The longitudinal follow-up of a newly proposed OCTA imaging finding (SSPiM) and the importance of it as a new biomarker for treatment response in diabetic macular edema.

PURPOSE: This study aimed to evaluate the frequency of SSPiM (suspended scattering particles in motion), systemic risk factors, ocular findings, progression characteristics, and treatment response in diabetic retinopathy (DR) patients. METHODS: In this prospective study, a total of 109 eyes of 109 patients with diabetic macular edema (DME) were included. Demographic characteristics and systemic data of the patients were recorded. In addition to a detailed ophthalmological examination, optical coherence tomography (OCT) and OCT angiography (OCTA) imaging were performed. According to the OCTA images, the patients were divided into two categories: SSPiM detected (SSPiM +) and undetected (SSPiM -). The patients were followed up at 0, 3, and 6 months. Treatment responses at 6 months in treatment-administered patients with and without SSPiM were examined. RESULTS: The frequency of SSPiM in DME cases was found to be 34.9%. No significant correlation was found between SSPiM and demographic characteristics, systemic, and biochemical parameters (p > 0.05). It was observed that SSPIM was most frequently localized in the outer nuclear layer adjacent to the outer plexiform (81.6%). SSPiM appearance disappeared in 7 (19.4%) of 36 patients with SSPiM who had regular follow-up for 6 months. In 4 (11.1%) of these seven patients, hard exudate plaques developed in the areas where SSPiM disappeared. Regarding treatment response at 6 months, the decrease in CMT was statistically significantly lower in the SSPiM group compared to cases without SSPiM. CONCLUSION: SSPiM is a finding seen in approximately one-third of DME patients and may adversely affect the response to the treatment.

Quantitative assessment of intervortex anastomosis in central serous chorioretinopathy and fellow eyes: Does the size of anastomotic vessels matter for the diagnosis?

PURPOSE: To evaluate the frequency and size of intervortex anastomosis at the posterior pole on en-face spectral domain optical coherence tomography (SD-OCT) images in central serous chorioretinopathy (CSC) cases and their fellow eyes and its associations with choroidal morphology. METHODS: Sixty-five treatment-naive eyes of 65 patients with CSC, 65 fellow eyes, and 55 eyes of healthy age-matched participants were included. The presence of intervortex anastomosis at the watershed zone and asymmetry of the choroidal vessels between the superior and inferior macula were evaluated using 6 × 6 mm en-face SD-OCT. The diameter of the widest Haller vessel and the diameter of the widest anastomotic Haller vessel passing through the watershed zone were measured on en-face SD-OCT images. The choroidal vascularity index (CVI) was assessed using ImageJ software. RESULTS: Intervortex vein anastomosis on the horizontal watershed zone was detected in 75.4% diseased eyes, 61.5% in fellow eyes, and 36.4% in healthy age-matched controls (p < 0.001). The mean CVI was significantly higher in both diseased (74.3 ± 2.3%) and fellow (73.8 ± 2.2%) eyes of CSC cases than in healthy controls (72.5 ± 2.3%) (p = 0.002, p = 0.013, respectively). In the cases with intervortex vein anastomosis, the diameter of the widest anastomotic Haller vessel passing through the watershed zone was 0.40 ± 0.10 mm in diseased eyes, 0.35 ± 0.11 mm in fellow eyes, and 0.30 ± 0.09 mm in healthy age-matched controls (p = 0.001). CONCLUSIONS: Intervortex anastomosis might be seen as a variation in normal eyes, however, its frequency and the size of anastomotic vessels are significant higher in not only CSC but also in fellow eyes.

Choroidal structural alterations in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy.

