Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch.

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 µm) when compared to the AFB (450.5 ± 122.6 µm) and RNB (442 ± 116 µm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments.

Quantitative investigation of the effect of surgically induced hypoparathyroidism on cataract development.

INTRODUCTION: Although cataract formation is known in hypoparathyroidism, lens clarity and its correlation with clinical parameters have not been investigated quantitatively before in patients with hypoparathyroidism. The aim of this study was to compare the crystalline lens clarity of patients with surgically induced hypoparathyroidism and healthy subjects. MATERIALS AND METHODS: Forty female patients with surgically induced hypoparathyroidism and 38 age-matched healthy female subjects were enrolled in this study. Scheimpflug corneal topography was performed to measure lens density (LD) and thickness (LT). Serum calcium, inorganic phosphorus, parathyroid hormone (PTH) levels, and disease duration were recorded. RESULTS: No statistically significant difference was observed between the hypoparathyroidism and control groups in the Pentacam densitometry zones 1-2-3, LT, and average and maximum LD (p > 0.05 for all). Nine blue-dot-like, two cortical, and two posterior subcapsular cataracts were detected in the hypoparathyroidism group. The frequency of total and blue-dot-like cataracts was significantly higher in the hypoparathyroidism group than in the control group (p = 0.008 and p = 0.002, respectively). In the hypoparathyroidism group, a significant correlation was observed between the maximum LD and the hypoparathyroidism duration (ß = 0.420, p = 0.017), and the maximum LD and serum PTH level (ß = -0.332, p = 0.049). CONCLUSION: The clarity of the crystalline lens may decrease in surgically induced hypoparathyroidism patients depending on the disease duration and PTH levels. Additionally, this study detected an increased frequency of blue-dot-like cataract in the patient group, which may be due to the effect of hypoparathyroidism.

Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months.

PURPOSE: This study aimed to report the visual and anatomical outcomes of intravitreal anti-VEGF treatment for diabetic macular edema (DME) in a real-world clinical setting from Turkey over 36 months. METHODS: This is a retrospective, multicenter (7 sites) study. The medical records of 1072 eyes (both previously treated and naive eyes) of 706 consecutive patients with visual impairment due to center-involving DME treated with intravitreal anti-VEGF injections between April 2007 and February 2017 were reviewed. The eyes were divided into mutually exclusive three groups based on the duration of follow-up (12, 24, or 36 months). Primary outcome measures were changes in visual acuity (VA) and central macular thickness (CMT) from baseline to final visit in each cohort, frequency of visits and intravitreal anti-VEGF injections. As secondary endpoints, VA outcomes were assessed in subgroups stratified by baseline VA [<70 ETDRS letters and ≥70 ETDRS letters] and loading dose status of anti-VEGF injections. RESULTS: VA increased by a mean of 8.2 letters (12-month cohort, p < 0.001), 5.3 letters (24-month cohort, p < 0.001), and 4.4 letters (36-month cohort, p = 0.017) at final visits. The eyes with <70 VA letters achieved more significant VA improvement at final visits in all cohorts compared with eyes with >70 VA letters (p < 0.001). The mean decreases in CMT from baseline to last visits at 12-, 24-, and 36- month cohorts were -100.5 µm, -107.7 µm, and -114.3 µm, respectively (p < 0.001). The mean number of injections given were 4.6, 2.3, and 1.8 during years 1 to 3, respectively. Patients who received loading dose showed greater VA gains than those who did not in all follow-up cohorts. CONCLUSION: Our study revealed that anti-VEGF treatment improved VA and CMT over a follow-up of 36 months. Although these real-life VA outcomes following anti-VEGF therapy for DME were similar to other real-life studies, they were inferior to those noted in randomized controlled trials, mainly due to undertreatment.

Smoking effect on peripapillary and macular microvascular structure in inactive Graves' ophthalmopathy.

