Evaluation of parafoveal vascular density using optical coherence tomography angiography in patients with central serous chorioretinopathy.

Using optical coherence tomography angiography (OCTA), we sought to evaluate parafoveal vascular density (VD) in patients with central serous chorioretinopathy (CSCR). Our study included 43 patients with a diagnosis of CSCR and 40 healthy controls. Ophthalmologic examination findings and OCTA measurements of the participants were retrospectively analysed. Of the 43 patients with CSCR, 31 were males (72%) and 12 were females (28%); the control group was 30 males (75%) and 10 females (25%) (p = 0.657). There were significant differences between affected eyes, unaffected eyes and healthy control eyes for all parameters in the superficial capillary plexus (SCP) VD and deep capillary plexus (DCP) VD (p < 0.05 for all values). It was also determined that the affected eyes had lower SCP-VD and DCP-VD than the unaffected eyes and that the unaffected eyes had lower SCP-VD and DCP-VD than the healthy control eyes (p < 0.05 for all values). While there were no significant differences in the deep foveal avascular zone (FAZ) area, the superficial FAZ area was larger in affected eyes than in both unaffected eyes and healthy control eyes (p < 0.05). In most areas, the SCP-VD and DCP-VD values were lower and the FAZ larger in the chronic group than in the acute group (p < 0.05). Retinal vascular changes were found in patients with both acute and chronic CSCR, and the fellow eyes of these patients were also affected. OCTA can therefore be considered an easily applicable, non-invasive screening option for evaluating the microvascular structure in these patients.

Evaluation of choroidal thickness in patients who have recovered from COVID-19.

PURPOSE: We aimed to evaluate choroidal thickness (CT) in patients who have recovered from COVID-19 by using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: We included fifty-eight patients who have recovered from COVID-19 (group 1) and fifty healthy control subjects (group 2) in this prospective study. Best corrected visual acuity, anterior segment and posterior segment examinations of all subjects were performed. CT scan and measurements were taken with the EDI mode of the Spectral Domain OCT device. RESULTS: Of the 108 subjects included in this study, 57 were female and 51 were male. The mean age was similar in both groups (36.10 ± 7.12 and 35.58 ± 7.29, respectively, p = 0.276). Group 1 had the following characteristics: the mean time since diagnosis was 53.18 ± 2.84; it had been 38.48 ± 4.07 days since the PCR test was negative; and all subjects were outpatients. It was detected that the CT of the patients in group 1 decreased in all areas compared to group 2, and this decrease was significant in subfoveal, temporal and inferior areas (257.48 ± 32.79, 273.62 ± 45.04, p = 0.04; 232.96 ± 41.79, 252.76 ± 46.09, p = 0.02, and 245.22 ± 44.58, 271.54 ± 55.07, p = 0.01, respectively). In the retinal nerve fiber layer analysis for group 1, thickening was detected in all areas, although it was not statistically significant, except in the temporal area where it was (superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global [p = 0 .08, p = 0.45, p = 0.73, p = 0.64, p = 0.74, p = 0.02, and p = 0.10, respectively]). CONCLUSION: For individuals who had recovered from COVID-19, it was found that CT decreased in all areas in these patients. Therefore, this study in which we have demonstrated the decrease in the thickness of the choroidal tissue, a tissue with high blood flow, may contribute to the understanding of the systemic microvascular waste of this disease.

Quantitative Evaluation of Pupil Responses in Patients with Prolactinomas Being Treated with Dopamine Agonists.

The aim of this study was to determine whether the dopamine agonist (DA) drug cabergoline used in the treatment of prolactinoma causes autonomic dysfunction by measuring static and dynamic pupillary responses. The study included 25 eyes from 25 patients who were receiving DA for the treatment of prolactinoma and 25 eyes from 25 healthy individuals. Static and dynamic pupillary responses were measured by automatic quantitative pupillometry. The scotopic pupillary diameter was found to be significantly higher in patients receiving DA medication compared with the control group, while pupil contraction time and pupillary dilatation latency were significantly lower. DA drug use changes static and dynamic pupillary responses, probably by increasing sympathetic tone. Pupillometry can be used as a non-invasive method to provide information about changes in the autonomic nervous system in patients receiving such drug therapy.

Autonomic dysfunction detection by an automatic pupillometer as a non-invasive test in patients recovered from COVID-19.

