Changes in retinal and choroidal capillary dynamics in patients with multisystem inflammatory syndrome in children.

PURPOSE: To evaluate patients with multisystemic inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using optical coherence tomography angiography (OCTA) during and after resolution of inflammation to investigate the effect of this entity on the retinal and choroidal circulation. METHODS: The study included 38 eyes of 19 patients diagnosed as having MIS-C between March 2021 and June 2021. OCTA measurements of choroidal thickness and vessel density in the radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), and deep capillary plexus (DCP) obtained at time of diagnosis and 60 days later were compared. Correlations between C-reactive protein (CRP) levels at diagnosis and retinochoroidal involvement were investigated. RESULTS: Compared to post-recovery follow-up examinations, patients with active MIS-C showed foveal avascular zone enlargement (p = 0.031), decreased vessel density in the temporal parafoveal SCP (p = 0.047) and all parafoveal areas of the DCP (p < 0.05 for all), and increased choroidal thickness (p = 0.021). Correlation analysis between CRP levels and OCTA changes during MIS-C revealed significant negative correlations with all parafoveal sectors of the SCP and DCP and a significant positive correlation with CT. CONCLUSION: There were especially marked effects on the DCP and choroid in MIS-C patients. Our findings also correlate with CRP levels. The use of optical coherence tomography angiography in patients with multisystemic inflammatory syndrome may have potential future implications for detecting ocular microvascular changes that occur before permanent damage develops. Clinical Trial Registration Number and Date: 77/1340; March 1, 2021.

LONG-TERM EFFECTS OF ANTI-VEGF MONOTHERAPY FOR RETINOPATHY OF PREMATURITY ON THE RETINAL AND REFRACTIVE DEVELOPMENT OF EYE.

PURPOSE: To evaluate vascular maturation of retina, axial, refractive, and foveal development after anti-VEGF treatment including bevacizumab, ranibizumab, and aflibercept in infants with treatment requiring retinopathy of prematurity (ROP) in long term. METHODS: This retrospective chart review study included children with a history of any anti-VEGF monotherapy for ROP in Zone 1 or posterior Zone 2 who have reached at least 24 months of corrected age. The records of ophthalmologic examination including strabismus evaluation, visual acuity measurement, refractive and axial measurements, optical coherence tomography, and fundus fluorescein angiography examinations with RetCam III were reviewed. RESULTS: A total of 36 eyes of 18 children met the inclusion criteria. The mean gestational age at birth was 27.8 2.13 (23-30) weeks, and ocular assessments were performed between 33 and 61.5 (mean: 42.58 8.6) months of corrected age. Treatment was with bevacizumab in 10 eyes, with ranibizumab in 14 eyes, and with aflibercept in 12 eyes. The mean spherical equivalent was -0.25 1.82; axial length was 20.81 0.62 mm. There was no significant difference among three anti-VEGF groups regarding the abnormal vascular retinal development ( P = 0.183) or leakage ( P = 0.842) on fluorescein angiography. CONCLUSION: All the anti-VEGF agents provided similar adequate axial and refractive development as well as similar abnormal vascular development in the peripheral retina. The long-term impact of this abnormally vascularized peripheral retina is a curiosity issue. From this point of view, it is an important need to determine the follow-up period and method after the anti-VEGF treatment for ROP.

Effect of Intravitreal Aflibercept vs Laser Photocoagulation on Treatment Success of Retinopathy of Prematurity: The FIREFLEYE Randomized Clinical Trial.

