Evaluation of systemic immune-inflammatory index in patients with wet age-related macular degeneration.

CLINICAL RELEVANCE: The systemic immune-inflammatory index is a relatively new parameter and has been shown to increase in inflammatory diseases. BACKGROUND: The primary aim of this study was to investigate the systemic immune-inflammatory index in patients with wet-type age-related macular degeneration. The secondary aim was to determine the relationship between best-corrected visual acuity, central macular thickness, subfoveal choroidal thickness, systemic immune-inflammatory index, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio. METHODS: This study retrospectively analysed patients with wet-type age-related macular degeneration between 2018 and 2022. Demographic data and peripheral complete blood count were obtained from the electronic medical record system. The most recent best-corrected visual acuity, central macular thickness, and subfoveal choroidal thickness values (within one month) for complete blood count were obtained from case sheets and the optical coherence tomography digital image database. The systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were calculated. Age- and sex-matched controls were also generated. RESULTS: Thirty-three patients (23 males, 10 females) with wet-type age-related macular degeneration and 43 controls (24 males, 19 females) were included. The groups were similar in terms of age and sex (78.0 ± 6.3 vs. 75.6 ± 6.6 years, p = 0.59; p = 0.38 for sex). The systemic immune-inflammatory index was higher in the wet-type age-related macular degeneration group (460.5 vs. 440.4); however, this difference was not statistically significant. When the correlations between the systemic immune-inflammatory index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, best-corrected visual acuity (logMAR), central macular thickness, and subfoveal choroidal thickness were examined, there was only a moderate positive correlation between best-corrected visual acuity and platelet-to-lymphocyte ratio (r = 0.46, p = 0.007). CONCLUSION: There were no differences in the systemic immune-inflammatory index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio between the wet-type age-related macular degeneration and control groups. There was a positive correlation between the platelet-to-lymphocyte ratio and best-corrected visual acuity (logMAR). The systemic immune-inflammatory index was higher in patients with wet-type age-related macular degeneration than in the control group; however, this difference was not statistically significant.

Is there a relationship between the first-day results of anti-VEGF therapy for macular edema due to vascular diseases and longterm outcomes? / Há alguma relação entre os resultados do primeiro dia de terapia anti-VEGF para edema macular devido a doenças vasculares e o resultado a longo prazo?

ABSTRACT Purpose: To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. Methods: The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. Results: In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). Conclusion: The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection.

RESUMO Objetivo: Avaliar as alterações precoces após a primeira injeção de anticorpos antifator de crescimento endotelial vascular (anti-VEGF) em casos de edema macular secundário à retinopatia diabética e oclusão da veia da retina e a relação entre essas alterações e o resultado a longo prazo. Métodos: Foram incluídos no estudo pacientes que receberam uma injeção de antifator de crescimento endotelial vascular para edema macular, virgem de tratamento e devido à oclusão da veia retiniana ou a retinopatia diabética. A espessura macular central foi medida no início do tratamento e no 1º dia, 2ª semana e 1º mês após a injeção, bem como na última visita, através de tomografia de coerência óptica de domínio espectral. Definiu-se uma "boa resposta" como uma redução ≥10% na espessura macular central no 1º dia após a injeção. Os pacientes foram reavaliados na última visita com relação à resposta ao tratamento no 1º dia após a injeção, com base em um resultado anatômico favorável, definido como uma espessura macular central <350 µm. Resultado: Foram registrados 26 (44,8%) pacientes com edema macular e oclusão da veia da retina e 32 (55,2%) com edema macular e retinopatia diabética. O tempo médio de acompanhamento foi de 24,0 meses (desvio-padrão de 8,5 meses). Foi observada uma diminuição estatisticamente significativa da espessura macular central após o tratamento antifator de crescimento endotelial vascular tanto em pacientes com edema macular e oclusão da veia retiniana quanto naqueles com edema macular e retinopatia diabética (p<0,001 para ambos). Todos os pacientes com edema macular e oclusão da veia retiniana responderam bem no 1º dia pós-injeção. Todos os que responderam mal no 1º dia pós-injeção pertenciam ao grupo com edema macular e retinopatia diabética (n=16,50%). A presença de manchas hiperrefletivas foi maior nos pacientes que responderam mal do que naqueles que tiveram boa resposta no grupo com edema macular e retinopatia diabética (p=0,03). Um dos 42 (2,4%) pacientes com boa resposta total teve espessura macular central >350 um, enquanto 5 (31,2%) do total de 16 pacientes com resposta ruim apresentaram espessura macular central >350 µm na última visita (p=0,003). Conclusão: O resultado anatômico de longo prazo do edema macular secundário à oclusão da veia retiniana e à retinopatia diabética pode ser previsto pela resposta ao tratamento no 1º dia após a injeção de antifator de crescimento endotelial vascular.

