Biochemical and histopathological evaluation of systemic and ocular toxicity of favipiravir in rats.

Purpose: Favipiravir (FAV) used against COVID-19 is an antiviral drug that causes adverse reactions, such as hyperuricaemia, liver damage, and hematopoetic toxicity. The aim of the study was to investigate the systemic and ocular side-effects of FAV in rats, for the first time.Materials and methods: A total of 18 albino male Wistar rats were used in the study. The rats were divided into 3 groups as the healthy group (HG), the group given 50 mg/kg/day favipiravir (FAV50), and the group given 200 mg/kg/d favipiravir (FAV200). These doses were given to the experimental groups for one week. At the end of the experiment histopathological examinations were performed on the conjunctiva and sclera of the eye. In addition, malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), interleukin-1ß (IL-1ß), and tumor necrosis factor alpha (TNF-α) levels were measured in blood samples taken from rats. Results: Compared to HG, the MDA (1.37 ± 0.61 vs. 4.82 ± 1.40 µmol/mL), IL-1ß (2.52 ± 1.14 vs. 6.67 ± 1.99 pg/mL), and TNF-α levels (3.28 ± 1.42 vs. 8.53 ± 3.06 pg/mL) of the FAV200 group were higher. The levels of tGSH (7.58 ± 1.98 vs. 2.50 ± 0.98 nmol/mL) and SOD (13.63 ± 3.43 vs. 3.81 ± 1.43 U/mL) the FAV200 group were lower than the HG (p < 0.05, for all). The degree of damage to the cornea and sclera of the FAV200 group was quite high according to HG (p < 0.001). Conclusions: FAV can cause damage to rat conjunctiva and sclera by increasing oxidant stress and inflammation at high dose.

Effect of mindfulness-based stress reduction on acute central serous chorioretinopathy: a randomized control trial.

PURPOSE: To assess the positive effects of mindfulness-based stress reduction (MBSR) on the structural and functional outcomes of patients with central serous chorioretinopathy (CSCR). METHODS: This study included 60 patients with CSCR who were randomly allocated to one of two groups: MBSR or control (which did not practice MBSR). These groups were then evaluated in terms of best corrected visual acuity (BCVA) and central macular thickness (CMT) at months 1, 3, and 6. RESULTS: There were no significant differences in BCVA or mean CMT between the groups at the beginning of the study (p = 0.615 and p = 0.561, respectively). There were statistically significant differences between the groups in terms of BCVA at 1, 3, and 6 months (p = 0.018, p = 0.001, and p = 0.002, respectively). There were also significant differences in the mean CMT across the groups at the first, third, and sixth months (p < 0.001, p = 0.001, and p < 0.001, respectively). CONCLUSION: MBSR may have beneficial outcomes in the early treatment of patients with CSCR, resulting in faster resolution of subretinal fluid and enhancement of BCVA.

Changes in retinal vascular density measured by optical coherence tomography angiography in patients with carotid artery stenosis after carotid artery stenting and angioplasty.

PURPOSE: The aim of this study was to compare the effect of carotid artery stenting and angioplasty (CASA) on retinal vascular density (VD) in patients with severe carotid stenosis with a healthy control group and to evaluate using optical coherence tomography angiography (OCTA). METHODS: For this prospective study, eyes on the operated side constituted the ipsilateral eye group, and the other eye constituted the contralateral eye group. 40 eyes of 40 patients with ipsilateral eye of carotisid artery stenosis (CAS), 34 eyes on contralateral side, and 30 healthy eyes (control group) were included in this study. We performed quantitative OCTA analyses of retinal VD changes, before and after CASA. The main outcome measures were the quantitative changes of VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP). RESULTS: We evaluated the VD of ipsilateral eyes and contralateral eyes separately before and after the procedure. All patients did not have visual symptoms. There was no significant difference in the VD of SCP in all groups before the procedure. No significant change was observed in all groups when the VD of the SCP was compared before and after the procedure. The VD of the DCP in the ipsilateral and contralateral group improved significantly after CASA. CONCLUSION: OCTA could noninvasively detect retinal VD improvements after CASA in CAS patients. Quantitative changes in VD evaluated using OCTA are thought to be early indicators in the diagnosis of CAS and in the follow-up of treatment success.

Evaluation of retinal neurovascular structures by optical coherence tomography and optical coherence tomography angiography in children and adolescents with type 1 diabetes mellitus without clinical sign of diabetic retinopathy.