OBJECTIVE: The aim of this study was to evaluate the smoking effect on peripapillary and macular microvascular structure in patients with inactive Graves' ophthalmopathy (GO) and to compare these structures with those of healthy control subjects. METHODS: A total of 34 healthy participants (control group), 22 inactive GO patients with smoking (smoker group) and 19 inactive GO patients with non-smoking (non-smoker group) were recruited in this prospective study. After detailed ophthalmological examination, vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), retinal peripapillary capillary (RPC) and foveal avascular zone (FAZ) area, and acircularity index (AI) of the FAZ were analysed with optical coherence tomography angiography (OCTA) for each eye. RESULTS: Vessel density in the total peripapillary; superior and inferior sectors of RPC were significantly lower in inactive GO patients with smoking (p < 0.05 for all sectors) compared to control group. Besides, the FAZ AI was significantly higher in smoker and non-smoker inactive GO groups compared to healthy subjects (p = 0.0001, p = 0.0001, respectively). No significant difference was found in the FAZ area, and all SCP, DCP macular measurements between groups (p > 0.05 for all). CONCLUSION: OCTA findings of lower peripapillary VD in the smoker group show smoking effect on the optic disc head microvasculature in inactive GO patients. These results could reflect early subclinical optic disc vasculature damage in smoker inactive GO subjects.

Static and Dynamic Pupillary Responses in Patients with Different Stages of Diabetic Retinopathy.

This study aimed to investigate pupillary involvement in patients with type 2 diabetes mellitus (DM) and to evaluate whether there is a relationship between severity of diabetic retinopathy (DR) and pupillary responses. The study included 133 individuals in four groups: proliferative DR, non-proliferative DR, DM group without retinal involvement and a control group. Static pupillometry measurements including scotopic pupil diameter (PD), mesopic PD, low photopic PD, high photopic PD, and dynamic pupillometry measurements, including resting diameter, amplitude, latency, velocity, duration of pupil contraction and latency, duration, and velocity of pupil dilatation were taken using an automated quantitative pupillometry system. The correlations between glycosylated haemoglobin values and duration of DM with these parameters were also investigated. The study showed that patients with DR may also have diabetic autonomic neuropathy and pupillometry can be a useful screening tool for detecting diabetic autonomic neuropathy.

Contrast sensitivity of patients with congenital color vision deficiency.

PURPOSE: To investigate the static and dynamic contrast sensitivity (CS) of patients with congenital red-green color vision deficiency (CVD) and to compare these values with those of healthy control subjects. METHODS: The study included 25 subjects with congenital CVD (10 with strong protan defect and 15 with strong deutan defect) and 20 age- and gender-matched healthy subjects. Following detailed ophthalmological examination, monocular static and dynamic CS measurements were taken with the Monpack3 device (Metrovision, Perenchies, France) on all subjects. The data from the right eyes of all the subjects were used for statistical analysis. RESULTS: The mean age of the groups was similar (deutan group: 25.3 ± 11.3 years, protan group: 27.1 ± 12.2 years, control group: 26.7 ± 8.8 years, p = 0.98). The mean static and dynamic CS values in the protan and deutan groups were higher compared to those of the healthy control subjects, but not at a statistically significant level (all p > 0.017). CONCLUSION: The static and dynamic CS values of patients with congenital red-green CVD were similar to those of healthy control subjects.

Pigment epithelial tears associated with anti-VEGF therapy: incidence, long-term visual outcome, and relationship with pigment epithelial detachment in age-related macular degeneration.

PURPOSE: To evaluate the prevalence of retinal pigment epithelium (RPE) tears associated with anti-VEGF therapy and its relation with retinal pigment epithelial detachment (PED). METHODS: A total of 226 patients with exudative age-related macular degeneration treated with intravitreal anti-VEGF were included retrospectively in the study. The presence of RPE tears; the effect of the presence, height, and duration of PED on the rate of RPE tears; and change in visual acuity during follow-up were recorded. RESULTS: Among 226 study patients, 28 (12.3%) had RPE tears. The RPE tear rate was significantly higher in patients with vascularized PED (vPED) than in those without PED (19.7% vs. 2.1%; P < 0.001). The change in visual acuity after the formation of RPE tear was not statistically significant (on logMAR scale: 0.92 ± 0.49 initially, 0.89 ± 0.41 after the RPE tear, 0.96 ± 0.45 at the last follow-up; P = 0.613). Pigment epithelial detachment height >580 µm (odds ratio = 69.4; 95% confidence interval = 16.7-288.1) and PED duration ≤ 4.5 months (odds ratio = 166.7; 95% confidence interval = 15.2-1000) were found to be significant risk factors for RPE tear formation. CONCLUSION: The RPE tears are not infrequent among eyes treated with intravitreal anti-VEGFs. The presence, increased height, and shorter duration of vPED are potential risk factors for RPE tears associated with anti-VEGF therapy.

Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma.

CLINICAL RELEVANCE: Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma. BACKGROUND: This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages. METHODS: In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature-function and structure-function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately. RESULTS: The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)-visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = -0.029 p = 0.89). CONCLUSION: The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

An analysis of the relationship between ABCC8 and KCNJ11 gene polymorphisms and diabetic retinopathy in Turkish population.

BACKGROUND: Diabetic retinopathy (DR) occurs due to high blood glucose damage to the retina and leads to blindness if left untreated. KATP and related genes (KCNJ11 and ABCC8) play an important role in insulin secretion by glucose-stimulated pancreatic beta cells and the regulation of insulin secretion. KCNJ11 E23K (rs5219), ABCC8-3 C/T (rs1799854), Thr759Thr (rs1801261) and Arg1273Arg (rs1799859) are among the possible related single nucleotide polymorphisms (SNPs). The aim of this study is to find out how DR and these SNPs are associated with one another in the Turkish population. MATERIALS AND METHODS: This study included 176 patients with type 2 diabetes mellitus without retinopathy (T2DM-rp), 177 DR patients, and 204 controls. Genomic DNA was extracted from whole blood, and genotypes were determined by the PCR-RFLP method. RESULTS: In the present study, a significant difference was not found between all the groups in terms of Arg1273Arg polymorphism located in the ABCC8 gene. The T allele and the TT genotype in the -3 C/T polymorphism in this gene may have a protective effect in the development of DR (p = 0.036 for the TT genotype; p = 0.034 for T allele) and PDR (p = 0.042 and 0.025 for the TT genotype). The AA genotype showed a significant increase in the DR group compared to T2DM-rp in the KCNJ11 E23K polymorphism (p = 0.046). CONCLUSIONS: Consequently, the T allele and TT genotype in the -3 C/T polymorphism of the ABCC8 gene may have a protective marker on the development of DR and PDR, while the AA genotype in the E23K polymorphism of the KCNJ11 gene may be effective in the development of DR in the Turkish population.

The Effect of ChromaGen Contact Lenses on Corneal Clarity: A Corneal Densitometry.

Objectives: The purpose of this study is to investigate the effect of ChromaGen contact lens (CCL) on corneal clarity, expressed through the measurement of corneal densitometry (CD) values. Methods: This study included 22 eyes of 22 patients with congenital red-green color vision deficiency who were admitted to our clinic for the CCL trial. After a detailed ophthalmological examination and CD measurement with Pentacam HR (Oculus Optikgerate GmbH, Wetzlar, Germany), the most appropriate CCLs were defined through pseudoisochromatic plates and inserted for 2 h. The CD measurement was repeated after the removal of the CCL. Comparison was made of CD values before and after the insertion of the most appropriate CCL. The after-CCL/before-CCL ratio was calculated, and the effect of CCL type on this ratio was investigated. Results: The after-CCL values were higher in the anterior, central, posterior, and total thickness of the 0-2 mm concentric zone (p=0.044, p=0.040, p=0.021, and p=0.032, respectively) when compared to the before-CCL values. There was no statistically significant difference between before-CCL and after-CCL values in any layer of the 2-6, 6-10, and 10-12 mm concentric zones (p>0.05, for all). After-CCL/before-CCL ratios were similar in the Magenta2 (M2), Magenta3 (M3), and Violet3 (V3) types of CCLs (p>0.017). Conclusion: Usage for 2 h of CCL was observed to increase CD values in all layers of the 0-2 mm concentric zone irrespective of the type of CCL. Further studies with longer follow-up are required to determine the long-term effects and detect differing effects of CCL with different base curves.

Prevalence of Serous Macular Detachment in Recurrent Macular Edema Secondary to Retinal Vein Occlusion.