Is there a relationship between the first-day results of anti-VEGF therapy for macular edema due to vascular diseases and longterm outcomes?

PURPOSE: To evaluate early changes after the first antivascular endothelial growth factor injection for macular edema secondary to diabetic retinopathy and retinal vein occlusion and the relationship between longterm outcomes. METHODS: The study enrolled patients who received anti-vascular endothelial growth factor injections for treatment-naive macular edema due to retinal vein occlusion and diabetic retinopathy. The central macular thickness was measured at baseline, post-injection day 1, week 2, and month 1, and at the last visit using spectral-domain optical coherence tomography. A good response was defined as a central macular thickness reduction of ≥10% on post-injection day 1. Patients were reassessed at the last visit with regard to treatment response on post-injection day 1 based on the favorable anatomic outcome defined as a central macular thickness <350 µm. RESULTS: In total, 26 (44.8%) patients had macular edema-retinal vein occlusion and 32 (55.2%) had macular edema-diabetic retinopathy. The mean follow-up time was 24.0 (SD 8.5) months. A statistically significant decrease in the central macular thickness was observed in both patients with macular edema-retinal vein occlusion and macular edema-diabetic retinopathy after antivascular endothelial growth factor injection therapy (p<0.001 for both). All patients with macular edema-retinal vein occlusion were good responders at post-injection day 1. All nongood responders at post-injection day 1 belong to the macular edema-diabetic retinopathy group (n=16.50%). The rate of hyperreflective spots was higher in nongood responders than in good responders of the macular edema-diabetic retinopathy group (p=0.03). Of 42 (2.4%) total good responders, one had a central macular thickness >350 µm, whereas 5 (31.2%) of 16 total nongood responders had a central macular thickness >350 µm at the last visit (p=0.003). CONCLUSION: The longterm anatomical outcomes of macular edema secondary to retinal vein occlusion and diabetic retinopathy may be predicted by treatment response 1 day after antivascular endothelial growth factor injection.

Paracentral acute middle maculopathy in a fasting patient after cataract surgery and its response to hyperbaric oxygen therapy.

INTRODUCTION: Paracentral acute middle maculopathy (PAMM) is a structural optical coherence tomography (OCT) sign secondary to ischemia in the intermediate and deep retinal vascular network, characterized by hyperreflectivity in the inner nuclear layer (INL). AIM: Our objective is to demonstrate PAMM development following uncomplicated cataract surgery, possibly triggered by fasting and dehydration. We also aim to emphasize the potential role of hyperbaric oxygen therapy in treating PAMM. CASE PRESENTATION: A 66-year-old man with a past medical history of Neurofibromatosis type 1 and cardiovascular disease underwent uncomplicated cataract surgery in the left eye. The patient was also fasting due to Ramadan. The patient complained of very low vision during the routine postoperative examination on the third day. His-best-corrected visual acuity (BCVA) was counting fingers at 1 meter. His-anterior and posterior segment examination was unremarkable. In infrared imaging, a large hyporeflective area was observed in the parafoveal region, and structural OCT also showed increased hyperreflectivity in the middle retinal layers corresponding to the junction of INL and outer plexiform layer (OPL) involving the entire INL which suggested PAMM. Following 14 sessions of hyperbaric oxygen therapy, the patient's BCVA increased to 0.9 on the 14th day of diagnosing PAMM. CONCLUSION: To the best of our knowledge, this is the first case representing a patient with  PAMM triggered by fasting and cataract surgery who responded positively to hyperbaric oxygen therapy. However, triggering of PAMM by fasting is entirely unproven and that this observation occurred in a highly complex case with many other possible contributing factors. Also, the triggering of PAMM by some manipulation during surgery is equally unproven.

Posterior sub-Tenon triamcinolone injection in the treatment of postoperative cystoid macular edema secondary to pars plana vitrectomy.