BACKGROUND: The aim of the study was to investigate whether retinal neurovascular structural impairment in children and adolescents with type 1 diabetes mellitus (T1D) without clinical signs of diabetic retinopathy (DR) could be detected early via optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: In the current prospective, cross-sectional, observational clinical study children and adolescents with T1D without DR were evaluated between December 2018 and May 2019. Retinal neurovascular structures in the macular and optic disc regions were examined in detail and quantitatively assessed using OCT and OCTA. Data from subjects with T1D were compared with data from healthy controls. Whether retinal neurovascular structural changes were significantly associated with puberty stage, diabetes duration, and HbA1c level was also investigated. RESULTS: The T1D group included 110 eyes and the control group included 84 eyes. In the T1D group the mean inside disc vessel density (VD) was significantly lower than that of the control group (p < 0.001), as was the mean superior temporal disc VD (p < 0.043). Puberty stage was significantly associated with retinal thickness, parafoveal superficial capillary plexus VD, and peripapillary retinal nerve fiber layer thickness (p < 0.05). Diabetes duration and HbA1c level was significantly correlated with retinal layer thickness, foveal avascular zone diameter, and superficial and deep capillary plexus VDs. CONCLUSION: In children and adolescents with T1D without clinical signs of DR, the VD of the disc region is affected earlier than the macular region. In these patients, early neurovascular impairment can be detected non-invasively via OCT and OCTA.

Evaluation of Lacrimal Drainage Function in the Anophthalmic Socket by Dacryoscintigraphy.

PURPOSE: To investigate whether impaired lacrimal pump function is a possible cause of discharge in patients wearing an artificial eye compared with the remaining healthy eye. METHODS: Consecutive patients wearing unilateral ocular prosthesis for ≥6 months were included in this retrospective study. Excluded were any deformities of eyelids or nasal passage, socket complications such as entropion, ectropion, ptosis, infection, pyogenic granuloma, contracted socket, obstruction of nasolacrimal duct diagnosed with lacrimal irrigation and a difference greater than 2 mm in terms of protrusion between two eyes detected by Hertel exophthalmometry. Patients were asked to score the levels of tearing and mucopurulent discharge between 0 and 5 to assess lacrimal drainage function subjectively. Furthermore, dacryoscintigraphy was performed to assess the functional status of the lacrimal system objectively. RESULTS: Included were 32 subjects (12 females, 20 males; aged 32.94 ±â€Š17.62, range 13-78). Mean duration of prosthetic wearing 26.41 ±â€Š21.30 (6-72) months. The mean subjective scores of tearing and mucopurulent discharge were 1.56 ±â€Š1.67 and 1.94 ±â€Š1.63, respectively. The rate of functional stenosis was significantly higher in the anophthalmic socket side as compared to the healthy side (P = 0.002). The rates of a presac, preduct, and intraduct obstruction was notes as n = 9, n = 10, n = 1 and n = 0, n = 6, n = 2 in the anophthalmic side and the companion eye, respectively (P = 0.021). CONCLUSION: Compared to paired healthy eyes, the ocular prosthesis exhibited significantly higher rates of functional lacrimal duct obstruction, especially at the presac level. The alterations in orbital volume and tear film composition in addition to reduced corneal reflex blinking may lead to the failure of lacrimal pump function in artificial eyes.

Retinopathy screening results of late-preterm infants born at 32-35 weeks of gestational age.

PURPOSE: The aim of this retrospective, nonrandomized, observational clinical study was to evaluate the screening results for retinopathy of prematurity (ROP) of late-preterm infants born at 32-35 weeks gestational age (GA). METHODS: Retinopathy screening data of late-preterm infants were evaluated between January 2015 and September 2018. The zones and stages of ROP development were classified according to the International ROP Committee criteria. Patients were categorized into four groups according to GA: 32 < 33 weeks GA, 33 < 34 weeks GA, 34 < 35 weeks GA, and 35 < 36 weeks GA. The rates of development of any stage of ROP or severe ROP (requiring treatment) were recorded. RESULTS: The study included 543 infants: 139 (25.4%) in 32 < 33 weeks GA, 127 (23.6%) in 33 < 34 weeks GA, 162 (30.2%) in 34 < 35 weeks GA, and 115 (20.8%) in 35 < 36 weeks GA. Different stages of ROP developed in 29 infants (20.9%) in 32 < 33 weeks GA, 19 infants (15%) in 33 < 34 weeks GA, 17 infants (10.5%) in 34 < 35 weeks GA, and 6 infants (5.2%) in 35 < 36 weeks GA. Treatment was required for 14 infants (2.6%) due to severe ROP: 7 (5%) in 32 < 33 weeks GA, 3 (2.4%) in 33 < 34 weeks GA, and 4 (2.5%) in 34 < 35 weeks GA. No treatment was required in 35 < 36 weeks GA. CONCLUSION: Late-preterm infants must be screened for ROP, especially those born in developing countries. Although rates of ROP development decrease as GA increases, infants born at 34 weeks of GA or younger, regardless of birth weight, should be examined at least once for ROP.