Importance: Laser photocoagulation, which is the standard treatment for retinopathy of prematurity (ROP), can have adverse events. Studies of anti-vascular endothelial growth factor injections have suggested efficacy in the treatment of ROP, but few studies have directly compared them with laser treatments. Objective: To compare intravitreal aflibercept vs laser photocoagulation in infants with ROP requiring treatment. Design, Setting, and Participants: This noninferiority, phase 3, 24-week, randomized clinical trial was conducted in 27 countries (64 hospital sites) throughout Asia, Europe, and South America. Overall, 118 infants (gestational age ≤32 weeks at birth or birth weight ≤1500 g) with ROP severity (zone I stage 1+ [stage 1 plus increased disease activity], zone I stage 2+, zone I stage 3, zone I stage 3+, zone II stage 2+, or zone II stage 3+) requiring treatment or with aggressive posterior ROP in at least 1 eye were enrolled between September 25, 2019, and August 28, 2020 (the last visit occurred on February 12, 2021). Interventions: Infants were randomized 2:1 to receive a 0.4-mg dose of intravitreal aflibercept (n = 75) or laser photocoagulation (n = 43) at baseline. Additional treatment was allowed as prespecified. Main Outcomes and Measures: The primary outcome was the proportion of infants without active ROP and unfavorable structural outcomes 24 weeks after starting treatment (assessed by investigators). The requirement for rescue treatment was considered treatment failure. Intravitreal aflibercept was deemed noninferior if the lower limit of the 1-sided 95% bayesian credible interval for the treatment difference was greater than -5%. Results: Among 118 infants randomized, 113 were treated (mean gestational age, 26.3 [SD, 1.9] weeks; 53 [46.9%] were female; 16.8% had aggressive posterior ROP, 19.5% had zone I ROP, and 63.7% had zone II ROP) and 104 completed the study. Treatment (intravitreal aflibercept: n = 75; laser photocoagulation: n = 38) was mostly bilateral (92.9%), and 82.2% of eyes in the intravitreal aflibercept group received 1 injection per eye. Treatment success was 85.5% with intravitreal aflibercept vs 82.1% with laser photocoagulation (between-group difference, 3.4% [1-sided 95% credible interval, -8.0% to ∞]). Rescue treatment was required in 4.8% (95% CI, 1.9% to 9.6%) of eyes in the intravitreal aflibercept group vs 11.1% (95% CI, 4.9% to 20.7%) of eyes in the laser photocoagulation group. The serious adverse event rates were 13.3% (ocular) and 24.0% (systemic) in the intravitreal aflibercept group compared with 7.9% and 36.8%, respectively, in the laser photocoagulation group. Three deaths, which occurred 4 to 9 weeks after intravitreal aflibercept treatment, were considered unrelated to aflibercept by the investigators. Conclusions and Relevance: Among infants with ROP, intravitreal aflibercept compared with laser photocoagulation did not meet criteria for noninferiority with respect to the primary outcome of the proportion of infants achieving treatment success at week 24. Further data would be required for more definitive conclusions regarding the comparative effects of intravitreal aflibercept and laser photocoagulation in this population. Trial Registration: ClinicalTrials.gov Identifier: NCT04004208.

Optical coherence tomography angiography in healthy children: normative data and age-related changes in microvascular structure of the optic disk and macula.

PURPOSE: To determine normative data and reference ranges according to age groups by measuring the foveal avascular zone (FAZ), superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DVP-VD), radial peripapillary capillary plexus vessel density (RPC-VD), and peripapillary retinal nerve fiber layer (ppRNFL) in healthy children and to determine the age and sex-related changes of these values. METHODS: This prospective study included data from 370 eyes of 370 healthy children (202 girls, 168 boys) aged 7-18 years. Participants were divided into four groups according to their age. Optical coherence tomography angiography (OCTA) measurements were taken using AngioVue (Avanti; Optivue). RESULTS: No statistically significant difference was observed in terms of FAZ, SCP-VD, DCP-VD, RPC-VD, and ppRNFL thickness values according to the age groups (except the RPC-VD superior) (p > 0.05 for all). VDs in all deep parafoveal regions in groups 1 and 2 were higher in girls. While FAZ values were higher in girls in all age groups (statistically significant in groups 1, 3, and 4), ad SPD and DPD values were higher in boys in all age groups (statistically significant in group 1 and 2 for SPD, and group 1 and 3 for DPD). CONCLUSIONS: We report normal reference ranges for macula and disk vessel density and ppRNFL parameters in healthy children aged 7-18 years using OCTA. These normative values could be useful in diagnosing retina and optic disk disease early in childhood.

Comparison of clinical outcomes of intravitreal ranibizumab and aflibercept treatment for retinopathy of prematurity.

PURPOSE: To compare the results of ranibizumab and aflibercept treatment in infants with treatment-requiring retinopathy of prematurity (ROP) in the posterior zone. METHODS: In this single-center, retrospective study, the records of the infants, who were treated between January 2015 and June 2017 in a tertiary center for screening and treatment of ROP, were reviewed. Infants who were administered ranibizumab or aflibercept as initial treatment and completed at least 1 year of corrected age were included. The patients were evaluated in terms of regression, progression or recurrence of the disease, vascularization of the peripheral retina, and ocular complication profile in early or late period. RESULTS: Fifty-four eyes of 27 infants who received ranibizumab treatment (ranibizumab group) and 72 eyes of 36 infants who received aflibercept treatment (aflibercept group) were enrolled. The rate of recurrence was 48.1% in ranibizumab group and 13.9% in aflibercept group. The mean recurrence times were at 8.2 ± 0.92 weeks following the injection of ranibizumab and at 14.2 ± 1.03 weeks following the injection of aflibercept. There were significant statistical differences between the groups in the rate of ROP recurrence, the time of recurrence, and the time of vascularization of peripheral retina (p = 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION: Although both ranibizumab and aflibercept are effective therapies for the treatment of ROP, more frequent and much earlier recurrences can be seen with ranibizumab treatment. Further studies are needed to obtain ideal options for the treatment of ROP.

A practical and easy surgical technique for recovery of an incarcerated haptic.