Purpose: To evaluate the efficacy and safety of posterior sub-Tenon triamcinolone (PSTA) in chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy (PPV). Methods: Consecutive 22 patients who developed chronic PCME after PPV and underwent PSTA treatment were included in this retrospective study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured pre injection and post injection at one month, three months, six months, and at last visit. The patients were divided into three groups according to the injection response status: complete, partial, and resistant. Results: The mean follow-up period was 26.4 ± 16.2 months after PSTA. According to pre-injection values, there was a significant improvement in the values of BCVA and CMT at the first, third, and sixth months and at the last examination (P < 0.05). In the final examination, PCME recovered completely in 12 patients, partially in 8 patients, and resistance was observed in 2 patients. Conclusion: Posterior sub-Tenon triamcinolone seems to be effective in chronic PCME following PPV.

Comparison of Intravitreal Dexamethasone Implant and Posterior Subtenon Triamcinolone Injection in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes.

INTRODUCTION: The aim of this study was to compare posterior subtenon triamcinolone (PSTA) application and intravitreal dexamethasone phosphate (DEX) implant in the treatment of diabetic macular edema (DME) in vitrectomized eyes. METHODS: This retrospective study included 64 (48.12%) patients who received PSTA and 69 (51.88%) patients who received DEX implants in DME treatment after vitrectomy. Best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed before injection; at 1, 3, and 6 months after injection. The postinjection values were statistically compared with the preinjection value. RESULTS: All postinjection CMT values in both groups were lower than the preinjection value (p < 0.05 for all). There were statistically significant increases in all postinjection BCVAs of the DEX group and postinjection 1-month BCVA of the PSTA group (p < 0.05 for all). However, there was no significant difference in BCVA values of the PSTA group at 3 and 6 months after injection (p > 0.05 for both). There was no statistically significant difference in all postinjection IOP values of the PSTA group (p > 0.05 for all). However, significant increases in IOP were observed in the DEX group at 1 and 3 months after injection (p < 0.05 and p = 0.02, respectively). The number of additional injections between the 3rd and 6th months after the initial injection was statistically higher in the PSTA group (p = 0.006). CONCLUSION: Both intravitreal DEX and PSTA administration are effective in the treatment of DME after vitrectomy. However, visual improvement persisted longer, and the need for additional injections was less in patients who received DEX.

Retinal nerve fibre layer and ganglion cell layer thickness changes following intravitreal aflibercept for age-related macular degeneration.

PURPOSE: To evaluate the effect of intravitreal aflibercept (IVA) injections on peripapillary retinal nerve fibre layer thickness (RNFLT) and macular ganglion cell layer thickness (GCLT) in neovascular age-related macular degeneration (nAMD) patients during a 1-year follow-up. METHODS: This is a prospective study including 34 patients who were treated with aflibercept for treatment-naive nAMD. Following a loading phase of 3-monthly aflibercept, re-injections were performed on a pro re nata regimen for 12 months. Best-corrected visual acuity, intraocular pressure, and spectral-domain-optical coherence tomography analysis were performed at baseline and 1 month, 3 months, 6 months, and 12 months following treatment. Peripapillary RNFLT and macular GCLT along with the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were evaluated at each visit. RESULTS: Mean number of aflibercept injections was 6.0 ± 1.8. Significant thinning was observed at the central macular ganglion cell layer and at 1 mm superior, temporal, and nasal ganglion cell layer compared to baseline at 1-year (p < 0.05). No significant change of RNFLT was shown (p > 0.05). Mean CMT and SFCT were significantly reduced after IVA therapy (p < 0.05, for both). No correlation was found between injection number and GCLT change. CONCLUSIONS: Intravitreal aflibercept caused significant ganglion cell layer thinning during a 1-year follow-up without any changes in RNFLT. Intravitreal aflibercept itself may have a chance to induce decreased GCLT in nAMD patients.

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema.

AIM: To evaluate long-term macular changes following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diabetic macular edema (DME). METHODS: Forty eligible eyes of 37 patients were included in this retrospective study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and 5-mm macular volume (5-MV) were examined preoperatively, postoperatively after 1, 2, 3, 6, 12, and 24 months, and at a final visit. Response to surgical treatment was considered as recurrence, reincrease, or recovery of DME based on macular changes. RESULTS: Mean follow-up time was 51.1 ± 19.0 months after surgery. Recurrence (n = 5) and reincrease (n = 17) of DME was observed in 22 eyes (55%) and additional treatments were applied. Recovery of DME was observed in 18 eyes (45%). Preoperative and final-visit mean BCVA (logMAR) was 1.08 ± 0.37 and 0.93 ± 0.45, respectively (p = 0.02). Preoperative and final-visit mean CMT was 514.74 ± 155.65 and 281.87 ± 112.58 µm, respectively (p < 0.001). The 5-MV significantly decreased following surgery (from 8.18 ± 1.57 to 6.52 ± 1.39 mm3; p < 0.001). DME was present in 12 eyes (30%) at the final visit. CONCLUSION: Although PPV with ILM peeling had efficacy in DME management, this effect tended to decrease over time, such that a considerable number of patients required additional treatment.

