Choroidal vascularity index in obstructive sleep apnea syndrome.

BACKGROUND: There is growing evidence supporting an association between obstructive sleep apnea syndrome (OSAS) and systemic vascular disorders. However, the data on choroidal microvasculature are limited. In recent years, choroidal thickness (CT) and choroidal vascularity index (CVI) have been of considerable interest as objective markers of choroidal vascularity. We hypothesized that the imbalance of vascular regulation in OSAS may adversely affect the CT and CVI and may help to assess the vascular risk in these patients. PURPOSE: This study aimed to evaluate the choroidal morphology in patients with OSAS. MATERIALS AND METHODS: Patients with moderate OSAS were included to this study. The subfoveal, nasal, and temporal CT were calculated. The choroidal area (CA) was binarized to the luminal area (LA) and stromal area (SA) using ImageJ software. The CVI was calculated as the proportion of the LA to the total CA. RESULTS: Of 40 eyes of 40 patients, the mean subfoveal CT was significantly decreased in the OSAS group in comparison to the controls (p = 0.032). The mean CA, LA, and SA were decreased in the OSAS group compared with the controls, but the differences did not reach a statistical significance (p = 0.132, p = 0.104, and p = 0.184, respectively). The CVI was not significantly changed in patients with OSAS (p = 1.000). CONCLUSION: Unlike CT, there were no significant differences in choroidal structural parameters and CVI in patients with OSAS.

Short-term effect of angiotensin-converting enzyme inhibitor on retinal vessel diameter in patients with systemic hypertension.

PURPOSE: To determine the retinal vessel diameter changes after angiotensin-converting enzyme (ACE) inhibitor treatment in a group of hypertensive patients. METHODS: This study included 60 treatment-naive hypertensive patients who were treated with ACE inhibitor. Sixty healthy volunteers served as control group. An optical coherence tomography scan protocol including the measurement of peripapillary retinal vessel diameters was performed at baseline and at 1st month. The diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV), superior nasal artery (SNA), inferior nasal artery (INA), superior nasal vein (SNV) and inferior nasal vein (INV) were statistically compared. RESULTS: The baseline diameters of the STA, ITA, SNA, and INA were significantly decreased in the patient group compared with the control group (all p < 0.05). There was a significant increase at 1st month after the treatment in comparison to baseline measurements (all p < 0.05). When compared with the controls, only the diameter of SNV showed a significant decrease at baseline (p = 0.031). After the treatment, the diameters of SNV and INV were significantly increased compared with baseline measurements (p = 0.049 and p = 0.035, respectively). There were no significant differences between the control group and the patient group at 1st month (all p > 0.05). CONCLUSION: Short-term treatment with ACE inhibitor led to a significant improvement in the retinal vessel diameters of patients with hypertension.

Cystoid macular edema following selective laser trabeculoplasty in a patient with ocular hypertension.

PURPOSE: Presentation of a case with ocular hypertension who developed cystoid macular edema (CME) following selective laser trabeculoplasty (SLT). CASE REPORT: A 62-year-old male patient who had undergone phacoemulsification surgery for traumatic cataract 9 years ago was on ocular hypertension treatment for the last 5 years. Due to uncontrolled intraocular pressure and side effect of medications, a 360° SLT was performed. The patient returned with decrased visual acuity 1 week after the procedure. There was CME in the treated eye. It healed completely after topical prednisolone acetate QID and nepafenac QID for 1 week, and no recurrence was observed during follow-ups. CONCLUSION: Cystoid macular edema may occur following SLT treatment in patients with previous traumatic cataract surgery which responds to topical treatment.

Effect of dexamethasone intravitreal implant (Ozurdex®) on corneal endothelium in retinal vein occlusion patients : Corneal endothelium after dexamethasone implant injection.