PURPOSE: To recognize dysfunctions in the autonomic nervous system (ANS) with changes in dynamic and static pupillary responses in patients who recovered from coronavirus disease-2019 (COVID-19) METHODS: One month after recovery from COVID-19, patients were subjected to eye examinations. Pupillary responses were measured using a pupillometry system. Dynamic pupil parameters (i.e., pupil contraction amplitude, pupil dilatation latency, pupil contraction latency, pupil dilatation duration, pupil dilatation velocity, pupil contraction duration, pupil contraction velocity, resting pupil diameter [PD]) and static pupil parameters (i.e., mesopic PD, scotopic PD, high photopic PD, and low photopic PD) were registered. RESULTS: Although high photopic and scotopic PDs were significantly higher in patients recovering from COVID-19 than in healthy controls (P = 0.04 and P = 0.002), no statistically significant difference was found in mesopic and low photopic PD (P = 0.19 and P = 0.41). Regarding dynamic pupillometry parameters, resting PD and pupil contraction velocity (P = 0.04 and P = 0.02, respectively) were significantly higher in patients recovering from COVID-19 than in healthy controls (P < 0.001 and P < 0.001, respectively), whereas pupil dilatation latency and pupil contraction duration were lower in these patients than in healthy controls (P = 0.01 and P = 0.008, respectively). No significant differences in pupil contraction amplitude, pupil dilatation duration, pupil contraction latency, and pupil dilatation velocity were found between the study groups (P = 0.93, P = 0.91, P = 0.42, and P = 0.48, respectively). CONCLUSION: Pupil responses, which are controlled by the ANS, were impaired in patients recovering from COVID-19. Pupillometry shows promise as a non-invasive, easy-to-apply diagnostic technology for detecting autonomic dysfunction in patients recovering from COVID-19. CLINICAL TRIAL REGISTRATION: Not applicable.

Examination of the effects of COVID 19 on corneal endothelium.

PURPOSE: To demonstrate the effects of the disease on the corneal endothelium in individuals recovering from COVID-19 through specular microscopy. METHODS: Eighty individuals recovering from COVID-19 (group 1) and 72 healthy controls (group 2) were included in this prospective study. After examining visual acuity, refractive defect detection, anterior and posterior segment examinations, and specular microscopy measurements were calculated from images with at least 100 cells. The mean cell density (CD), mean coefficient of variation (CV), mean hexagonal cell percentage, mean cell area (AVG), and central corneal thickness (CCT) were evaluated. RESULTS: The mean time from diagnosis of the disease in group 1 was 54.25 ± 6.36 days. The mean time elapsed since the PCR test became negative was 38.45 ± 6.87 days. Only four were treated in the hospital. Specular microscopy data showed that the CD was 2713.56 ± 246.25 and 2845.80 ± 299.27 in groups 1 and 2, respectively (p = 0.003). The CV values were 42.92 ± 6.79 and 40.16 ± 5.97, respectively (p = 0.009). The hexagonality were 46.51 ± 7.35 and 49.12 ± 6.87, respectively (p = 0.024). The AVG was 371.60 ± 34.64 and 353.16 ± 35.29, respectively (p = 0.007). The CCT values were 553.00 ± 73.2, and 526.84 ± 33.57, respectively (p = 0.005). CONCLUSION: A decrease in the number of endothelial cells and hexagonal cells (polymorphism) as well as an increase in the cell area change coefficient (polymegatism) and the average cell area were observed from corneal specular microscopic examination of individuals recovering from COVID-19 in the early period of the disease. These results may be important in understanding the systemic effects of the disease.

Long-term effects of trabeculectomy in primary open-angle glaucoma on segmented macular ganglion cell complex alterations.

PURPOSE: The aim of this study is to compare, using optical coherence tomography (OCT), the changes in the thickness of the macular nerve fiber layer (mNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL) and peripapillary global retinal nerve fiber layer (gRNFL) (in a span of 3 years) in surgically treated eyes with primary open-angle glaucoma (POAG). METHODS: The medical records of 32 consecutive POAG patients who underwent trabeculectomy with mitomycin-C, between January 2013 and December 2014, were retrospectively reviewed. Pre- and postoperative measurements of IOP and OCT were analyzed 1, 2 and 3 years after the operation. RESULTS: Among all patients, no significant changes in the thickness of the mNFL, mGCL or mIPL were found, with a significant reduction observed only in the IOP values and peripapillary gRNFL thickness during the 3-year postoperative period. In a subgroup analysis based on the preoperative peak IOPs (median value:41 mmHg), the thickness of the mNFL, mGCL and mIPL in the 3-year postoperative period increased significantly in the lower preoperative peak IOP group (IOP < 41 mmHg), whereas the macular OCT parameters in the 3-year postoperative period decreased in the higher preoperative peak IOP group. CONCLUSIONS: Eyes exhibiting lesser preoperative peak IOP demonstrated greater preservation of the layer-by-layer segmented macular ganglion cell complex thickness as compared to eyes exhibiting greater preoperative peak IOP; also when the IOPs determined for the two groups in the period of follow-up were quite comparable.