Comparison of anatomical and visual outcomes following different anti-vascular endothelial growth factor treatments in subretinal neovascular membrane secondary to type 2 proliferative macular telangiectasia.

PURPOSE: To evaluate central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and visual outcomes following different intravitreal anti-vascular endothelial growth factor (VEGF) treatments in eyes with subretinal neovascular membrane (SRNVM) due to type 2 proliferative macular telangiectasia (Mac Tel 2). MATERIALS AND METHODS: A total of 38 eyes of 34 patients who underwent intravitreal aflibercept (IVA), intravitreal ranibizumab (IVR), or intravitreal bevacizumab (IVB) injections secondary to SRNVM due to type 2 proliferative MacTel were retrospectively reviewed. The CMT, central macular volume (CMV), best corrected visual acuity (BCVA), and SFCT were evaluated at baseline and at 2 weeks, at 1 month, and at final visits following treatment. Spectral-domain optical coherence tomography and enhanced depth optical coherence tomography were used for the analysis. RESULTS: The mean age of the patients was 58.34 ± 12.48 years (range, 27-79 years). The mean follow-up time was 15.97 ± 6.79 months (range 5-32 months). The mean BCVA showed a statistically significant increase in each group (< 0.001). There was no statistically significant difference in BCVA changes between groups in follow-up periods. There was a significant decrease in CMT following IVA (326.4 ± 168.03 µm to 236 ± 58.33 µm) and IVB (383.71 ± 156.79 µm to 343.85 ± 146.25 µm) (p < 0.001, p = 0.004, respectively) whereas no significant decrease in CMT was observed following IVR (374.57 ± 124.28 µm to 339.71 ± 126.10 µm) (p = 0.65) between baseline and final visit. The SFCT significantly decreased following both IVB and IVR treatments (p = 0.009, p = 0.03, respectively). CONCLUSIONS: The IVA, IVR, and IVB were found to be effective with regards to anatomical and visual outcomes in proliferative Mac Tel type 2 patients related with SRNVM. Patients receiving both IVA and IVB needed less injections compared to patients who received IVR. Moreover, IVB and IVR lead to significant decrease in SFCT whereas IVA did not show significant effect on SFCT.

Ocular surface evaluation in pediatric Hashimoto's thyroiditis without thyroid-associated ophthalmopathy / Avaliação da superfície ocular na tireoidite de Hashimoto pediátrica sem oftalmopatia associada à tireoide

ABSTRACT Purpose: We aimed to assess ocular surface characteristics in children with Hashimoto's thyroiditis without thyroid-associated ophthalmopathy and compare the results with those of healthy children. Methods: Twenty-two children with Hashimoto's thyroiditis (Group 1) and 20 healthy children without any ocular and/or systemic disorder (Group 2) were enrolled in the study. Ocular Surface Disease Index questionnaire, tear film osmolarity measurement (TearLab Osmolarity System, San Diego, CA, USA), Schirmer and tear film breakup time tests, meibography, and conjunctival brush cytology were performed and compared the results between the groups. Results: The study group included 19 girls and 3 boys in Group 1 and 12 girls and 8 boys in Group 2 (p=0.081). Thyroid-associated ophthalmopathy was not identified in any of the patients. Mean tear film osmolarity was 310.23 ± 11.98 mOsm/l in Group 1 and 313.60 ± 15.03 mOsm/l in Group 2 (p=0.424). Mean Schirmer test score was lower in Group 1 (14.91 ± 6.27) compared with Group 2 (23.60 ± 5.63) (p=0.001). Mean tear film breakup time was lower in Group 1 (11.78 ± 4.07) compared with Group 2 (15.1 ± 1.6) (p=0.013). Moreover, mean meibomian gland area loss was 25.01% ± 10.04% in Group 1 and 16.54% ± 6.02% in Group 2 (p=0.002). Conjunctival cytologic analysis in Group 1 revealed grade 0 changes in 6 patients (27.3%), grade 1 changes in 14 patients (63.6%), and grade 2 changes in 2 patients (9.1%), whereas 18 patients (90%) had grade 0 changes and 2 patients (10%) had grade 1 changes (p=0.001) in Group 2. Conclusions: The study demonstrates several ocular surface changes in children with Hashimoto's thyroiditis. These findings may indicate a tendency for dry eye in pediatric Hashimoto's thyroiditis patients without clinical evidence of thyroid-associated ophthalmopathy.