Comparison of Three Different Techniques on the Movement of Implants After Evisceration.

PURPOSE: To compare the results of 3 evisceration techniques involving placement of an acrylic implant within the scleral shell without posterior sclerotomy (Group 1), posterior sclerotomy with placement of a porous implant within the intraconal space (Group 2) and posterior sclerotomy with placement of a acrylic implant within the intraconal space (Group 3) with respect to ocular mobility, implant complications and patient satisfaction. METHODS: Single-center, retrospective, interventional case series. A chart review of 72 patients undergoing evisceration between February 2013 and January 2018 was carried out. Thirty-five patients met the inclusion criteria having a normal or near normal size eye and at least 6 months follow-up. The horizontal movements of the implant and the artificial eye was measured by using a ruler. Data analyses were conducted using the Mann-Whitney U test for 2 independent samples. RESULTS: Neither infection nor prolapse of the implant had occurred in any of the patients. The mean implant sizes were 18 mm in Group 1, 20 mm in Group 2 and 20 mm in Group 3. Statistically, a significant difference was assessed between Group 1 and Group 2 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. Statistically, a significant difference was assessed between Group 1 and Group 3 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. However, there was no statistically significant difference between Group 2 and Group 3 in neither nasal and temporal movement of the socket nor nasal and temporal movement of the artificial eye. CONCLUSION: Group 1 showed the significantly better movement of both prosthesis and socket in adduction and abduction than Group 2 and 3. The likely explanation for this may be that preserving the scleral shell integrity allows more efficient transmission of muscle contraction to the socket and prosthesis.

Efficacy and safety of the paul glaucoma implant in the treatment of refractory primary congenital glaucoma.

PURPOSE: To evaluate the safety and efficacy of the PAUL Glaucoma Implant (PGI) for managing refractory primary congenital glaucoma (PCG) over a one-year period. STUDY DESIGN: Retrospective. METHODS: A study was conducted using the medical records of thirty eyes of 17 patients who underwent PGI surgery for the treatment of refractory PCG. Primary outcome measures included failure criteria such as intraocular pressure (IOP) > 21 mm Hg, < 20% IOP reduction, necessity for further glaucoma intervention, implant removal, or loss of vision. Secondary outcomes focused on mean IOP, average number of glaucoma medications, best corrected visual acuity (logMAR), and incidence of complications. RESULTS: The mean preoperative IOP of 38.8 ± 9.2 mmHg significantly decreased to 16.1 ± 3.3 mmHg at 12 months postoperatively (p < 0.001). The average number of glaucoma medications reduced from 3.6 ± 0.5 preoperatively to 0.9 ± 1.2 at 12 months post-op. Visual acuity remained stable in 24 eyes, decreased in 4, and increased in 2. Early postoperative complications occurred in 13.3% of patients, but no late complications were reported. The cumulative success rate was 86.6%. CONCLUSION: The PGI appears to be a safe and effective option for managing refractory primary congenital glaucoma, demonstrating significant IOP reduction and decreased dependence on glaucoma medications over a one-year period, with a high success rate and manageable complication profile.

Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma.

PURPOSE: To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. METHODS: This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. RESULTS: For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. CONCLUSION: GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.

One-Year Outcomes of the PAUL Glaucoma Implant Compared With the Ahmed Glaucoma Valve for the Treatment of Silicone Oil Glaucoma.