Crystalline gene mutations in Turkish children with congenital cataracts.

PURPOSE: To detect crystallin gene mutations in Turkish children with congenital cataracts. METHODS: The present study included 56 children (38 males and 18 females) who were diagnosed with congenital cataract in our ophthalmology clinic. The patients' blood samples were collected and sent to the medical genetics laboratory. The samples were assessed using the sequence analysis method, which covered all exons of CRYAA, CRYAB, CRYBB1, CRYBB2, CRYBB3, CRYGC and CRYGD. RESULTS: In total, 56 patients with congenital cataracts were included in the present study. Of these, 68% were male and 32% were female. The age range of the patients was 2 months to 5 years. The mean age of onset was 21.08 ± 15.15 months. All the patients had bilateral congenital cataracts. The female-to-male ratio was 1:2.1. Mutation analysis was performed to detect possible mutations in CRYAA, CRYAB, CRYBB1, CRYBB2, CRYBB3, CRYGC and CRYGD. Of the four mutations detected, one was novel (c.383A > T in CRYGD) and three were known (c.592C > T in CRYBB2, c.164A > G in CRYGC and c.592C > T in CRYBB2). Two of these three mutations were detected in the same gene (CRYBB2). Crystallin gene mutations were detected in 7% of patients with congenital cataracts (four out of 56 patients) in the present study. CONCLUSIONS: We think that mutations in crystallin genes are responsible for 7% of congenital cataract cases in our country. The detection of these mutations may help in the molecular diagnosis of congenital cataracts.

Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome?

PURPOSE: We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS). METHODS: We included in this study patients with OSAS, who were divided into three groups according to the apnea-hypopnea index (AHI) (group 1, mild [n = 20]; group 2, moderate [n = 20]; and group 3, severe [n = 20]), and healthy controls (group 4, n = 20). Pupillary responses were measured using a pupillometry system. RESULTS: Static (mesopic PD, P = 0.0019; low photopic PD, P = 0.001) and dynamic pupil responses (resting diameter, P = 0.004; amplitude of pupil contraction, P < 0.001; duration of pupil contraction, P = 0.022; velocity of pupil contraction, P = 0.001; and velocity of pupil dilation, P = 0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P = 0.008), low photopic PD (P = 0.003), resting diameter (P = 0.001), amplitude of pupil contraction (P < 0.001), duration of pupil contraction (P = 0.011), velocity of pupil contraction (P < 0.001), and velocity of pupil dilation (P = 0.001). CONCLUSION: We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.

Genetic analysis of patients with primary congenital glaucoma.

PURPOSE: To determine the common gene mutation in patients with primary congenital glaucoma (PCG) in the Southeast region of Turkey via genetic analysis and to evaluate whether there were other gene mutations in these patients. METHODS: A total of 25 patients with PCG were included in this study. We performed sequence analysis including all exons of cytochrome p450 1B1 (CYP1B1), myocilin (MYOC), forkhead box C1 (FOXC1), and paired-like homeodomain 2 (PITX2) genes of the obtained samples. Further, we analyzed the results using the Nextgen analysis program. RESULTS: The CYP1B1 gene mutation was detected in 20 (80%) of 25 patients, and FOXC1 gene mutation was detected in one (4%) patient. The mutation site of nine (45%) of the 20 CYP1B1 genes was found in the second exon. The pathogenic variant (p.Gly61Glu) was observed in 12 (60%) patients (in the first and second exons); the mutation type of six (50%) of these patients was homozygous. The mutation site of one patient with FOXC1 gene mutation was found to be in the first exon; its pathogenic variant was p.Met400lle. The mutation type in this gene was observed to be heterozygous. Lastly, there were no mutations in the MYOC, FOXC1, and PITX2 genes in combination with the CYP1B1 gene mutation. CONCLUSION: The most common cause of PCG in our region is the CYP1B1 gene mutation, and the most frequent pathogenic variant is c.182G > A (p.Gly61Glu). We also determined that the CYP1B1 gene mutation was alone and did not occur with other gene mutations (MYOC, FOXC1, and PITX2).