RESUMO Objetivo: Avaliar as características da superfície ocular em crianças com tireoidite de Hashimoto sem oftalmopatia associada à tireoide e comparar os resultados com aqueles de crianças saudáveis. Métodos: Vinte e duas crianças com tireoidite de Hashimoto (Grupo 1) e 20 crianças saudáveis sem qualquer distúrbio ocular e/ou sistêmico (Grupo 2) participaram do estudo. Utilizou-se o questionário Índice da Doença da Superfície Ocular, medida de osmolaridade do filme lacrimal (Tearlab Osmolarity System, San Diego, CA, EUA), teste de Schirmer e tempo de ruptura do filme lacrimal, meibografia e citologia do raspado conjuntival e comparação dos resultados entre os grupos. Resultados: O grupo de estudo incluiu 19 meninas e 3 meninos no Grupo 1 e 12 meninas e 8 meninos no Grupo 2 (p=0,081). A oftalmopatia associada à tireoide não foi identificada em nenhum dos pacientes. A média da osmolari­dade do filme lacrimal foi 310,23 ± 11,98 mOsm/l no Grupo 1 e 313,60 ± 15,03 mOsm/l no Grupo 2 (p=0,424). A média do escore do teste de Schirmer foi menor no Grupo 1 (14,91 ± 6,27) do que no Grupo 2 (23,60 ± 5,63) (p=0,001). A média do tempo de ruptura do filme lacrimal foi menor no Grupo 1 (11,78 ± 4,07) em comparação com o Grupo 2 (15,1 ± 1,6) (p=0,013). Além disso, a média da perda de área da glândula meibomiana foi 25,01% ± 10,04% no Grupo 1 e 16,54% ± 6,02% no Grupo 2 (p=0,002). A análise da citologia conjuntival no Grupo 1 revelou alterações de grau 0 em 6 pacientes (27,3%), alterações de grau 1 em 14 pacientes (63,6%) e alterações de grau 2 em 2 pacientes (9,1%), enquanto 18 pacientes (90%) com alteração de grau 0 e 2 pacientes (10%) com alteração de grau 1 (p=0,001) no Grupo 2. Conclusões: O estudo demonstra várias alterações da superfície ocular em crianças com tireoidite de Hashimoto. Esses achados podem indicar uma tendência para olho seco em pacientes pediátricos com tireoidite de Hashimoto, sem evidências clínicas de oftalmopatia associada à tireoide.

Subfoveal choroidal thickness changes after intravitreal bevacizumab injection for neovascular age-related macular degeneration and diabetic macular edema.

The purpose of this study was to investigate the changes in subfoveal choroidal thickness (SFCT) after intravitreal injection of bevacizumab (IVB) for neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). This retrospective, consecutive, interventional case series study included 43 eyes [21 affected eyes with neovascular AMD (AMD group) and 22 affected eyes with DME (DME group)] which were treated with 1.25 mg/0.5 ml IVB and 43 untreated fellow eyes of 43 patients. SFCT was measured in all 86 eyes at baseline before IVB injection and at day 1, week 1, and month 1 after injection by use of enhanced depth imaging optical coherence tomography (EDI OCT). Central foveal thickness (CFT) and best-corrected visual acuity were analyzed at baseline and during follow-up visits. Main outcome measure was change in SFCT in 1 month after treatment. All 43 eyes treated with IVB showed a significant reduction in SFCT. Mean SFCT in treated eyes decreased from 237.1 ± 75.3 µm at baseline to 214.0 ± 65.7 µm at day 1, 205.4 ± 59.7 at week 1, and 222.7 ± 73.3 at month 1, whereas SFCT in fellow eyes changed from 228.4 ± 63.6 at baseline to 224.5 ± 68.5 at day 1, 220.4 ± 72.1 at week 1, and 226.9 ± 74.0 at month 1. SFCT demonstrated a similar trend toward decrease in both groups. CFT decreased significantly and visual acuity improved significantly. SFCT decreased significantly in AMD and DME eyes following injection. The decreasing effect of bevacizumab on choroidal thickness was highest at first week and continued to the end of first month after injection.