Objectives: To evaluate the prevalence of serous macular detachment (SMD) accompanying recurrent cystoid macular edema (CME) in patients initially treated for CME secondary to retinal vein occlusion (RVO) with accompanying SMD, and discuss the factors that affect the prevalence. Materials and Methods: We retrospectively evaluated the medical records of 71 patients with RVO-associated CME and SMD who achieved complete anatomical resolution after treatment with either a single dexamethasone implant or three loading doses of ranibizumab and developed recurrent CME during follow-up. Results: Initial treatment was a single intravitreal dexamethasone implant in 45 patients (63.4%) (Group 1) and three loading doses of intravitreal ranibizumab in 26 patients (36.6%) (Group 2). The mean time to CME recurrence was 4.7±0.8 months (range, 4-7 months) and was similar in both groups (p=0.984). At the time of CME recurrence, SMD was present in 41 patients (57.7%) and absent in 30 patients (42.3%). SMD was present in 27 (60.0%) of the 45 Group 1 patients and 14 (53.8%) of the 26 Group 2 patients (p=0.613). SMD was present in 48.8% of branch RVO and 71.4% of central RVO patients at the time of recurrence (p<0.001). Conclusion: SMD accompanied recurrent CME in only 57.7% of patients previously treated for CME and SMD and seems to be more frequent in patients with central RVO. Initial intravitreal treatment choice of either ranibizumab or dexamethasone implant did not affect the prevalence of concurrent SMD in patients with recurrent CME.

The pupillary dynamics of patients with physiological anisocoria.

BACKGROUND: To evaluate static pupillometric measurements and making inter-ocular comparative analysis in healthy subjects for demonstrating the prevalance of physiological anisocoria in various lighting conditions and to compare the variations of the dynamic pupillometric measurements of the patients with physiological anisocoria. METHODS: Automatic quantitative pupillometry system was used to measure pupillary diameters in low mesopic (0.1 cd/m2), high mesopic (1 cd/m2), low photopic (10 cd/m2) and high photopic (100 cd/m2) conditions. After inter-ocular comparison of these data, the prevalance of physiological anisocoria was detected in four different lighting conditions. The inter-ocular dynamic pupillometric parameters (amplitude, latency, duration and velocity of pupil contraction; latency, duration and velocity of pupil dilation) of these patients were further analysed. RESULTS: After inter-ocular comparison of pupillary diameters of 195 participants [96 females (49.2%) and 99 males (50.8%)] with a mean age of 38.4 ± 18.9 years (range 7-78 years), six (3.1%) participants under high photopic; 11 (5.6%) participants under low photopic; 25 (12.8%) participants under high mesopic, and 34 (17.4%) participants under low mesopic illumination levels exhibited physiological anisocoria. The mean relative amplitude of anisocoric small pupils' contraction was lower than the mean relative amplitudes of pupil contraction of both isocoric and anisocoric large pupils (p = 0.021, p = 0.035, respectively). The mean velocity of anisocoric small pupils' contraction was lower than the mean velocity of anisocoric large pupils' contraction (p = 0.013). CONCLUSIONS: The mean contraction amplitude and contraction velocity of smaller pupils was lower when compared to fellow larger pupils of anisocoric patients.

Treatment of neovascular age related macular degeneration during COVID-19 pandemic: The short term consequences of unintended lapses.

AIM: To investigate the short-term effects of COVID-19 pandemic related unintended treatment lapses on neovascular age related macular degeneration (nAMD) patients. METHODS: In this prospective cross-sectional study, 140 patients who had at least one anti-vascular endothelial growth factor (VEGF) injection for nAMD within 12 months before COVID-19 pandemic and who had at least 3 months of unintended lapse for control visits during pandemic were recruited and underwent a detailed opthalmological examination and optical coherence tomography imaging. RESULTS: Of these 140 eyes, 113 (80.7%) were active with presence of either intraretinal and/or subretinal fluid and necessitated intravitreal anti-VEGF injections; and 20 (14.3%) of them complicated with subretinal hemorrhage. The mean interval of clinical visits and intravitreal antiVEGF injections were found to be prolonged during COVID-19 pandemics, which demonstrates a statistically significant lapse for both (p = 0.001 and p = 0.003 consecutively). The decreased visual acuity due to lapse was positively correlated with number of intravitreal anti-VEGF injections at last 6 months before COVID-19 pandemic (r = 0.217, p = 0.010) and central subfoveal thickness at first post-COVID-19 visit (r = 0.175, p = 0.038); and negatively correlated with follow-up duration (r = -0.231, p = 0.006) and number of control visits (r = -0.243, p = 0.004). Fifteen (16.9%) of the 89 patients who had drusen in the fellow eye before COVID-19 pandemic evolved to nAMD with an accompanying subretinal and/or intraretinal fluid. CONCLUSION: Unintended lapses during COVID-19 pandemic resulted with poor functional and structural outcomes for nAMD patients, especially for those at the beginning of the treatment period and who still have an unstable clinical course.