PURPOSE: To assess choroidal structural changes in diabetic patients in association with disease duration, HbA1c level, and presence of retinopathy. METHODS: This retrospective cross-sectional study included treatment-naive patients with non-proliferative DR (NPDR) (group 1), diabetic patients without DR (group 2), and healthy subjects (group 3). Patients were also grouped according to the duration of diabetes: long-term group (> 15 years, n = 32) and short-term group (˂ 15 years, n = 28). The choroidal thickness was measured at three points; subfoveal, 1500 µm nasal, and 1500 µm temporal to the fovea. The choroidal area, stromal area, luminal area (LA), and choroidal vascularity index (CVI) were quantified using ImageJ. Partial correlation analysis and one-way analysis of covariance test were performed for statistical analysis. RESULTS: The study included 30 eyes of 30 treatment-naive patients with NPDR (group 1), 30 eyes of 30 diabetic patients without DR (group 2), and 30 eyes of 30 healthy persons (group 3). The mean subfoveal, nasal, and temporal choroidal thicknesses were decreased in group 1 in comparison with controls (p < 0.001, p = 0.035, and p = 0.005, respectively). The mean LA in group 1 and group 2 were both significantly lower compared to group 3 (group 1 vs. group 3, p = 0.004; group 2 vs. group 3, p = 0.020). CVI was significantly lower in group 1 and group 2 than in controls (group 1 vs. group 3, p = 0.019; group 2 vs. group 3, p = 0.025). CVI was significantly lower in the long-duration group than in the short-duration group (p < 0.001). A moderate negative correlation was found between the duration of diabetes and CVI (r = - 0.467, p < 0.001). A moderate negative correlation was found between HbA1c level and luminal area and CVI (r = - 0.466, p < 0.001, and r = - 0.425, p < 0.001, respectively). CONCLUSION: Choroidal structure and CVI are altered even in the absence of clinically confirmed retinopathy and these alterations are related to the duration of diabetes.

Effect of autologous growth factors on apoptosis and thickness of the outer nuclear layer in an experimental retinal degeneration model.

Retinal pigment epithelium and photoreceptor cells are a microenvironment where 90 different peptides are synthesized for transduction, visual cycle, intracellular electron transport chain, and removal of metabolic wastes. Depending on the inheritance pattern, either mutant proteins accumulate inside the cells or the energy cycle is disrupted. Disruption of homeostasis causes the cells to switch to the dormant phase; if the improper conditions last longer, then apoptosis eventually develops resulting in a loss of visual function. In neural tissues, growth factors such as neural growth factor, brain-derived neurotrophic factor, ciliary neurotrophic factor, and insulin-like growth factor are regulatory peptides for intracellular energy cycle and intracellular digestion. In this study, it has been shown histopathologically that autologous growth factors can prevent apoptosis and prevent loss of outer retinal thickness in the retinal degeneration model created with sodium iodate.

Inherited eye diseases in Turkey: Current approaches and future directions.

The aim of this review is to reveal Turkey's current status of medical practice in inherited eye diseases and the necessary steps to improve healthcare services and research activities in this area. Since consanguinity rate is high, disease burden is estimated to be high in Turkey. Universal health insurance system, easily accessible medical specialists, increasing genetic test, and counseling opportunities are the key advantages of Turkey's healthcare system. However, specialized clinics for inherited eye diseases, low-vision rehabilitation services, training of ophthalmologists about the recent developments in ocular genetics, and multidisciplinary translational research are the main headlines needed to be focused for better health services and successful research in Turkey.

A comparative study of the choroidal vascularity indexes in the fellow eyes of patients with pachychoroid neovasculopathy and central serous chorioretinopathy by binarization method.

PURPOSE: To evaluate the choroidal vascularity index (CVI) in the fellow eyes of patients with pachychoroid neovasculopathy (PCN) and central serous chorioretinopathy (CSC). METHODS: Fifty-eight asymptomatic fellow eyes from 58 patients diagnosed with PCN or CSC and 26 eyes from 26 healthy participants were included. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured with ImageJ software and Niblack threshold method. The CVI, which was the proportion of the LA to the CA, was assessed. RESULTS: The CA, LA, and SA were widest in the fellow eyes of the CSC group. The differences between the fellow eyes of the CSC group and the control group and the differences between the fellow eyes of the PCN group and the CSC group were significant (p < 0.001). The CVI of the fellow eyes of the CSC group was significantly higher than the control group (74.93 ± 3.58 vs. 73.38 ± 3.09, p = 0.023). CONCLUSION: The differences in the CA, LA, and SA in particular pachychoroid diseases were evident in the asymptomatic fellow eyes. Pachychoroid diseases are characterized by thick choroid or vessels as a common feature, but they may have different structural choroidal features, which might result in different consequences.

ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS: Incidence, Causes, and Best Practices for Managing and Preventing Conjunctival Erosion.

PURPOSE: To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS: This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS: Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION: Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.

Role of Inflammation in Retinal Microcirculation in Diabetic Eyes: Correlation between Aqueous Flare and Microvascular Findings.

PURPOSE: To investigate the correlation between aqueous flare and macular microvascular status assessed by optic coherence tomography angiography (OCTA) in diabetes mellitus. METHODS: A cross-sectional study was conducted on 52 diabetic patients with nonproliferative retinopathy, 44 diabetic patients without retinopathy, and 20 nondiabetic age-matched controls. Spectral domain OCT, OCTA, and laser flare-cell meter were performed. RESULTS: Compared to eyes without retinopathy, eyes with retinopathy had higher flare intensity (p = 0.024), enlarged capillary nonperfusion area (p < 0.001), and enlarged foveal avascular zone (p < 0.001). There was a significant correlation between flare intensity and capillary nonperfusion areas (p < 0.001, r = 0.511) and superficial capillary density (p = 0.005, r = -0.388) in diabetic eyes with retinopathy. CONCLUSION: The results demonstrated a positive correlation between aqueous flare levels, an indicator of intraocular inflammation, and microvascular damage demonstrated by OCTA in the early stages of diabetic retinopathy (DR). This finding supports the role of inflammation in the pathogenesis of DR.

Comparison of United States and International Ophthalmic Drug Pricing.

PURPOSE: To compare United States and international drug pricing for commonly prescribed intravitreal and topical ophthalmic medications. DESIGN: Cross-sectional observational study. METHODS: For 25 commonly used ophthalmic medications (3 intravitreal, 22 topical), we obtained 2017 third quarter United States average wholesale price (AWP), drug acquisition cost, or consumer pricing through United States government health insurance plans (Veterans Affairs [VA], Medicaid, Medicare Part B, and Medicare Part D) and commercial drug plans (CVS Caremark and Navitus Health Solutions), online pricing without insurance through a large United States warehouse retailer (Costco), and international drug pricing through government-sponsored health plans in Italy, Spain, Turkey, Canada, and Japan. MAIN OUTCOME MEASURES: Drug acquisition costs and consumer pricing of ophthalmic drugs through various payment systems. All prices were converted to United States dollars. RESULTS: For intravitreal medications in the United States, aflibercept and ranibizumab were priced similarly to each other and were more expensive than dexamethasone implants. Pricing of aflibercept and ranibizumab through government health insurance plans in Italy, Spain, Turkey, Canada, and Japan were less expensive by as much as 84.3% compared with the United States. For topical medications in the United States, pricing varied significantly both across different classes of medications and also between nonbranded and branded medications. Drug acquisition costs through the VA and Medicaid were inexpensive on average, but pricing through a hospital-employee drug insurance plan offered the smallest range (between $2.35 and $60.00). In all 5 non-United States countries studied, each topical medication with the exceptions of cyclosporine emulsion and difluprednate was less than $100, and 94.4% of topical medications in these countries had a nonbranded or branded option that was less than $50. CONCLUSIONS: In the United States, for topical more than intravitreal medications, significant price variation exists across both different drug pricing systems and different medications. Price differentials between nonbranded and branded medications can be significant. Internationally, topical medications exhibited a more limited and lower price range compared with drug pricing in the United States.

Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and optical coherence tomography after half-fluence photodynamic therapy in chronic central serous chorioretinopathy.