BACKGROUND: To assess corneal endothelial cell changes after intravitreal dexamethasone (DEX) implant (Ozurdex®) injection in patients with macular edema secondary to retinal vein occlusion (RVO). METHODS: Twenty-two eyes of 22 patients were assessed prospectively after intravitreal 0.7 mg DEX implant injection. Twenty-two eyes of 22 healthy volunteers served as control group. Corneal endothelial cell parameters including endothelial cell density (ECD), coefficient of variation of cell size (CV), percentage of hexagonality (Hex) and central corneal thickness (CCT) were analyzed before and 1 and 3 months after injection by specular microscopy. The results of the study were compared statistically. RESULTS: There were 17 (77.3%) patients with branch RVO and 5 (22.7%) patients with central RVO. Mean intraocular pressure (IOP) was 14.73 mmHg before injection, 17.05 mmHg at 1 month and 17.15 mmHg at 3 months after injection. Mean IOP at 1 and 3 months were significantly higher than pre-injection value (p = 0.002 and p = 0.003, respectively). There was a statistically significant reduction in mean ECD at 3 months after injection compared to pre-injection and 1 month (p = 0.013, p = 0.009, respectively) in the injected eyes. Mean ECD showed no significant difference in the uninjected fellow eyes during the follow up (p>0.05). Mean CV and Hex did not reveal a statistically significant difference in injected and uninjected fellow eyes (p > 0.05). No significant change was observed in mean CCT values during the follow up (p = 0.8). CONCLUSION: Intravitreal dexamethasone implant may cause a transient reduction in corneal endothelial cell density in short term without changing cell morphology.

Corneal Endothelial Cell Density and Morphology in Different Trimesters of Pregnancy.

OBJECTIVES: To evaluate corneal endothelial cell density (CD) and morphology in different trimesters of pregnancy. METHODS: This prospective study included 66 (66 eyes) pregnant women. The patient group was divided into three subgroups comprised of 22 women in the first, second, and third trimesters of pregnancy. An age-matched group of 22 (22 eyes) volunteers served as controls. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical). Central corneal thickness (CCT) and CD, hexagonal cell ratio (HEX), and coefficient of variation (CV) of the corneal endothelial cell layer of the patients were measured at each trimester. RESULTS: Central corneal thickness did not change significantly during the pregnancy compared to controls (P>0.05). Endothelial CD was decreased in the first trimester and increased in the second and third trimesters, but the difference was not significant (P>0.05). Hexagonal cell ratio was decreased significantly in the first trimester (P<0.05). There was an increase in the second and third trimesters, which was not statistically significant (P>0.05). Coefficient of variation was increased significantly in the first trimester and showed a significant decrease in the second and third trimesters (P<0.05, respectively). Endothelial CD had a significant positive correlation with CV and HEX had a negative correlation with CV in the second trimester (r=0.438, P=0.041 and r=-0.822, P<0.001, respectively). CONCLUSION: Central corneal thickness and endothelial CD did not change significantly throughout the pregnancy. Hexagonal cell ratio and CV showed a significant but transient increase in the first trimester.

Corneal endothelial changes following a single session of selective laser trabeculoplasty for pseudoexfoliative glaucoma.

PURPOSE: To evaluate corneal endothelial cell parameters after a single session of selective laser trabeculoplasty (SLT) in pseudoexfoliative glaucoma (PEG) patients. METHODS: Corneal endothelial cell parameters of 18 PEG patients were compared with 18 healthy subjects following SLT treatment. All patients underwent SLT treatment to 180 degrees of inferior trabecular meshwork. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical, Hyogo, Japan). Endothelial cell density (ECD), hexagonal cell ratio (HEX), coefficient of variation (CV) of the corneal endothelial cell layer and central corneal thickness of the patients were measured at each visit. RESULTS: There was a statistically significant decrease in ECD (p = 0.004) and a statistically significant increase in CV (p = 0.041) at superior cornea 1 week after SLT. They returned to pre-SLT values at 1 month. One hour post-SLT HEX of inferior cornea was statistically significantly reduced (p = 0.01). At central cornea, there was a significant increase in HEX after 1 week (p = 0.001). Post-SLT IOP showed a significant positive correlation with CV and significant negative correlation with HEX at superior and inferior cornea. There was no correlation between total laser energy used and endothelial cell parameters. CONCLUSION: Effect of a single session of SLT on corneal endothelium of PEG patients appears to be transient, and superior cornea was more affected than central and inferior cornea. All parameters returned to pre-SLT values at 1 month after treatment.

Choroidal thickness in obese women.