PRCIS: Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures. OBJECTIVE: To evaluate the outcomes of the PAUL glaucoma implant (PGI) and Ahmed glaucoma valve (AGV) in patients with secondary glaucoma caused due to silicone oil emulsification. PATIENTS AND METHODS: A retrospective examination was conducted using the medical records of 36 patients who developed secondary glaucoma due to silicone oil emulsification after vitreoretinal surgery and then underwent PGI and AGV implantation surgery. The main outcome measures in the PGI and AGV groups were intraocular pressure (IOP) and its change, the number of antiglaucoma medications, and postoperative complications during the 12-month follow-up period. IOP of <6 mm Hg is used to define hypotonia. RESULTS: There was no statistically significant difference among the patients who underwent PGI and AGV surgeries in terms of IOP averages, both preoperatively and postoperatively on day 1, week 1, month 1, month 3, month 6, and month 12 ( P > 0.05). Before PGI and AGV implantation, the mean IOP was 40 ± 13 mm Hg and 39.3 ± 10 mm Hg, and the mean number of medications was 3.8 ± 0.4 and 4 ± 0, respectively. At the end of the 12-month follow-up period, the mean IOP was 13.5 ± 2.2 ( P < 0.001) mm Hg and 14.9 ± 4.2 ( P < 0.001) mm Hg, whereas the mean number of glaucoma medications decreased to 1.7 ± 1.3 ( P < 0.001) and 1.9 ± 1.8 ( P < 0.001) in the PGI and AGV groups, respectively. Surgical success was achieved in 17 of 18 eyes (94%) in the PGI group and 16 of 18 eyes (89%) in the AGV group. CONCLUSIONS: Although the outcomes were similar in both the PGI and AGV groups, complications requiring medical and surgical intervention were less common in the PGI group. Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures.

Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma.

Objectives: The aim of the study was to evaluate the outcomes and complications associated with PAUL glaucoma implant (PGI) surgery in pseudoexfoliation glaucoma (PXG) patients, comparing them with a primary open-angle glaucoma (POAG) control group. Methods: A retrospective analysis included 39 PXG and 29 POAG eyes undergoing PGI surgery between January 2020 and December 2022. Surgical success was defined as intraocular pressure (IOP) between ≤21 and ≥6 mmHg at 12 months and no loss of light perception. Demographic data, ocular examinations, and complications were recorded. Results: PXG patients (68.5±9.9 years) differed significantly in age from POAG patients (54.1±10.6 years) (p<0.05). Surgical success rates at 12 months were 97.4% (PXG) and 86.2% (POAG). No significant inter-group differences in gender, laterality, lens status, vertical cup/disc ratio, or pre-operative best-corrected visual acuity were observed. Mean IOP comparisons showed significant differences within both groups (p<0.001). Ripcord suture removal occurred at mean 30.3±7.43 days (PXG) and 30.6±9.89 days (POAG). Median pre-operative AGM use was 4 (PXG) and 3 (POAG). No significant differences were noted postoperatively. Conclusion: To the best of our knowledge, this is the first study to evaluate the results of PGI in PXG and POAG, demonstrating a remarkable success rate and limited complications. Encouragingly, PXG patients with a history of unsuccessful filtration surgery demonstrated positive outcomes. The findings affirm PGI as a promising surgical intervention for PXG and POAG, exhibiting high success rates and manageable complications.

Optical Coherence Tomography Angiography Evaluation of Retinal and Choroidal Microvascular Morphological Changes Following Strabismus Surgery.

PURPOSE: To evaluate the structural and microvascular changes in the retina and choroid after strabismus surgery. METHODS: The study included 44 eyes from 44 patients who underwent strabismus surgery between August 2020 and December 2021. Among these patients, 9 (20%) underwent horizontal one-muscle surgery, 27 (61%) underwent horizontal two-muscle surgery, and 8 (18%) underwent inferior oblique muscle anteriorization surgery. Optical coherence tomography angiography scans were conducted preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS: The outer retinal blood flow showed a significant increase at 1 day postoperatively in horizontal two-muscle and inferior oblique muscle anteriorization surgery, whereas no significant difference was observed between periods in horizontal one-muscle surgery (P = .007). Choriocapillaris blood flow exhibited a significant increase at 1 day and 1 month postoperatively compared to the preoperative period (P < .001). Whole image superficial capillary plexus vascular density was significantly lower at 1 day postoperatively than preoperatively and 1 and 3 months postoperatively (P < .001). Whole image deep capillary plexus vascular density was significantly lower at 1 day than at 1 month postoperatively (P = .002). CONCLUSIONS: Following strabismus surgery, temporary changes in the hemodynamic microcirculation in the retina and choroid are observed. A transient decrease in retinal artery blood supply may be noticed, possibly attributed to the reduced anterior segment blood supply. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Nd:YAG Laser Capsulotomy vs. Needle Aspiration in Intumescent Cataracts: A Comparative Study of Complications and Outcomes.