PURPOSE: To concurrently evaluate the effect of half-fluence photodynamic therapy (hf PDT) on choriocapillaris (CC) perfusion and choroidal structure in chronic central serous chorioretinopathy (CSC). METHODS: This prospective study included 48 eyes of 41 patients with chronic CSC. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were analyzed. Choroidal area (CA), luminal area (LA), and stromal area (SA) were computed using Image J software. RESULTS: One month after hf-PDT, total CA decreased to 1.312 mm2 from 1.490 mm2 (p < 0.001), LA decreased to 0.981 mm2 from 1.097 mm2 (p < 0.001), and SA decreased to 0.331 mm2 from 0.393 mm2 (p < 0.001). In OCTA, the CC flow in the eyes with CSC (17.75 mm2) was statistically significantly lower than the fellow eyes (18.93 mm2) at the baseline visit (p < 0.001). After hf-PDT, the flow in the choriocapillaris statistically significantly increased to 18.81 mm2 at the first month (p = 0.02). CONCLUSIONS: OCTA proves that after hf-PDT a significant increase in CC perfusion occurred at first month. The decrease of the luminal areas in enhanced depth imaging optical coherence tomography is mainly due to a decrease in large-caliber vessels, which indicates that hf-PDT has an effect on larger choroidal vessels and spares CC flow.

Role of a mydriasis-free, full-field flicker ERG device in the detection of diabetic retinopathy.

PURPOSE: To determine if the RETeval system can be used for the screening of diabetic retinopathy (DR) to provide early diagnosis. METHODS: The subjects were 42 diabetic patients selectively recruited by examination of their medical records to have varying severities of DR. The severity of DR was classified into four groups according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Full-field electroretinograms (ERG) without mydriasis were obtained by the DR assessment protocol of the RETeval system. Macular retinal nerve fiber layer (RNFL) thickness was measured by optical coherence tomography. We compared the DR assessment protocol results and the macular RNFL thickness among four groups. Moreover, an analysis was conducted on whether there was any correlation among the DR assessment protocol results, duration of diabetes mellitus, and RNFL thickness individually for each group of patients. RESULTS: The mean ages and mean duration of diabetes mellitus of the four groups were similar. The DR assessment protocol results in the moderate-severe nonproliferative DR, and proliferative DR groups were significantly higher than those in the other groups (p < 0.001). The mean macular RNFL thickness was similar in all groups. No significant correlation was found between the DR assessment protocol results and duration of DM and the RNFL thickness. CONCLUSIONS: Our results suggest that the RETeval full-field ERG system can be used as an adjunctive tool for the mass screening of DR, while macular RNFL thickness would not be useful.

Effects of subtenon-injected autologous platelet-rich plasma on visual functions in eyes with retinitis pigmentosa: preliminary clinical results.

PURPOSE: One of the main reasons for apoptosis and dormant cell phases in degenerative retinal diseases such as retinitis pigmentosa (RP) is growth factor withdrawal in the cellular microenvironment. Growth factors and neurotrophins can significantly slow down retinal degeneration and cell death in animal models. One possible source of autologous growth factors is platelet-rich plasma. The purpose of this study was to determine if subtenon injections of autologous platelet-rich plasma (aPRP) can have beneficial effects on visual function in RP patients by reactivating dormant photoreceptors. MATERIAL AND METHODS: This prospective open-label clinical trial, conducted between September 2016 and February 2017, involved 71 eyes belonging to 48 RP patients with various degrees of narrowed visual field. Forty-nine eyes belonging to 37 patients were injected with aPRP. A comparison group was made up of 11 patients who had symmetrical bilateral narrowed visual field (VF) of both eyes. Among these 11 patients, one eye was injected with aPRP, while the other eye was injected with autologous platelet-poor plasma (aPPP) to serve as a control. The total duration of the study was 9 weeks: the aPRP or aPPP subtenon injections were applied three times, with 3-week intervals between injections, and the patients were followed for three more weeks after the third injection. Visual acuity (VA) tests were conducted on all patients, and VF, microperimetry (MP), and multifocal electroretinography (mfERG) tests were conducted on suitable patients to evaluate the visual function changes before and after the aPRP or aPPP injections. RESULTS: The best-corrected visual acuity values in the ETDRS chart improved by 11.6 letters (from 70 to 81.6 letters) in 19 of 48 eyes following aPRP application; this result, however, was not statistically significant (p = 0.056). Following aPRP injections in 48 eyes, the mean deviation of the VF values improved from - 25.3 to - 23.1 dB (p = 0.0001). Results regarding the mfERG P1 amplitudes improved in ring 1 from 24.4 to 38.5 nv/deg2 (p = 0.0001), in ring 2 from 6.7 to 9.3 nv/deg2 (p = 0.0301), and in ring 3 from 3.5 to 4.5 nv/deg2 (p = 0.0329). The mfERG P1 implicit times improved in ring 1 from 40.0 to 34.4 ms (p = 0.01), in ring 2 from 42.5 to 33.2 ms (p = 0.01), and in ring 3 from 42.1 to 37.9 ms (p = 0.04). The mfERG N1 amplitudes improved in ring 1 from 0.18 to 0.25 nv/deg2 (p = 0.011) and in ring 2 from 0.05 to 0.08 nv/deg2 (p = 0.014). The mfERG N1 implicit time also improved in ring 1 from 18.9 to 16.2 ms (p = 0.040) and in ring 2 from 20.9 to 15.5 ms (p = 0.002). No improvement was seen in the 11 control eyes into which aPPP was injected. In the 23 RP patients with macular involvement, the MP average threshold values improved with aPRP injections from 15.0 to 16.4 dB (p = 0.0001). No ocular or systemic adverse events related to the injections or aPRP were observed during the follow-up period. CONCLUSION: Preliminary clinical results are encouraging in terms of statistically significant improvements in VF, mfERG values, and MP. The subtenon injection of aPRP seems to be a therapeutic option for treatment and might lead to positive results in the vision of RP patients. Long-term results regarding adverse events are unknown. There have not been any serious adverse events and any ophthalmic or systemic side effects for 1 year follow-up. Further studies with long-term follow-up are needed to determine the duration of efficacy and the frequency of application.