BACKGROUND: Excessive weight is a well-known risk factor for microvascular diseases. Changes in thickness in a vascular tissue, such as the choroid, can be useful to evaluate the effect of obesity on the microvascular system. The aim of this study was to evaluate the choroidal thickness (CT) changes in obese women, using optical coherence tomography (OCT). METHODS: The prospective clinical study included examination of the right eyes of 72 patients. The right eyes of 68 patients were examined and served as the controls. A complete ophthalmological examination and OCT imaging were performed for each group studied. The CT in each eye was measured using OCT. RESULTS: The obese group consisted of 72 female patients with a mean age of 37.27 ± 1.18 years. The control group included 68 female subjects with a mean age of 37.85 ± 7.98 years (p > 0.05). There was no statistical significant difference for the foveal retinal thickness measurements between the two groups (p > 0.5). Our study revealed significant choroidal tissue thickening subfoveally and at areas 500 µm temporal, 500 µm nasal, and 1500 µm nasal to the fovea in the obese group (all p < 0.05). There was a positive correlation between body mass index (BMI) and CT changes. CONCLUSIONS: CT may increase in obese women and a positive correlation was found between BMI and CT. The trial protocol was approved by the Local Ethical Committee of the Kirikkale University, date of registration: April 27, 2015 (registration number: 10/11).

Plasma adropin level in patients with pseudoexfoliation.

The aim of this study was to evaluate plasma adropin levels in patients with pseudoexfoliation (PEX). This retrospective case-control study included 35 patients with PEX and 35 individuals without PEX who served as controls. Plasma adropin levels with triglycerides, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and haemoglobin A1c (HGBA1C) concentrations were measured in both groups. The mean serum adropin levels were 3.24 ± 0.95 ng/mL (range, 1.90-7.88 ng/mL) in patients with PEX syndrome and 5.78 ± 2.85 ng/mL (range, 2.08-5.41 ng/mL) in PEX glaucoma patients. There was no statistically significant difference in mean adropin levels between PEX syndrome and PEX glaucoma patients. However, similar adropin levels were found in the PEX glaucoma patients and the control group (P > 0.05). The mean serum adropin levels were 3.34 ± 0.89 ng/mL (range, 1.90-5.39 ng/mL) in the PEX group and 5.78 ± 2.85 ng/mL (range, 3.08-11.06 ng/mL) in the control group. The mean serum adropin level of the PEX group was significantly lower than that of the control group (P < 0.001). There were no significant differences between the two groups in terms of serum glucose, total cholesterol, LDL, HDL, HGBA1C, triglycerides levels, or body mass index (all P > 0.05). Adropin level is lower in patients with PEX.

Changes in the choroidal thickness in reproductive-aged women with iron-deficiency anemia.

BACKGROUND: The aim of this study was to investigate the potential significance of the central macular thickness (foveal thickness-FT) and choroidal thickness (CT) in the eyes of patients with iron-deficiency anemia, the most common form of the anemia, via enhanced-depth imaging optical coherence tomography (EDI-OCT). We also investigated whether such changes might serve as an early indicator of underlying hematological disease. METHODS: This prospective clinical study compared 96 female patients with iron-deficiency anemia and 60 healthy female control subjects. The macular and choroidal thicknesses in the temporal and nasal subfoveal areas were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) at 500 and 1500 microns and in five different regions (FCT, T1500, T500, N500, and N1500). RESULTS: The mean ages of the patients and healthy controls were 34.08 ± 10.39 years and 32.29 ± 8.28 years, respectively (P =0.232). There were no significant changes in macular thickness between the groups (225.58 ± 19.76 vs. 222.45 ± 13.51, P =0.2). The choroidal thickness was significantly reduced in the patient group relative to the controls at all measured points (foveal choroidal thickness, P = 0.042; nasal-500 microns, P = 0.033; temporal-500 microns, P = 0.033; and temporal-1500 microns, P = 0.019). At some points, the choroidal thickness findings correlated with the hemoglobin values (temporal-500 microns, r = -0.287, P = 0.001; nasal-500 microns, r = -0.287, P = 0.005; nasal-1500 microns, r = -0.245, P = 0.016; and temporal-1500 microns, r = -0.280, P = 0.06). CONCLUSIONS: Patients with iron-deficiency anemia had a significantly reduced choroidal thickness.

Ocular blood flow in polycystic ovary syndrome.