Evaluation of the acute changes in objective accommodation, pupil size and ocular wavefront aberrations after cigarette smoking.

CONTEXT: The acute effects of cigarette smoking on pupil size and ocular wavefront aberrations (OWA) have been previously documented. The accommodation status of the eye is well known to be related to ocular aberrations. No previous study has evaluated the impact of cigarette smoking on the accommodation status of the eye. This study presents intriguing findings regarding the changes in objective accommodation of the eye after cigarette smoking. OBJECTIVE: To evaluate the acute changes in objective accommodation and OWA after cigarette smoking. MATERIALS AND METHODS: A total of 34 otherwise healthy cigarette smoker participants were included in this prospective study. All subjects smoked a single cigarette containing 1 mg nicotine. Measurements of pupil size, OWA and objective accommodation were done before and after smoking. A Wavefront Aberrometer device (Irx3, Imagine Eyes, Orsay, France) was used for the measurements. RESULTS: The mean age of the participants was 36.6 ± 10.3 years (range 21-51 years). Pupil size did not significantly differ before (mean 5.72 ± 1.21 mm) and after smoking (mean 5.68 ± 1.14 mm) (p = 0.62). However, a significant decrease was observed in total spherical aberration (TSA) of the eye after smoking (p = 0.01). There was an increase in objective accommodation after smoking at each accommodative stimulus (range 0-5). This increment was significant at 2 D (p = 0.02) and 3 D (p = 0.03) of stimulus. DISCUSSION AND CONCLUSIONS: The TSA of the eye significantly decreases after smoking. Cigarette smoking also causes a significant increase in objective accommodation at 2 D and 3 D of stimulus.

Implantation of foldable posterior chamber intraocular lens in aphakic vitrectomized eyes without capsular support.

PURPOSE: To evaluate the outcomes of three different surgical techniques for foldable posterior chamber intraocular lens (PCIOL) implantation in vitrectomized eyes without capsular support. METHODS: A total of 60 patients with aphakic and vitrectomized eyes without capsular support were enrolled. All patients underwent three-piece foldable PCIOL implantation into the posterior chamber through a small corneal incision. Transscleral fixation (TSF), iris fixation (IF), and intrascleral tunnel fixation (ISF) surgical techniques were performed. RESULTS: Postoperative PCIOL subluxation or dislocation occurred in one case in the TSF group and two cases in the ISF group. Intraoperative PCIOL dislocation occurred in two patients in the IF group. The incidence of temporary postoperative complications, such as mild intraocular hemorrhage and cystoid macular edema, was higher in the ISF group. No statistically significant difference in PCIOL-related astigmatism was observed between groups. Visual acuity improved in all groups. CONCLUSIONS: Postoperative outcomes were comparable between TSF, IF, and ISF for PCIOL in vitrectomized eyes without capsular support.

Implantation of foldable posterior chamber intraocular lens in aphakic vitrectomized eyes without capsular support / Implantação lente intraocular dobrável de câmara posterior em olhos afácicos vitrectomizados sem apoio capsular

ABSTRACT Purpose: To evaluate the outcomes of three different surgical techniques for foldable posterior chamber intraocular lens (PCIOL) implantation in vitrectomized eyes without capsular support. Methods: A total of 60 patients with aphakic and vitrectomized eyes without capsular support were enrolled. All patients underwent three-piece foldable PCIOL implantation into the posterior chamber through a small corneal incision. Transscleral fixation (TSF), iris fixation (IF), and intrascleral tunnel fixation (ISF) surgical techniques were performed. Results: Postoperative PCIOL subluxation or dislocation occurred in one case in the TSF group and two cases in the ISF group. Intraoperative PCIOL dislocation occurred in two patients in the IF group. The incidence of temporary postoperative complications, such as mild intraocular hemorrhage and cystoid macular edema, was higher in the ISF group. No statistically significant difference in PCIOL-related astigmatism was observed between groups. Visual acuity improved in all groups. Conclusions: Postoperative outcomes were comparable between TSF, IF, and ISF for PCIOL in vitrectomized eyes without capsular support.