PURPOSE: The aim of this study is to compare the complications and postoperative outcomes of Nd:YAG laser anterior capsulotomy versus a needle aspiration approach for capsulorhexis in patients with intumescent cataracts. SETTING: University of Health Sciences, Basaksehir Cam and Sakura City Hospital department of Ophthalmology, Istanbul, Turkey. DESIGN: Retrospective, cross-sectional study. METHOD: Intumescent cataract patients were divided into two groups. Group 1 (37 eyes) underwent Nd:YAG Laser capsulotomy pre-surgery, which reduced lens pressure. In group 2 (31 eyes), the capsulorhexis was completed by reducing the intralenticular pressure by needle aspiration and then gradually expanding the capsule. Demographics, pre/post-op parameters, complications, and surgical times were analyzed. RESULTS: Evaluated were 68 eyes from 68 patients. Age and gender exhibited no significant differences between groups. Group 2 had more complications than Group 1 (p=0.041). Specifically, no capsular tear extensions were seen in Group 1, while four patients in Group 2 had tears extending to the lens periphery. Group 1 showed a significant decrease in surgical maneuvers and time (p=0.028), while no significant difference was found in effective phacoemulsification time (p=0.076). CONCLUSION: Nd: YAG laser capsulotomy effectively prevented capsular extensions and reduced surgical time in intumescent cataracts. This technique provides a safe alternative to traditional methods, potentially reducing intraoperative risks and improving surgical efficiency. The findings support Nd: YAG laser anterior capsulotomy as a viable approach for capsulorhexis in intumescent cataracts, emphasizing its potential benefits in reducing complications and enhancing surgical outcomes.

Twelve-Month Results of Pterygium Surgery with Autologous Blood Assisted, Sutureless Conjunctival Autograft: Safe and Comfortable Surgical Technique.

Objectives: To evaluate the efficiency and safety of autologous blood-assisted, sutureless conjunctival autograft surgery in the management of pterygium. Methods: This study included the eyes of 124 patients who were divided into two groups. Group 1 consisted of 62 patients who received autologous blood-assisted, sutureless conjunctival autograft, and Group 2 consisted of 62 patients who underwent conventional sutured conjunctival autograft surgery. The primary outcome measure was graft stability, and the secondary outcome measures were postoperative immediate patient comfort and recurrence rates at 12 months. Results: The mean duration of surgery was significantly shorter in Group 1 (9.84±2.64 min) than in Group 2 (17.90±4.42 min) (p<0.001). The postoperative pain visual analog scale score was significantly lower in Group 1 (p<0.001). The postoperative complications included graft loss in four patients in Group 1 and recurrence of pterygium in six patients in Group 2. Conclusion: The autologous blood-assisted, sutureless conjunctival autograft technique seems superior to the conventional sutured autograft technique in terms of postoperative patient comfort, lower recurrence rates, and shorter duration of surgery.

A double-blinded randomized clinical trial for pain perception: The efficacy and safety of topical cold saline solution anesthesia in phacoemulsification.

PURPOSE: To compare the efficacy and safety of cold saline solution (0.9% NaCl) with topical ophthalmic proparacaine for maintaining topical anesthesia of patients undergoing phacoemulsification surgery. METHODS: The prospective, double-blinded, and randomized clinical study was randomly assigned to two groups that underwent phacoemulsification surgery due to cataracts. The cold saline group included 86 eyes of 86 patients with topical anesthesia of cold saline solution alone. The proparacaine group included 84 eyes of 84 patients with topical ophthalmic proparacaine (room temperature) anesthesia alone. The patients were scored according to a pain survey questionnaire of Visual Analog Scale (VAS) ranked between 0 and 10. The surgeon scored surgical experience by a Surgeon Questionnaire Scale (SQS) in three parameters, each of which was ranked from 1 to 3 based on questions regarding ease and comfort during the surgery. RESULTS: The mean VAS scores were 1.29 ± 0.65 and 1.22 ± 0.66 for the cold saline and proparacaine groups, respectively (P = 0.182). The mean scores of SQS (lower values represented favorable results) were 4.11 ± 0.76 and 3.97 ± 0.74 in the cold saline and proparacaine groups, respectively (P = 0.163). Ten patients in the proparacaine group experienced corneal epitheliopathy in the postoperative period. CONCLUSION: As an easily accessible and cost-effective method, cold saline solution alone might be an alternative to topical ophthalmic proparacaine alone with comparable safe and effective results. The absence of allergic or toxic effects also provided a significant advantage in the cold saline application.