REPEATABILITY OF AUTOMATED VESSEL DENSITY AND SUPERFICIAL AND DEEP FOVEAL AVASCULAR ZONE AREA MEASUREMENTS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: Diurnal Findings.

PURPOSE: To evaluate the repeatability of vessel density and superficial and deep foveal avascular zone measurements using optical coherence tomography angiography, and to specify a diurnal change range. METHODS: Forty-six eyes of 25 healthy individuals were included. Optical coherence tomography angiography measurements were planned for three consecutive sessions, with 3 hours in between them. AngioVue software of the RTVue XR Avanti was used. Superficial and deep retinal layer vessel density values, including the whole retina, fovea, and each parafoveal zone, were obtained from the software. The intraclass correlation, coefficient of variation, and coefficient of repeatability were calculated for each parameter. RESULTS: The whole image intraclass correlation value was 0.81 for the superficial and 0.86 for the deep layer among the three consecutive sessions. The smallest real difference (coefficient of repeatability) value of whole image measurements was 7.72% for the superficial and 9.84% for the deep retinal layer. Foveal avascular zone area intraclass correlation value was 0.97 for the superficial and 0.83 for the deep retinal layer. CONCLUSION: The optical coherence tomography angiography analysis provides quantitative data about the retinal microvasculature, which could be used to distinguish between normal and pathology. Changes in superficial vessel density >8% and deep vessel density >10% may be considered as real clinical change rather than variation.

The Recovery of Microvascular Status Evaluated by Optical Coherence Tomography Angiography in Patients after Successful Macular Hole Surgery.

PURPOSE: The aim of this study was to evaluate the optical coherence tomography angiography (OCTA) features of patients who underwent successful macular hole (MH) surgery. METHODS: Nineteen patients who underwent surgery in a single eye due to MH and 13 healthy subjects as a control group were included in the study. Vascular densities, flow indexes, and the foveal avascular zone (FAZ) area in superficial and deep retinal capillary plexuses were evaluated by OCTA in the right eyes of the control group, and both the surgical and healthy fellow eyes of the patients. RESULTS: The mean vascular densities of the superficial and deep capillary plexuses were significantly lower in the surgical eyes than in the control group (44.1 vs. 49.6%, p = 0.002, and 47.3 vs. 59.1%, p = 0.009, respectively). The mean superficial and deep capillary flow indexes were significantly lower in the surgical eyes than in the control group (0.85 vs. 1.35, p = 0.003, and 0.57 vs. 1.45, p = 0.001, respectively), while the mean superficial and deep FAZ area were significantly greater in the surgical eyes in comparison to the control group (0.55 vs. 0.32, p < 0.001, and 0.64 vs. 0.37, p = 0.001, respectively). There was no difference between the flow indexes of both layers of the healthy fellow eyes and the control group. CONCLUSIONS: These preliminary results may be an explanation for unsatisfactory visual gain after surgery, despite the successful anatomical closure of the MH.