The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy.

PURPOSE: This study aimed to compare static and dynamic pupil responses of diabetic patients with and without nonproliferative diabetic retinopathy (DR) and normal healthy individuals under different lighting conditions via quantitative automated pupillometry. METHODS: Forty patients with DM with nonproliferative DR (group 1), 40 patients with DM without DR (group 2), and 40 healthy controls (group 3) underwent a complete ophthalmologic examination. Static pupillometry [scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD] and dynamic pupillometry (resting PD, contraction amplitude, latency, duration, velocity of contraction, dilatation latency, and duration and velocity at rest) were measured via automatic quantitative pupillometry. RESULTS: Analysis of variance revealed that scotopic PD [F(2, 117) = 6.42; p = 0.02], mesopic PD [F(2, 117) = 3.20; p = 0.04], and low photopic PD [F(2, 117) = 4.86; p = 0.009] were significantly different among the groups. Scotopic PD and low photopic PD were significantly lower in group 1 than in group 2 (p = 0.03 and p = 0.03, respectively). Meanwhile, the resting diameter, velocity of pupil contraction, and velocity of pupil dilatation were found to be significantly lower (p = 0.02, p = 0.01, and p = 0.008, respectively), and the duration of pupil contraction was significantly higher in group 1 than in group 3 (p = 0.03). CONCLUSION: Both DM patients with and without nonproliferative DR exhibited pupillary involvement. Automated pupillometry may be an easily applicable, noninvasive screening option for reducing mortality and morbidity rates associated with diabetic autonomic neuropathy.

Brimonidine-timolol versus brinzolamide-timolol for treatment of elevated intraocular pressure after phacoemulsification surgery.

PURPOSE: To compare the efficacy of the fixed combination of brimonidine-timolol (FCBT) and the fixed combination of brinzolamide-timolol (FCBZT) treatments for elevated intraocular pressure (IOP) after phacoemulsification cataract surgery. METHODS: A randomised, prospective, double-blinded study was conducted on 277 eyes of 257 patients who underwent phacoemulsification cataract surgery. Patients were divided into three groups based on the medication administered after cataract surgery as follows: FCBT, FCBZT and a control group where no antiglaucoma medications were used. IOP was recorded at preoperative and postoperative hours 6 and 24 and days 3 and 5. RESULTS: No statistical differences were observed among the groups regarding age, sex and baseline IOP levels (p > 0.05). Mean IOP levels were significantly lower in the treatment groups than in the control group at postoperative hours 6 and 24 and days 3 and 5 (p < 0.001). Administration of one drop of FCBT or FCBZT demonstrated similar effects on preventing IOP spikes within 24 h of phacoemulsification cataract surgery. FCBZT more effectively lowered IOP than FCBT at days 3 and 5 (p < 0.05). CONCLUSIONS: We demonstrate that the postoperative administration of FCBT or FCBZT is effective in lowering IOP after phacoemulsification cataract surgery; FCBZT more effectively lowered IOP than FCBT at postoperative days 3 and 5.

MULTIMODAL IMAGING OF UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A CHILD PATIENT.

PURPOSE: To report a case of the clinical manifestation of unilateral acute idiopathic maculopathy in a child patient. METHODS: Case report. RESULTS: An 11-year-old male patient complaining of visual impairment in the left eye that had persisted for 3 weeks was admitted to the Dicle University Ophthalmology Clinic. Fundus examination, optical coherence tomography (OCT), enhanced depth imaging OCT, fundus autofluorescence, and fundus fluorescence angiography examinations were conducted. During the fundus examination, a yellowish gray area of swelling with yellowish granules spanning approximately half the diameter of the disk was found on the left macula. Optical coherence tomography revealed serous detachment and hyperreflective debris, OCT angiography showed hyperreflective spots on the outer retina, enhanced depth imaging OCT revealed an increase in choroidal thickness, fundus autofluorescence showed hyperreflective spots, and fundus fluorescence angiography revealed late-phase hyperfluorescence accumulation. Acute idiopathic maculopathy was diagnosed from these findings. CONCLUSION: Acute idiopathic maculopathy should be considered in the differential diagnosis of children presenting with a complaint of unilateral low vision.

Evaluation of parafoveal and peripapillary vascular densities using optical coherence tomography angiography in children with thalassemia major.