OCT and OCTA evaluation of vascular and morphological structures in the retina in recovered pediatric patients with COVID-19.

BACKGROUND: Using OCT and OCTA imaging, we aimed to determine whether COVID-19 induces pathological changes in vascular and morphological structures in the pediatric retina. METHODS: The current prospective, cross-sectional, observational clinical study included recovered pediatric patients with COVID-19 evaluated between May 2020 and June 2020. Retinal vascular (radial peripapillary, superficial, and deep capillary plexus vessel densities) and morphological (peripapillary retinal nerve fiber, ganglion cell layer, retinal, and choroidal thickness) in the optic disk and macula regions were quantitively assessed using OCT and OCTA. Data were compared between COVID-19 patients and age-matched controls. RESULTS: The COVID-19 group included 32 eyes of 16 patients and the control group included 32 eyes of 16 cases. Fundus and biomicroscopic examinations revealed no signs of pathology in the COVID-19 group. Mean peripapillary retinal nerve fiber, ganglion cell layer, and choroidal thickness values were significantly greater in the COVID-19 group than in the control group (p<0.05). OCTA indicated that mean superficial and deep capillary plexus vessel densities, and choriocapillaris flow area values were significantly lower in the COVID-19 group than in the control group, whereas mean radial peripapillary capillary plexus vessel density values were significantly higher (p<0.05). CONCLUSIONS: Even if fundus examination results appear normal in pediatric patients with COVID-19, vascular and morphological changes may be observed in the retina. Further studies with larger numbers of patients are needed to elucidate the clinical significance of vascular and morphological changes in this population.

Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy.

AIM AND OBJECTIVE: To evaluate the efficacy and safety of XEN stent implantation in the inferonasal quadrant after prior failed trabeculectomy. MATERIALS AND METHODS: Fourteen open-angle glaucoma patients with prior failed trabeculectomy were recruited to this retrospective study. Implantation of the stent was performed as a stand-alone procedure. The mean follow-up duration was 14.2 months. Best-corrected visual acuity, intraocular pressure (IOP), number of medications, complications, and the requirement for additional procedures were among the outcome measures recorded. RESULTS: Mean IOP reduced by 49.3% from 24.14 ± 2.74 mm Hg preoperatively to 12.23 ± 2.89 mm Hg at month 12 (p < 0.001). Medication usage reduced from 3.71 ± 0.47 medications preoperatively to 1.31 ± 1.55 at month 12 (p = 0.003). Adverse events included transient slight intracameral hemorrhage (5 eyes, 35.7%), second trabeculectomy required (2 eyes, 14.3%), and numerical hypotony (IOP <5 mm Hg, in 3 cases, 21.4%), all of which resolved spontaneously. Six eyes (42.8%) required postoperative bleb needling to further reduce IOP. There were no cases of vision loss, stent exposure, hypotony, lower eyelid malposition, bleb dysesthesia, or bleb-related infection. CONCLUSION: XEN gel stent implantation in the inferonasal quadrant can be considered a viable surgical option for patients with a history of previously failed trabeculectomy requiring further IOP lowering. CLINICAL SIGNIFICANCE: To the best of our knowledge, this is the first case series describing the outcome of inferonasal implantation of XEN gel stent following failed trabeculectomy. HOW TO CITE THIS ARTICLE: Düzgün E, Olgun A, Karapapak M, et al. Outcomes of XEN Gel Stent Implantation in the Inferonasal Quadrant after Failed Trabeculectomy. J Curr Glaucoma Pract 2021;15(2):64-69.

Functional and Morphological Results of Epiretinal Membrane Surgery in Idiopathic versus Diabetic Epiretinal Membranes.