The use of optical coherence tomography angiography in pachychoroid spectrum diseases: a concurrent comparison with dye angiography.

PURPOSE: The study objective was to compare dye angiography and optical coherence tomography angiography (OCTA) in detecting choroidal neovascuarization (CNV) in patients presenting with pachychoroid features and flat irregular pigment epithelial detachment (PED). METHODS: Nineteen eyes of 17 patients, presenting with flat PED and pachychoroid features, and without age-related macular degeneration or any other degenerative change, were analyzed. Fuorescein angiography (FA)/Indocyanine green angiography (ICGA) and OCTA were performed during the same visit. Subfoveal choroidal thickness was measured by enhanced depth imaging using spectral domain optical coherence tomography. RESULTS: The mean age of the patients was 59.1 years. Mean subfoveal choroidal thickness was 388 µm. FA revealed non-patognomic features including RPE alterations, window defects, leaking points and leakage from an undetermined source. ICGA revealed choroidal vascular plaque in eight eyes (42%) and suspicious plaque in five eyes (26%). Nonneovascular features, such as hyperpermeability or dilated choroidal vessels, were observed in six eyes (32%). OCTA showed choroidal neovascularization in 14 (74%). For all of the eyes, which ICGA was positive for presence of CNV, OCTA also showed CNV, and in one case it also revealed polypoidal characteristics of the neovascular network. OCTA was also able to detect CNV in all of the eyes with suspicious plaque, and in one eye without CNV appearance using ICGA. CONCLUSIONS: OCTA demonstrated greater sensitivity in detecting type 1 CNV than conventional dye angiography in cases with pachychoroid spectrum disease.

A Color Perimetric Test to Evaluate Macular Pigment Density in Age-Related Macular Degeneration.

PURPOSE: To evaluate differences in measurements of macular pigment optical density (MPOD) in patients with dry age-related macular degeneration (AMD) and a group of healthy patients (control group). Short-term repeatability of MPOD measures was also assessed in the control group. METHODS: This cross-sectional study included 31 eyes from 31 patients with bilateral dry AMD, 21 eyes from 21 cases with dry AMD in the study eye and exudative AMD in the fellow eye. The control group included 17 eyes from 17 healthy patients of similar age and sex. The MPOD values were measured using a commercially available color perimetry technique (CP). Short-term repeatability of MPOD measurements by the CP technique was assessed in 20 eyes of 20 healthy subjects who were measured 3 times on 3 consecutive days. RESULTS: The mean values for MPOD were 5.59 ± 2.06 dB in cases in which both eyes had dry AMD, 5.25 ± 2.72 dB in cases in which one eye had wet AMD and the studied eye had dry AMD, and 5.97 ± 2.14 dB in the eyes of the healthy control group. The mean value was lower in cases in which the fellow eye had wet AMD; however, no significant difference in MPOD was found between the three groups (p = 0.659) or between the group with dry AMD in both eyes and the healthy control group (p = 0.977). The intraclass correlation coefficient (ICC) value was 0.664 between day 1 and day 2, and 0.822 between day 2 and day 3. CONCLUSIONS: Our results do not show a direct relation between MPOD and dry AMD. Color perimetry does not provide acceptable short-term repeatability for measuring MPOD. Learning effects may contribute to the measured test-retest variability. Other studies are needed to determine if CP is suitable for repeated measurements during the long term follow-up with the same patient.

Is There Any Difference between Ranibizumab and Aflibercept Injections in Terms of Inflammation Measured with Anterior Chamber Flare Levels in Age-Related Macular Degeneration Patients: A Comparative Study.