Background: Thalassemia major (TM) is an inherited anaemia caused by faulty haemoglobin synthesis. Reducing serum iron levels using iron chelating agents is an important step in the treatment of TM, and the effects on the eye of both the disease and these agents can be determined by regular eye examination. Objectives: We evaluated macular and optic nerve vascular densities in children with TM and compared the results with healthy controls using optical coherence tomography angiography (OCTA). Design: This is a prospective study. Methods: A total of 30 children with TM and 30 healthy controls were included in the study. The area of the foveal avascular zone (FAZ) and the vascular densities (VD) of the optic nerve head (ONH), radial peripapillary capillary (RPC) and deep and superficial retinal vascular networks were measured using OCTA. Results: A statistically significant decrease in VD was observed in the whole image and the parafovea, superior hemi, superior and inferior parts of the superficial capillary plexus and in the whole image and the superior regions of the deep capillary plexus in the TM patient group compared with the control group (p < 0.05). A significant decrease in VD was also observed in the whole image and the inside disc, peripapillary, nasal, inferonasal and temporal regions of the ONH and in the whole image and the inside disc, peripapillary and inferonasal regions of the RPC network in patients with TM (p < 0.05). A significant positive correlation was observed between both serum ferritin levels and deferasirox dosage, on one hand, and both the superficial (p = 0.023 and p = 0.002, respectively) and deep FAZs (p = 0.015 and p = 0.045, respectively), on the other hand. A negative correlation was also found between the deferasirox dosage and the VDs of the superficial (p = 0.010) and deep (p = 0.001) foveal plexuses. Conclusion: Retinal VD and FAZ are affected in patients with TM. OCTA, which can noninvasively measure retinal VD in patients with TM, may be a useful tool for the early detection of retinal microvascular changes that may occur during the course of the disease.

Relationship between optical coherence tomography angiography and visual evoked potential in patients with multiple sclerosis.

PURPOSE: This study aimed to identify an easy-to-apply biomarker by correlating visual evoked potential (VEP) with optical coherence tomography angiography (OCTA) results in multiple sclerosis (MS). METHODS: Our study was planned prospectively. Patients with MS were divided into two groups, VEP prolonged group 1 and VEP normal group 2. Age-matched and gender-matched healthy individuals (group 3) were included as the control group. Vascular density (VD) of the optic nerve head (ONH) and radial peripapillary capillaries (RPCs) were measured and recorded by OCTA. The optic nerve damage of patients was measured and recorded with a VEP device. RESULTS: Thirty-two eyes were included in group 1, 50 eyes were included in group 2, and 51 healthy eyes were included in group 3. In terms of visual acuity, group 1 was significantly lower than the other groups (P < 0.001). Regardless of the prolongation of p100 latency in patients with MS, whole image, inside disc ONH VD and in the same sectors in RPC VD were found to be significantly lower than the control group (P < 0.05). Retinal nerve fiber layer thickness was found to be significantly lower in group 1 than in group 2 and group 3 (P < 0.05). There was a significant correlation between low ONH VD and RPC VD and prolonged VEP P100 (P < 0.05). CONCLUSION: VEP measurements can be correlated with OCTA measurements in patients with MS and can be used as a biomarker to determine the degree of optic nerve damage.

Evaluation of the effect of obstructive sleep apnea syndrome on retinal microvascularity by optical coherence tomography angiography.

PURPOSE: Using optical coherence tomography angiography (OCTA), we sought to determine whether there are retinal microvascular changes in patients with obstructive sleep apnea syndrome (OSAS). METHOD: The study included 56 patients diagnosed with OSAS by polysomnography [21 patients with mild OSAS (group 1), 14 with moderate OSAS (group 2) and 21 with severe OSAS (group 3)], and 26 healthy individuals as a control group (group 4). The vascular densities of the superficial capillary plexus and deep capillary plexus of the retinal segmentations, together with the foveal avascular zone (FAZ) width, were measured for all participants, using OCTA. RESULT: Compared with the control group, vascular densitiy in whole image of superficial capillary plexus were found to be significantly lower in group 2. In addition, vascular densitiy in fovea region of superficial capillary plexus was significantly lower in group 1 than the control group. In deep capillary plexus, vascular densitiy of whole image, superior hemi and nasal regions were found to be significantly lower in group 2 and group 3 compared with the control group. Parafoveal region in group 3 had significantly lower vascular densities than the controls. A significantly larger FAZ was also found in group 1 and group 3 in the deep capillary plexus, compared with the controls. CONCLUSION: We detected smaller vascular densities in both the superficial capillary plexus and deep capillary plexus and a larger deep capillary plexus FAZ in OSAS patients. Therefore, OCTA may be useful as a non-invasive method to understand the systemic effects of OSAS.