PURPOSE: Idiopathic and diabetic epiretinal membranes (ERM) are different in terms of pathophysiology, etiology, and macular morphology, and thus might respond to surgical treatment differently. We aimed to compare the surgical results of two groups. METHODS: Retrospective case series study of 71 eyes of 66 patients who underwent pars plana vitrectomy (PPV) due to idiopathic or diabetic ERM with at least 1-year follow-up. Examinations were performed before, and 1, 3, 6, and 12 months after surgery. The average macular thicknesses in nine sectors described by the Early Treatment Diabetic Retinopathy Study (ETDRS) were measured with spectral-domain optical coherence tomography (OCT), and BCVA was evaluated. ERM recurrence rates were investigated. RESULTS: In both idiopathic and diabetic groups, retinal thickness (RT) changes occurred as long as 12 months after vitrectomy surgery for ERM. However, in the idiopathic group, significant changes were mainly seen in the first 6 months, while in the diabetic group changes slowed considerably between the third and sixth months, but again accelerated (becoming significant) during the last 6 months. CONCLUSIONS: According to the findings of this study, as compared to those with idiopathic ERM, diabetic patients would likely see continuing benefits from ERM surgery 6 to 12 months post surgery. The BCVA changes of the two groups were similar. ILM peeling decreased ERM recurrence in the idiopathic group but not in the diabetic group.

Pre-Conditioning Serum Uric Acid as a Risk Factor for Sinusoidal Obstruction Syndrome of the Liver in Children Undergoing Hematopoietic Stem Cell Transplantation

Objective: Uric acid (UA), a known danger signal released from injured cells, is a valuable sign of inflammation. We aimed to evaluate the association of serum UA levels before the start of conditioning regimens with the risk of hepatic sinusoidal obstruction syndrome (SOS) development after hematopoietic stem cell transplantation (HSCT). Materials and Methods: Two hundred and twenty-two children who underwent allogeneic HSCT at the Pediatric BMT Unit of Hacettepe University between 2000 and 2014 were included in this retrospective study. Serum UA levels were measured before conditioning as an indicator of the pre-transplant inflammatory status of the patients. Patients with and without a diagnosis of SOS were compared regarding primary diagnosis, previously described risk factors for SOS, and pre-conditioning serum UA. Results: SOS was diagnosed in 42 patients who had higher pre-conditioning serum UA levels compared to those who did not. Pre-transplant serum creatinine, gamma-glutamyl transferase, bilirubin, ferritin, and C-reactive protein levels did not differ significantly among patients with and without SOS; however, serum albumin was lower in the patients who developed SOS. Receiver operating characteristic analysis revealed that a pre-conditioning UA level higher than 3.32 mg/dL was predictive of SOS. When applied to a multivariate model, only pre-conditioning UA and albumin levels remained significant risk factors for SOS (UA: odds ratio [OR], 2.54; 95% confidence interval [CI], 1.26-5.12, p=0.009; albumin: OR, 0.45, 95% CI, 0.22-0.95, p=0.037). Conclusion: Our results suggest that pre-conditioning serum UA is an independent risk factor for SOS, and it might be used as an early predictor of hepatic SOS together with previously described clinical and laboratory parameters.

Evaluation of the Effect of Different Treatment Management on Refractive Outcomes in Severe Retinopathy of Prematurity.

Objectives: The purpose of the study was to evaluate the effect of different treatment modalities on refractive outcomes in patients treated with severe retinopathy of prematurity (ROP). Methods: The records of children who were treated for severe ROP in our clinic between January 2015 and August 2018 were retrospectively reviewed. The children who were treated were analyzed in three subgroups as intravitreal bevacizumab (IVB), laser photocoagulation (LPC), and IVB + LPC. Spherical equivalent (SEQ), spherical and cylindrical power measurements of the cases were recorded in diopters (D). SE ≤-0.25D was accepted as myopia and SE of more than 1 D between two eyes was accepted as anisometropia. Results: A total of 160 eyes of 80 participants were eligible for inclusion: 38 eyes in the IVB group, 24 eyes in the LPC group, 16 eyes in the IVB + LPC group, 44 eyes in the spontaneously regressed group, and 38 eyes in the full-term children. Although the mean spherical power and SEQ in the IVB group were lower than in the LPC group (p=0.019 and 0.013, respectively), there was no significant difference between the IVB group and the IVB + LPC group (p=0.541 and 0.804, respectively). In terms of mean cylindrical power and prevalence of myopia and anisometropia, there was no significant difference between the treatment groups (p>0.05). Conclusion: Although spherical power and SEQ can change according to the ROP treatment management, there is no difference in terms of the cylindrical power, prevalence of myopia, and anisometropia. The most important risk factor for myopia and anisometropia in premature children may be ROP severity and retinal immaturity.