PURPOSE: To evaluate the inflammatory reaction to intravitreal aflibercept (IVA) or ranibizumab (IVR) in patients with age-related macular degeneration (AMD). METHODS: A total of 60 eyes of 60 neovascular AMD patients and 30 eyes of 30 age-matched healthy people as a control group were included in this observational, prospective, comparative study. The AMD patients received 1:1 either IVA or IVR. Anterior chamber flare was measured with the Kowa FM-600 laser flare meter (Kowa Company, Ltd., Tokyo, Japan) at days 0, 1, and 30. The mean flare value and standard deviation are expressed as photon counts per millisecond. RESULTS: There were 51 (56.7%) men and 39 (43.3%) women, with a mean age of 72.7 ± 7.5 years. Mean aqueous flare values at baseline, day 1 and day 30 were 7.08 ± 2.44, 7.23 ± 2.56, and 6.99 ± 2.29, respectively, for the IVR group, 6.87 ± 3.18, 6.86 ± 3.19, and 6.53 ± 2.79, respectively, for the IVA group, and 6.4 ± 3.29, 6.41 ± 3.06, and 6.42 ± 3.05, respectively, for the control group. There was no statistically significant difference in terms of baseline flare values for these three groups (p = 0.666). At the 1-day follow-up, a slight but not significant increase in flare was observed in the ranibizumab group. However, there was no significant change in aqueous flare values in either the ranibizumab- or the aflibercept-injected patients (p = 0.768 and p = 0.387, respectively) or between the groups (p = 0.635). No significant clinical inflammatory reactions were noted before or after intravitreal injections of either ranibizumab or aflibercept. CONCLUSION: No significant short-term intraocular inflammation was noted in the eyes receiving aflibercept or ranibizumab for the treatment of neovascular AMD. Although aflibercept has more immunogenic properties than ranibizumab, such as having an extra Fc portion and being a larger molecule, it is likely that its more potent anti-inflammatory effects prevent it from inducing inflammation.

Short-term outcomes of switching anti-VEGF agents in eyes with treatment-resistant wet AMD.

BACKGROUND: To investigate the short-term outcomes of treatment with intravitreal aflibercept in cases with wet age-related macular degeneration (AMD) resistant to ranibizumab. METHODS: The study included patients who had been undergoing follow-up for a minimum of three months at the Ankara University Faculty of Medicine Ophthalmology Department's Retina Unit with a diagnosis of wet AMD. All cases had received intravitreal aflibercept injection due to the presence of intraretinal/subretinal fluid and pigment epithelial detachment (PED), as detected by optical coherence tomography (OCT), despite having received intravitreal ranibizumab. Medical records of the cases were investigated retrospectively and the demographic data, treatments administered before aflibercept injection, best-corrected visual acuity (BCVA) before and after aflibercept injection, central macular thickness (CMT), and the presence of intraretinal/subretinal fluid and the height and presence of PED were recorded. RESULTS: A total of 29 eyes from 11 females and 17 males were included in the study. The mean age was 73.89 ± 7.49 (62-92). The average number of intraocular injections administered before aflibercept injection was 11.75 ± 5.73 (6-25). The mean duration of follow-up following aflibercept injection was 4.55 ± 2.14 (3-11) months, with a mean of 3.44 ± 0.73 (3-5) aflibercept injections during this period. The mean BCVA values before and after aflibercept injection were found to be 0.83 and 0.77 LogMAR, respectively. The mean CMT values before and after aflibercept injection were 471.3 (97-1365) and 345.1 (97-585) microns, respectively (p < 0.001). The PED height before and after aflibercept injection was 350.4 ± 151.7 (129-793) and 255.52 ± 156.8 (0-528) microns, respectively (p < 0.05). CONCLUSION: Switching to intravitreal aflibercept appears to be an effective treatment modality for patients with AMD who are resistant to ranibizumab. While anatomic success including the effect of reducing the PED height was achieved in the short term following aflibercept injection in all cases, no concomitant increase in visual acuity occurred. This is attributed to the long-term presence of chronic fluid and the development of scar tissue before the treatment.