Is choroidal vascularity index a useful marker in different stages of idiopathic epiretinal membranes?

BACKGROUND: This study aims to evaluate the choroidal vascularity index in patients with idiopathic epiretinal membrane at different stages. METHODS: This prospective study included 125 eyes of 125 patients with idiopathic epiretinal membrane and 62 eyes of 62 healthy control subjects. In this study, epiretinal membrane stages were defined based on the spectral-domain optical coherence tomography staging system. The choroidal vascularity index was measured as the ratio of the luminal area to the stromal area in the central 1500 µm after binarization on enhanced depth imaging optical coherence tomography images. Data on epiretinal membrane stages, choroidal vascularity index, and best-corrected visual acuity were noted. RESULTS: Of 125 eyes with epiretinal membrane, 38 (30.4 %) had stage 1, 32 (25.6 %) had stage 2, and 55 (44 %) had stage 3 disease. Visual acuity was better in eyes with stage 1 or 2 epiretinal membrane than those with stage 3 epiretinal membrane (p < 0.001). The mean choroidal vascularity index was 2.29 ± 1.02 in the control, 2.23 ± 0.98 in the stage 1 epiretinal membrane, 2.22 ± 0.91 in the stage 2 epiretinal membrane, and 2.23 ± 1.11 in the stage 3 epiretinal membrane group. There was no significant difference between epiretinal membrane subgroups and the control group regarding the choroidal vascularity index (p = 0.81). CONCLUSION: From the results obtained in the present study, the choroidal vascularity index was not effected by either the development or the progression of idiopathic epiretinal membrane.

Pattern electroretinography in patients with unilateral acute central serous chorioretinopathy.

BACKGROUND: To evaluate the pattern electroretinography (PERG) in patients with acute central serous chorioretinopathy (CSCR) at baseline and after spontaneous resolution. METHODS: A total of 32 patients (mean ± SD age: 38.8 ± 8.2 years, 71.9 per cent female) with unilateral acute CSCR and spontaneous resolution during follow-up period were included. The unaffected eyes of the study patients comprised the control group. The best-corrected visual acuity, PERG and optical coherence tomography findings were recorded both at baseline and following spontaneous resolution at two to four months. RESULTS: The P50 and N95 amplitudes of the affected eyes were significantly lower than the control group both at baseline and after CSCR resolution (p < 0.001 for each). A significant increase was noted in both P50 and N95 amplitudes of the affected eyes from baseline to post-resolution (p < 0.001 for each). Subfoveal choroidal thickness was significantly higher in the affected eyes as compared with control eyes both at the baseline and after CSCR resolution along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001 for each). The central retinal thickness was higher in the affected eyes as compared with the control eyes at baseline (p = 0.009), along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001). Between the baseline P50 amplitude and the visual acuities of the affected eyes, a strong correlation was noted at baseline (r = -0.691, p < 0.001) and a moderate correlation was noted after CSCR resolution (r = -0.422, p = 0.031). CONCLUSIONS: In conclusion, our findings revealed an association of CSCR with impaired P50 and N95 amplitudes and a significant improvement but not a complete recovery in both parameters after CSCR resolution. Our findings emphasise potential utility of PERG in the electrophysiological evaluation of functional impairment in CSCR patients and the likelihood of P50 amplitude to have a prognostic value in CSCR.

The effect of the ChromaGen contact lens system on visual performance.

