 no grupo controle, 42,7 ± 15,0 no grupo subconjuntival e 55,8 ± 18,2 no grupo tópico. As diferenças entre os grupos de tratamento e grupo de controlo foram estatisticamente significativos (p<0,05). A histopatologia mostrou que os grupos de tratamento apresentavam menos neovascularização, inflamação e atividade de fibroblastos do que o grupo controle (p<0,05). ...

Analysis of the horizontal corneal diameter, central corneal thickness, and axial length in premature infants / Diâmetro horizontal corneano, espessura corneana central e o comprimento axial em prematuros

Purpose: To determine the horizontal corneal diameter, central corneal thickness, and axial length in premature infants. Methods: Infants with a birth weight of less than 2,500 g or with a gestation period of less than 36 weeks were included in the study. Infants with retinopathy of prematurity (ROP) were allocated to Group 1 (n=138), while those without ROP were allocated to Group 2 (n=236). All infants underwent a complete ophthalmologic examination, including corneal diameter measurements, pachymetry, biometry, and fundoscopy. Between-group comparisons of horizontal corneal diameter, central corneal thickness, and axial lengths were performed. Independent sample t-tests were used for statistical analysis. Results: Data was obtained from 374 eyes of 187 infants (102 female, 85 male). The mean gestational age at birth was 30.7 ± 2.7 weeks (range 25-36 weeks), the mean birth weight was 1,514 ± 533.3 g (range 750-1,970 g), and the mean postmenstrual age at examination was 40.0 ± 4.8 weeks. The mean gestational age and the mean birth weight of Group 1 were statistically lower than Group 2 (p<0.05). There were no significant differences in horizontal corneal diameter, central corneal thickness, and axial length between the two groups (p>0.05). Conclusions: The presence of ROP in premature infants does not alter the horizontal corneal diameter, central corneal thickness, or axial length. .

Objetivo: Determinar o diâmetro horizontal corneano, a espessura corneana central e o comprimento axial de prematuros. Métodos: Crianças com peso de nascimento menor que 2.500 g ou idade gestacional menor que 36 semanas foram incluídas no estudo. Recém-nascidos com retinopatia da prematuridade (ROP) foram alocados no Grupo 1 (n=138), sem ROP foram alocados no Grupo 2 (n=236). Todos os bebês foram submetidos a exame oftalmológico completo, incluindo medida do diâmetro corneano, paquimetria, biometria e fundoscopia. O diâmetro horizontal corneano, a espessura corneana central e o comprimento axial dos grupos foram comparados. Teste de "Student" para amostras independentes foi utilizado na análise estatística. Resultados: Os dados foram obtidos a partir de 374 olhos de 187 crianças (102 meninas, 85 meninos). A idade gestacional média ao nascer foi de 30,7 ± 2,7 semanas (variação de 25 a 36 semanas). O peso médio ao nascer foi de 1.514 ± 533,3 g (variação de 750 a 1.970 g). A idade pós-menstrual média de exame foi de 40,0 ± 4,8 semanas. A idade gestacional e o peso médio do Grupo 1 eram estatisticamente inferiores aos do Grupo 2 (p<0,05). Não houve diferenças significativas no diâmetro horizontal da córnea, espessura corneana central e medidas de comprimento axial entre dois grupos (p>0,05). Conclusões: A presença de ROP em prematuros não altera o diâmetro da córnea horizontal, espessura corneana central e o comprimento axial. .