Intraocular pressure changes related to intravitreal injections of ranibizumab: analysis of pseudophakia and glaucoma subgroup.

The purpose of this study was to determine intraocular pressure (IOP) changes following intravitreal ranibizumab injections and to investigate the effect of pre-existing glaucoma and pseudophakia. Two hundred and two eyes of 175 patients who received repeated intravitreal ranibizumab injections were included in this study. IOP measurements were obtained at both 30 min and 24 h after each injection. IOP changes after the first, third, sixth, ninth, and twelfth injections were analyzed. Data gotten from subgroups with pre-existing glaucoma and pseudophakia were also analyzed. The mean number of injections was 4.81 ± 2.7 (range: 3-18), while the mean IOP prior to the first intravitreal ranibizumab injection was 15.11 ± 2.8 (9-25) mmHg. At the last visit, IOP was 14.66 ± 2.8 (9-22) mmHg. There was no cumulative increase in IOP at either 30 min or 24 h values throughout repeated injections. Pseudophakic patients had significantly lower mean IOP values at 30 min after all injections except for twelfth. The number of eyes with an IOP higher than 21 mm Hg and the mean IOP values were significantly higher in patients with pre-existing glaucoma at 30 min after the first and third injections. Pseudophakic eyes are less prone to immediate IOP spikes than phakic eyes. Pre-existing glaucoma may be a potential risk factor for uncontrolled IOP spikes immediately after intravitreal injection; nonetheless, this effect is usually transient and does not cause long-term problems. Also, ranibizumab injections can be administered safely under close monitoring.

The effect of age and cataract surgery on macular pigment optic density: a cross-sectional, comparative study.

BACKGROUND: To analyze the effects of age, cataract surgery and postoperative period on macular pigment optical density (MPOD). METHODS: The study included cases referred to Ankara University Department of Ophthalmology, between April and June 2012, who had a transparent natural lens or had undergone cataract surgery at least a year ago with their best corrected visual acuity of ≥ 0.5 based on Snellen chart. Presence of an ocular disease that might affect lens, retina and optic nerve (cataract, macular degeneration, diabetic retinopathy, glaucoma etc.), cataract surgery within the previous year, light-colored iris, smoking and use of micronutrition supplementation were determined as exclusion criteria. After detailed opthalmologic examination of all patients, they were divided into three groups based on their age and their lens status as: group 1, patients < 50 years of age having a clear lens; group 2, patients > 50 years of age having a clear lens; and group 3, patients > 50 years of age who had cataract surgery. Age, gender, and postoperative period of the patients as well as the MPOD values of the eyes measured with heterochromatic flicker photometric (HFP) method (MacularMetricsTM) were included in the analysis. RESULTS: Sixty-eight eyes of 37 cases with a mean age of 53.4 ± 15.3 years were enrolled in the study. Group 1 included 20 eyes of 10 cases (mean age 29.4 ± 9.5); group 2 included 32 eyes of 16 cases (mean age 60.3 ± 6.8); and group 3 included 16 eyes of 11 cases (mean age 65.2 ± 9.7). The mean macular pigment optical density value of all cases was 0.511 ± 0.192 log unit, while the mean MPOD values of groups 1, 2 and 3 were 0.570 ± 170, 0.528 ± 203 and 0.400 ± 180 log units, respectively. The mean MPOD values of the patients with clear lens aged < 50 and aged > 50 years did not reveal a statisticially significant difference (p = 1). However, the mean MPOD value of the cataract surgery group (group 3) was found to be statistically significantly lower than the group 1 and group 2 (p = 0.022, p = 0.039, respectively). The correlations between MPOD values and postoperative periods of the patients in group 3 showed that a decrease in MPOD values in parallel with duration of the postoperative period and this negative correlation was found to be statistically significant (r: -0.66, p = 0.005). CONCLUSION: Our study has demonstrated that a significant correlation does not exist between age of the patients and MPOD values. MPOD values were lower than age-matched patients who had undergone cataract surgery and finally an inverse correlation existed between duration of the postoperative period after cataract surgery and MPOD values.