BACKGROUND: To evaluate the effects of the ChromaGen contact lens (CCL) on best-corrected visual acuity, contrast sensitivity and pseudoisochromatic test plate performance in patients with congenital colour vision deficiency (CVD). METHODS: CCLs were inserted into 50 eyes of 25 patients with congenital red-green CVD. The patients were tested with the Ishihara and Hardy-Rand-Rittler test plates before and after the insertion of Magenta 2, Magenta 3, and Violet 3 CCLs. The patients' mean numbers of recognised symbols were calculated and the most appropriate CCL was determined for each eye. The best-corrected visual acuity for both far and near vision and contrast sensitivity were evaluated before and after the insertion of the appropriate CCLs, and the results were compared. RESULTS: The mean age of the patients was 26.56 ± 10.30 years. While all CCLs increased the mean numbers of recognised symbols on the Ishihara (p < 0.001 for all), Magenta 3 was observed to be the most useful CCL. On the other hand, while all CCLs increased the mean numbers of recognised symbols on Hardy-Rand-Rittler (p < 0.001 for all), Magenta 2 and Magenta 3 were detected as the most useful CCLs. After insertion of the most appropriate CCL for each eye, the mean best-corrected visual acuity for both far and near vision were decreased (p < 0.001 for both). Statistically significant alterations were also detected at some spatial frequencies of contrast sensitivity measurements. CONCLUSION: CCLs decrease the far and near best-corrected visual acuity, and static and dynamic contrast sensitivity at some spatial frequencies, and invalidate the pass criteria of pseudoisochromatic test plates by increasing the number of recognised symbols.

Anterior Segment Findings in Patients With Osteogenesis Imperfecta: A Case-Control Study.

PURPOSE: To evaluate the anterior segment parameters in patients with osteogenesis imperfecta (OI) compared with healthy control subjects. METHODS: Seventeen patients with OI and 19 age-matched healthy controls were included into this cross-sectional case-control study. Corneal topographic, topometric and Belin-Ambrósio Enhanced Ectasia Display III analysis, corneal densitometry (12-mm corneal diameter), and lens densitometry measurements were obtained by using the Pentacam HR-Scheimpflug imaging system (Oculus, Wetzlar, Germany). The corneal endothelial cell properties were determined by specular microscopy. RESULTS: In comparison to the control group, patients with OI had significantly higher front astigmatism (0.8 ± 0.4 vs. 1.4 ± 1.1 mm, P = 0.026), thinner thinnest corneal thickness (556.4 ± 32.7 µm vs. 482.5 ± 66.9 µm, P = 0.002), smaller corneal volume (62.4 ± 3.5 mm vs. 53.7 ± 6.4 mm, P < 0.001), lower anterior chamber depth (3.2 ± 0.3 mm vs. 3.0 ± 0.2 mm, P = 0.009), higher index of vertical asymmetry (0.1 ± 0.04 vs. 0.2 ± 0.11, P < 0.001), higher posterior elevation (6.0 ± 2.7 µm vs. 11.9 ± 7.8 µm, P = 0.002), lower maximum Ambrósio relational thickness indice (456.6 ± 67.5 vs. 365.6 ± 115.7, P = 0.009), and higher final "D" value (0.7 ± 0.4 vs. 2.0 ± 1.6, P = 0.002). The corneal and lens densitometry values were similar in all concentric zones and layers in both groups except that 6 to 10 mm in the center. Corneal densitometry was higher in eyes with OI than that in the control group (9.8 ± 1.7 and 8.8 ± 1.0, P = 0.010). There was no difference in endothelial cell morphology between the groups (P > 0.05). CONCLUSIONS: The morphologic parameters determined on the corneal analysis are in general agreement with the known pathophysiology of OI. Corneal analysis may prove useful in monitoring patients with OI in clinical practice.

Evaluation of tear meniscus dimensions using anterior segment optical coherence tomography in video terminal display workers.