RESUMO Objetivo: Avaliar os resultados de três diferentes técnicas cirúrgicas para implantação da lente intraocular de câmara posterior (PCIOL) dobrável em olhos vitrectomizados sem apoio capsular. Métodos: Um total de 60 olhos de 60 pacientes afácicos vitrectomizados, sem apoio capsular foram inscritos. Todos os pacientes foram submetidos ao implante de PCIOL dobrável de três peças na câmara posterior, através de uma pequena incisão na córnea. Foram utilizados as técnicas cirúrgicas de fixação transescleral (TSF), fixação iriana (IF) e túnel de fixação intraescleral (ISF). Resultados: Subluxação ou luxação da PCIOL ocorreu em um caso no grupo TSF e em dois casos no grupo ISF. Deslocamentos intraoperatórios da PCIOL ocorram em dois pacientes no grupo IF. Frequência de complicações pós-operatórias temporárias como hemorragia intraocular leve e edema macular cistóide foi maior no grupo ISF. Não houve diferença estatisticamente significativa do astigmatismo relacionado à PCIOL entre os grupos. A acuidade visual melhorou em todos os grupos. Conclusões: Nenhuma das três técnicas cirúrgicas teve destaque em termos de resultados cirúrgicos comparativos.

Management of iatrogenic crystalline lens injury occurred during intravitreal injection.

To evaluate the approach to management of iatrogenic crystalline lens injury occurred during intravitreal injection (IVI). The patients who were managed operatively or followed-up without intervention after the iatrogenic lens injury due to IVI were included in the study. Capsular breaks remained either quiescent or resulted in cataract formation in the patients with inadvertent crystalline lens capsule damage. Phacoemulsification surgery was performed in patients with cataract formation with lower fluidic settings. A total of 9 cases included in the study. Seven cases underwent phacoemulsification with intraocular lens implantation. Two cases remained as quiescent lens injury during the follow-up. In 2 cases, dislocation of lens fragments occurred during phacoemulsification where pars plana vitrectomy was performed at the same session. After iatrogenic crystalline lens injury, capsular damage could remain quiescent or progress to cataract formation. Although phacoemulsification surgery can be performed with appropriate parameters, lens fragment dislocation can be observed in cases with traumatic lens damage secondary to IVI.

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity.

PURPOSE: To evaluate 2-year outcomes following intravitreal bevacizumab (IVB) as monotherapy for aggressive posterior retinopathy of prematurity (APROP). METHODS: Medical records of 40 infants were retrospectively reviewed. Group I included infants who had received IVB injections for APROP. Group II included infants who underwent laser treatment for APROP. Anatomic and refractive outcomes and the presence of anisometropia and strabismus were assessed at follow-up examinations. RESULTS: Group I included 48 eyes of 25 infants (11 males) with a mean gestational age (GA) of 26.40 ± 1.82 weeks and a mean birth weight (BW) of 901.40 ± 304.60 g. Group II included 30 eyes of 15 infants (6 males) with a mean GA of 27.30 ± 1.82 weeks and a mean BW of 941.00 ± 282.48 g. GA, BW, and gender distributions were similar between groups (P=0.187, P=0.685, and P=1.000, respectively). Refractive errors were significantly less myopic in group I (0.42 ± 3.42 D) than in group II (-6.66 ± 4.96 D) at 2 years (P=0.001). Significantly higher rates of anisometropia and strabismus were observed in group II than in group I (P=0.009 and P=0.036, respectively). CONCLUSIONS: The study demonstrated that IVB monotherapy can be useful in the treatment of APROP. The decreased incidence of early unfavorable refractive and functional outcomes in the IVB group compared with the laser group showed a potential benefit for patients treated with IVB, and this needs to be better evaluated in future prospective studies.

Evaluation of 2-year outcomes following intravitreal bevacizumab (IVB) for aggressive posterior retinopathy of prematurity / Avaliação dos resultados após 2 anos de injeção de bevacizumab intravítreo para retinopatia da prematuridade posterior agressiva