Evaluation of Retinal Microvascular Perfusion Changes in Patients with Celiac Disease.

PURPOSE: We aimed to determine whether there are retinal microvascular changes in patients with celiac disease (CD). METHODS: A total of 30 patients with CD (group 1) and 30 healthy controls (group 2) were included in this study. AngioVue optical coherence tomography angiography (OCTA) device was used to evaluate the retinal microvascular structure. RESULTS: Some of the values of both optic nerve head (ONH) vessel density (VD) and radial peripapillary capillary VDs were found to be significantly lower in group 1 than in group 2. These 2 groups were similar except for one of the parameters of superficial capillary plexus VD (SCP-VD), whereas it was found that deep capillary plexus VD (DCP-VD) was lower in group 1 than in group 2 except for the foveal area. CONCLUSION: It was determined that some VDs obtained from the ONH and DCP-VD obtained from most areas of the macular region were significantly lower.

Retinal Microvascular Changes in Patients with Multiple Myeloma: A Study Based on Optical Coherence Tomography Angiography.

Purpose: Ocular microvascular networks and variables were analyzed using optical coherence tomography angiography (OCTA) in patients with multiple myeloma (MM) who had no pathological findings in their routine ophthalmologic examinations.Methods: The study included 31 patients with a diagnosis of MM and 30 healthy controls. The ophthalmologic examination findings and OCTA measurements of the participants were prospectively analyzed. We evaluated the superficial capillary plexus (SCP) vessel density (VD) and deep capillary plexus (DCP) VD in macular region, radial peripapillary capillary (RPC) VD, optic nerve head (ONH) VD and the foveal avascular zone (FAZ) area.Results: The samples were gender-balanced, and there were no significant differences in age or gender between the MM and control groups. From the OCTA, all the ONH-VD measurements, except for the peripapillary and superotemporal parameters, were found to be significantly lower in MM patients than in the control group; the same was found for the whole image, inferonasal, superonasal, and superotemporal RPC-VD values; for all the SCP-VD values, except for the inferior hemi and temporal; and for all the DCP-VD values. It was also observed that the deep FAZ area was wider in the MM group than in the control group.Conclusions: We detected decreased VD in deep and superficial macular retinal areas, papillary, peripapillary regions, suggesting decreased blood flow and possible ischemia in MM patients. Therefore, obtaining information on ischemia by using a noninvasive and easily measurable method such as OCTA, may be beneficial in terms of follow-up and treatment but this needs to be supported by further, larger studies.

Magnitude of Diurnal Change in Retinal Vessel Density: Comparison Between Exfoliative Glaucoma and Primary Open-Angle Glaucoma.

OBJECTIVES: The aim of this study was to investigate the magnitude of diurnal fluctuation in the superficial parafoveal vessel density (pfVD) and radial peripapillary capillary-peripapillary vessel density (RPC-ppVD) in exfoliative glaucoma (XFG) patients using optical coherence tomography angiography (OCTA) and to compare the findings with those of primary open-angle glaucoma (POAG) patients with glaucomatous damage of comparable severity. METHODS: A total of 50 patients with XFG and 48 with POAG were examined in this retrospective cross-sectional study. The OCTA readings and intraocular pressure (IOP) values were obtained at 9 am, 11 am, 2 pm, and 4 pm on the same day. The maximal change in the IOP and vessel density (VD) values was evaluated to determine the magnitude of diurnal variation. RESULTS: No significant difference was found in the magnitude of the average diurnal superficial-pfVD, RPC-ppVD and IOP change between the XFG and POAG groups. Comparison of the diurnal variation of sub-sector VD revealed that the magnitude of the diurnal variation in the VD of the inferonasal peripapillary and superior parafoveal regions was greater in the XFG group than that of the POAG group (p=0.004 and p=0.021, respectively). Furthermore, the differences persisted after correcting for the confounding factors of IOP, mean deviation (MD), and global retinal nerve fiber layer (RNFL) values. The magnitude of the average superficial-pfVD and the average RPC-ppVD was not correlated with the MD, total ganglion cell complex, global RNFL, or the magnitude of IOP values in either group. CONCLUSION: The eyes of XFG patients demonstrated more significant diurnal fluctuation in VD (including the superior superficial-pfVD as well as the inferonasal RPC-ppVD) when compared with POAG patients, despite no statistical significance between groups in the IOP variation.