AIM: The aim of this study was to evaluate whether the presence of polycystic ovary syndrome (PCOS) alters ocular blood flow parameters. MATERIAL AND METHODS: Color Doppler imaging of the orbital vessels was performed in 41 eyes of 41 patients with PCOS. Forty-eight eyes of 48 age-matched volunteers served as controls. The ophthalmic artery (OA), the central retinal artery and the posterior ciliary artery were examined. Ocular blood flow indices of the peak systolic velocity, diastolic velocity, end-diastolic velocity, systolic/diastolic ratio, resistive index and pulsatility index were computed. RESULTS: The peak systolic velocity, diastolic velocity and end-diastolic velocity of the OA, central retinal artery and posterior ciliary artery were significantly increased in PCOS patients in comparison to the controls (all P < 0.001). The mean systolic/diastolic ratio, resistive index and pulsatility index of the OA in PCOS patients were significantly decreased (all P < 0.05). Ocular blood flow velocity was positively correlated with serum luteinizing hormone, follicle-stimulating hormone and total cholesterol levels. There was a significant negative correlation between serum glucose and insulin levels and ocular blood flow velocity. CONCLUSION: Ocular blood flow velocity is increased in PCOS patients and vascular resistance seems to decrease only in the OA.

Optical coherence tomography and visual field findings in patients with Friedreich ataxia.

BACKGROUND: To investigate the optical coherence tomography (OCT) and visual field findings in Friedreich ataxia (FRDA). METHODS: Ten eyes of 10 patients with genetically confirmed FRDA were included in this study. Twenty-two eyes of 22 age- and sex-matched volunteers served as controls. All eyes were examined with spectral domain OCT (Retinascan Advanced RS-3000; NIDEK) and Humphrey Field Analyzer (HFA II 750; Zeiss-Humphrey Systems). RESULTS: OCT measurements of the average peripapillary retinal nerve fiber layer (RNFL) thickness, average peripapillary retinal thickness (RT), and foveal RT showed a statistically significant reduction in patients with FRDA (P < 0.0001). There was no statistically significant difference in choroidal thickness. OCT measurements of horizontal cup-to-disc (C/D) ratio, vertical C/D ratio, and average cup area were significantly increased in patients with FRDA. Visual acuity was significantly correlated with age at onset (P = 0.021) and average RNFL value (P = 0.045). There was a significant correlation between foveal thickness and disease duration (P = 0.014). Mean RNFL thickness was significantly correlated with the severity of neurological involvement (P = 0.039). Visual field testing (VFT) revealed a generalized reduction of sensitivity in the patients. CONCLUSION: Patients with FRDA may have a measurable degree of retinal thinning as determined by OCT and a generalized reduction of sensitivity in VFT. Combining structural and functional findings may be used in the follow-up of patients with FRDA.

Compressive optic neuropathy presenting with psychiatric symptoms.

We report a case of bilateral optic neuropathy presenting with psychiatric symptoms. A 50-year-old woman was admitted with blurry vision in both eyes. She had a 3 months' history of depressed mood. Both optic discs had mild temporal pallor with visible spontaneous venous pulsations. Magnetic resonance imaging of the brain showed a large frontal mass compressing the optic nerves. The tumor was surgically resected, and tissue pathology demonstrated an olfactory groove meningioma.

Antimicrobial effectiveness of silicone oil, heavy silicone oil and perfluorodecaline against Bacillus cereus.

The purpose of this work is to study the effectiveness of silicone oil, heavy silicone oil and perfluorodecaline against Bacillus cereus. For this we tested the antimicrobial activities of three intraocularly used liquids--silicone oil (Siluron 1000), heavy silicone oil (Densiron-68) and perfluorodecaline (F-Decalin)--against B. cereus (NCTC 9946). The antimicrobial effects of silicone oil, heavy silicone oil and perfluorodecaline were determined by the growing capability of the microorganism. We found that the number of B. cereus decreased in all three concentrations of silicone oil. The bacteria grew for approximately 2 weeks in heavy silicone oil and declined after 17 days. Perfluorodecaline significantly reduced B. cereus colonies and was the most effective of the liquids. In conclusion, silicone oil and perfluorodecaline seem to be effective against B. cereus.