ABSTRACTPurpose:To evaluate 2-year outcomes following intravitreal bevacizumab (IVB) as monotherapy for aggressive posterior retinopathy of prematurity (APROP).Methods:Medical records of 40 infants were retrospectively reviewed. Group I included infants who had received IVB injections for APROP. Group II included infants who underwent laser treatment for APROP. Anatomic and refractive outcomes and the presence of anisometropia and strabismus were assessed at follow-up examinations.Results:Group I included 48 eyes of 25 infants (11 males) with a mean gestational age (GA) of 26.40 ± 1.82 weeks and a mean birth weight (BW) of 901.40 ± 304.60 g. Group II included 30 eyes of 15 infants (6 males) with a mean GA of 27.30 ± 1.82 weeks and a mean BW of 941.00 ± 282.48 g. GA, BW, and gender distributions were similar between groups (P=0.187, P=0.685, and P=1.000, respectively). Refractive errors were significantly less myopic in group I (0.42 ± 3.42 D) than in group II (-6.66 ± 4.96 D) at 2 years (P=0.001). Significantly higher rates of anisometropia and strabismus were observed in group II than in group I (P=0.009 and P=0.036, respectively).Conclusions:The study demonstrated that IVB monotherapy can be useful in the treatment of APROP. The decreased incidence of early unfavorable refractive and functional outcomes in the IVB group compared with the laser group showed a potential benefit for patients treated with IVB, and this needs to be better evaluated in future prospective studies.

RESUMOObjetivo:Avaliar a evolução de 2 anos em crianças que receberam bevacizumab intravítreo (IVB) como monoterapia para retinopatia da prematuridade posterior agressiva (APROP).Métodos:Arquivos médicos de 40 crianças foram revisados retrospectivamente. Grupo I incluiu as crianças que tiveram injeções IVB para APROP. Grupo II foi composto por crianças que se submeteram a tratamento a laser para APROP. Os resultados anatômicos e refracionais, presença de anisometropia e estrabismo foram avaliados durante exames de acompanhamento.Resultados:Grupo I incluiu 48 olhos de 25 crianças (11 do sexo masculino) com média de idade gestacional (GA) de 26,40 ± 1,82 semanas, e média de peso ao nascimento (BW) de 901,40 ± 304,60 g. Grupo II incluiu 30 olhos de 15 crianças (6 do sexo masculino) com GA de 27,30 ± 1,82 semanas e BW de 941,00 ± 282,48 g. GA, BW e distribuição por sexo foram semelhantes entre os grupos (p=0,187, p=0,685, p=1,000, respectivamente). Nenhuma anormalidade anatômica foi observada em ambos os grupos. Erro refrativo foi significativamente menos míope no grupo I (0,42 ± 3,42 D) do que o grupo II (-6,66 ± 4,96 D) em exames aos 2 anos (p=0,001). Houve significativamente maior taxa de anisometropia e estrabismo no grupo II em relação ao grupo I (p=0,009, p=0,036, respectivamente).Conclusões:O estudo demonstrou que a monoterapia IVB pode ser útil no tratamento de APROP. A diminuição da incidência de resultados refracionais e funcionais desfavoráveis precoces no grupo IVB em comparação com o grupo do laser mostraram um benefício potencial para os pacientes tratados com IVB, e isto tem de ser melhor avaliado em estudos prospectivos no futuro.

Anterior segment ischemia following diode laser photocoagulation for aggressive posterior retinopathy of prematurity.

PURPOSE: To describe the clinical and demographical characteristics and treatment outcomes of the premature infants who were presented with the signs of anterior segment ischemia (ASI) following transpupillary diode laser photocoagulation for aggressive posterior retinopathy of prematurity (APROP). METHODS: The records of the premature infants who developed ASI following bilateral laser photocoagulation between November 2010 and December 2013 in a single institution for the treatment of APROP were retrospectively reviewed. The clinical and demographical characteristics, laser parameters, anterior segment complications, and structural outcomes were evaluated. RESULTS: Nine eyes of five infants (three males, two females) were recruited for the study. Mean gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at the time of laser ablation were 28.2 ± 2.5 weeks, 1,287.0 ± 483.4 g and 34.8 ± 2.2 weeks, respectively. All eyes were treated with a near-confluent pattern of laser ablation. Several anterior segment complications were observed including corneal edema (nine eyes), posterior synechia (nine eyes), pupillary membranes (five eyes), shallow anterior chamber (three eyes), hyphema (three eyes), and focal lens opacities (two eyes), of all resolved completely. Permanent dense cataracts observed in two eyes of two infants who were scheduled for lensectomy and anterior vitrectomy. None of the eyes progressed to phthisis bulbi. CONCLUSIONS: Anterior segment ischemia after laser treatment of APROP is a rarely encountered clinical entity. Mild and transient cases may resolve without any long-term sequelae but severe ones may progress to permanent cataract requiring further surgery.