BACKGROUND: To evaluate tear meniscus height and tear meniscus area measured by optical coherence tomography (OCT) and to determine the prevalence of dry eye disease in video display terminal (VDT) users. METHODS: This was a case-control study performed on VDT users. The case group consisted of 53 subjects who vocationally use VDT more than six hours per day and the control group consisted of 49 subjects who used VDT not more than one hour per day. The pre-vocational and post-vocational tear meniscus height and tear meniscus area measurements were performed twice in one day using OCT. Tear-film break-up time, Schirmer's test, Ocular Surface Disease Index score and corneal staining score measurements were performed in all subjects. RESULTS: The mean age was 38.9 ± 5.5 years in VDT users and 37.8 ± 5.8 years in the control group (p = 0.426). Twenty patients (37.7 per cent) had dry eye disease in VDT users and five patients (10.2 per cent) had dry eye disease in the control group (p = 0.001). The mean tear meniscus height and tear meniscus area values (pre-vocational and post-vocational) were significantly lower in VDT users than in the control group (p < 0.001, p < 0.001, p = 0.024 and p < 0.001, respectively). The Schirmer's test results, Ocular Surface Disease Index scores, corneal staining scores and tear-film break-up time values revealed significant differences between VDT users and control subjects (p = 0.002, p = 0.006, p < 0.001 and p < 0.001, respectively). In addition, significant correlations were demonstrated between Schirmer's test results, Ocular Surface Disease Index scores, corneal staining scores, tear-film break-up time measurements, tear meniscus height results and tear meniscus area values. CONCLUSION: Tear meniscus evaluation using OCT is an effective, non-invasive and sensitive method for detection of dry eye disease in VDT users.

CENTRAL RETINAL ARTERY OCCLUSION WITH DOUBLE CILIORETINAL ARTERY SPARING.

PURPOSE: To report a patient with central retinal artery occlusion with double cilioretinal artery sparing. METHODS: Retrospective case report. RESULTS: A 45-year-old woman presented with sudden vision loss in her left eye for 10 days. Her best-corrected visual acuity was counting fingers at 2 meters in the left eye and 20/20 in the right eye. Funduscopy showed retinal opacity of posterior fundus, most marked in the macular region, and two small areas of the normal retina; one temporal to the optic disk and the other superior to the optic disk corresponding to the patent cilioretinal retinal arteries in the left eye; the right eye was normal. Fundus fluorescein angiography showed rapid filling of the two cilioretinal vessels and delayed filling of the central retinal artery at initial and last visits. Spectral domain optical coherence tomography findings disclosed diffuse thickening of the neurosensory retina in the perifoveolar area except two small areas at the first visit. After 6 months, spectral domain optical coherence tomography revealed diffuse thinning of the neurosensory retina except two small areas of the retina fed from two patent cilioretinal arteries. CONCLUSION: In this report, we documented double cilioretinal artery sparing in a patient with central retinal artery occlusion. It seems that a second cilioretinal artery can be present in some patients with central retinal artery occlusion.

Quantitative analysis of retinal microcirculation in children with hyperopic anisometropic amblyopia: an optical coherence tomography angiography study.

PURPOSE: To evaluate optical coherence tomographic angiography (OCTA) findings on retinal microcirculation in hyperopic anisometropic amblyopia compared with fellow eyes and nonamblyopic control eyes. METHODS: A total of 40 pediatric patients with hyperopic anisometropic amblyopia and 57 control subjects were recruited, and 137 eyes (40 amblyopic, 40 fellow, and 57 control eyes) were evaluated. Data on best-corrected visual acuity (logMAR), axial length (mm), refractive error, and OCTA findings (foveal avascular zone parameters, macular vascular density in superficial and deep retinal capillary plexus, central macular thickness) were recorded in amblyopic, fellow, and control eyes. RESULTS: Compared with fellow and control eyes, amblyopic eyes were associated with significantly lower foveal vessel density values within 300 µm around the foveal avascular zone (P < 0.01) and lower vascular density in certain areas of superficial and deep retinal capillary plexus in axial length- and refraction-adjusted analysis (P < 0.05 for all), along with significantly higher full thickness of the central macula (P = 0.04). In amblyopic eyes, best-corrected visual acuity values were negatively correlated with foveal density (r = -0.57; P = 0.02) and deep capillary retinal plexus vascular density in foveal (r = -0.51; P = 0.03) parafovea temporal (r = -0.52; P = 0.03), and parafovea superior (r = -0.51; P = 0.04) areas. CONCLUSIONS: Our findings indicate a possible association between retinal microcirculation and amblyopia.