Retinal nerve fiber layer thickness in vitiligo patients.

BACKGROUND: This study was designed to investigate the effect of vitiligo on the retinal nerve fiber layer (RNFL) thickness. MATERIALS AND METHODS: This prospective study was conducted in the Department of Ophthalmology at Kirikkale University during 2010 and 2011. Sixty eight eyes of 34 vitiligo patients were included in the study. Eighty four eyes were served as control. RNFL thickness was measured by scanning laser polarimetry (Nerve Fiber Analyzer, GDx VCC: 5.3.3; Laser Diagnostic Technologies, San Diego, CA, USA). RESULTS: The mean duration of vitiligo was found to be 9.8 ± 2.3 years. The mean average RNFL thickness outside the disc margin was significantly lower in the right eyes of vitiligo group in comparison to the controls (P = 0.02). The mean average thickness of RNFL beneath the measuring ellipse in the superior sector of both eyes were significantly lower than the controls (P = 0.004, P = 0.008, respectively). The topographical distributions of RNFL thickness in superior, inferior, nasal and temporal quadrants were similar for two groups. CONCLUSION: RNFL thickness seems to be unaffected in vitiligo patients.

State and trait anxiety levels of adolescents in a changing society, Kirikkale city, Turkey.

Adolescents face rapidly changing challenges. Psychosocial health problems during adolescence are relatively common in all cultures. This study was designed to evaluate the state and trait anxiety status and influencing sociodemographic and other factors, thought to pertain to youth, on anxiety among school children in Kirikkale. It was carried out at three public primary and two high schools representative of two different socioeconomic statuses. 430 Turkish school children (246 girls, 184 boys) were asked voluntarily to answer a set of questionnaires in their classrooms at the beginning of a training programme. Then the State and Trait Anxiety Inventory for Children was administered. Mean age of the students was 14.16 ± 1.87 years. The mean total STAI-CS and STAI-CT scores were 40.24 ± 11.64, and 44.71 ± 9.64, respectively. There were no differences in STAI-CS and STAI-CT scores between boys and girls in both schools and in all age groups. Among girls, a positive body image had a significant effect on state anxiety scores. There was a positive correlation between age and anxiety scores (r = .17, F:12.176, p < .001). Students identifying their families SES as bad and/or moderate scored significantly higher in comparison to the other groups (p < .05). STAI-CS scores were higher for lower educational grade, higher body weight and sleep problems. In Kirikkale, a city faced with substantial changes in cultural and traditional norms, adolescents could be expected to be under stress and appear to be responding to stress with anxiety.

Visual recovery from optic atrophy following acute optic neuropathy in the fellow eye.

The left eye of a 65-year-old male was blind due to optic atrophy and only seeing eye had also dry type age-related macular degeneration. An anterior ischemic optic neuropathy developed in the better seeing eye. Vision recovered in the blind eye in a short time after losing the better eye. Gaining some vision in a blind eye may be an adaptation of visual pathway in such patients.

Factors effecting the choroidal vascularity index in children with mild to moderate myopia.

PURPOSE: To measure the choroidal structural parameters in a population of myopic children and determine the factors effecting the choroidal vascularity index (CVI). METHODS: In total, 200 eyes of 200 children (100 females, 100 males) with a mean age of 11.5 ± 1.6 years were included in the study. Macular imaging was performed using EDI mode of spectral domain-optical coherence tomography. Binarization of the choroidal area was performed with ImageJ software. Total choroidal area, luminal area (LA), stromal area (SA), and CVI were automatically calculated. RESULTS: The mean choroidal, stromal and luminal areas were measured as 0.952 ± 0.127 mm2, 0.626 ± 0.103 mm2 and 0.325 ± 0.076 mm2, respectively. The mean CVI was 65.81% ± 6.56. Age and the axial length (AL) of the participants were not found to be associated with the LA and the CVI. (r=-0.078, p=0.274, r=0.017, p=0.808, and r=0,051, p=0.474 and r=-0.128, p=0.071, respectively). There was a statistically significant strong association between the LA and CVI measurements and SE of the participants (r=0.736, p=0.001, and r=-0.605; p=0.001). CONCLUSION: Age and AL were not associated with the CVI, but SE was significantly associated with the CVI.