PURPOSE: To present a surgical intervention for a posterior haptic trapped between the cartridge and plunger during intraocular lens (IOL) implantation. MATERIALS AND METHODS: Posterior haptic incarceration was detected in 36 cases during implantation of a one-piece foldable IOL during cataract surgery with phacoemulsification. In 11 of the patients (Group 1), recovery was achieved by forcibly pulling out the incarcerated posterior haptic. In 25 cases (Group 2), the haptic was recovered by using an MVR knife to cut the cartridge tip from the bottom up parallel to the trapped haptic. RESULTS: In Group 1, tears were seen on the incarcerated haptic in all cases (100%). In Group 2, the procedure was successful in all 25 cases and there was no accidental cutting of the haptic. In all cases, the surgeries were completed with the recovered IOL in Group 2. CONCLUSIONS: Posterior haptic incarceration in cataract surgery can be solved by the simple and easy method of cutting the cartridge tip from the bottom upwards and releasing the haptic.

Intravitreal anti-VEGF treatment for retinopathy of prematurity in infants with active adenoviral keratoconjunctivitis.

PURPOSE: To evaluate the results of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for retinopathy of prematurity (ROP) in infants with active adenoviral keratoconjunctivitis (AKC). MATERIAL AND METHODS: A retrospective analysis was performed using the medical records of all infants treated with intravitreal injections of anti-VEGF agents during an AKC outbreak previously reported in the literature at a tertiary center for treatment of ROP. The infants were divided into two groups. Group 1 included nine infants (18 eyes) with AKC, while Group 2 included 13 infants (26 eyes) without AKC. RESULTS: During the AKC outbreak, 22 infants were treated with anti-VEGF agents for treatment-requiring ROP. In all patients in both groups, the ROP and plus disease displayed a significant regression within 2 days after the intravitreal injections. Moreover, no serious complications such as endophthalmitis, retinal detachment, cataract or intravitreal hemorrhage were observed after the treatment and there were no statistically significant differences between the groups in terms of postoperative complications. CONCLUSION: Immediate and appropriate intervention is very important in cases of treatment-requiring ROP otherwise it can result in blindness. However, laser treatment for ROP is technically difficult in infants with active AKC. The results of this study showed that favorable outcomes without serious ocular complications could be obtained via intravitreal injections of anti-VEGF agents in infants with active AKC.

A comparative study: deep anterior lamellar keratoplasty for corneal dystrophies using two different donor stromal tissues.

PURPOSE: This study aimed to present a comparison of early postoperative results of deep anterior lamellar keratoplasty (DALK) surgery performed using the two different corneal graft sources. MATERIALS AND METHODS: This retrospective clinical study included the surgery performed on 26 eyes of 26 patients who underwent DALK for the stromal dystrophies. At the time of surgery, donor stromal tissue for DALK was sourced using the two different preparatory techniques. For 14 cases (Group 1), the donor grafts were prepared quickly by removing the descemet's membrane (DM) without much care after the exposure of the bare DM in the recipient cornea. For 12 cases (Group 2), the grafts for DALK surgery had already been prepared during a previous descemet's membrane endothelial keratoplasty (DMEK). RESULTS: The groups differed statistically regarding the blue staining of the grafts at the time of surgery and on the first day post-DALK. The first day after surgery, 14 (100%) grafts were clear in Group 1, while eight (66.7%) grafts were clear and four (33.3%) were edematous in Group 2 (p = 0.019). Bubbling was performed in three (25.0% of Group 2) of the four cases on the first day post-DALK, while none of the patients in Group 1 underwent this procedure (p = 0.47). The postoperative increase in visual acuity was higher in Group 1 in the early postoperative period (p = 0.012). CONCLUSION: During the early postoperative period, complications (as graft edema, detachment, re-bubbling) were observed more frequently in the DALK operations performed with stromal tissue having blue stain remaining from the DMEK performed on the same day and in the same session.

Effects of age and gender on macular thickness in healthy subjects using spectral optical coherence tomography/scanning laser ophthalmoscopy.

PURPOSE: To examine healthy subjects for normal macular thickness values and determine the effects of gender and age in a Turkish population, using spectral optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO). MATERIAL AND METHOD: Six hundred fourteen eyes of 307 subjects with no history of ocular diseases and normal ophthalmic examination were recruited in this cross-sectional, prospective study. The participants were divided into three groups based on age (between 20 and 29 years: group 1, between 30 and 39 years: group 2, between 40 and 49 years: group 3). All subjects were scanned with spectral OCT/SLO, performed by one examiner to acquire the retinal thickness map in the ETDRS grid, and values were recorded for nine sectors, and effects of age and gender were evaluated. RESULTS: When all the subjects were evaluated, the thicknesses were lower in women than men in all sectors (p < 0.001). When divided in groups based on age, this difference remained only in the outer segments. However, the differences in outer layers, except outer nasal layer, were thicker in women in group 3 when compared to others in group 3. When compared between groups, only central thickness in group 3 was shown to be higher than group 1 (p = 0.06). There was no significant difference of thicknesses in any sector when compared right and left eyes of all subjects. CONCLUSIONS: The study reports the variation in retinal thickness between age and gender in a relatively large sample of a Turkish population. It is important to consider these effects while interpreting the OCT images to make an appropriate diagnosis in retinal diseases.

Treatment for stage 4A retinopathy of prematurity: laser and/or ranibizumab.

PURPOSE: Stage 4A retinopathy of prematurity (ROP) is a critical phase where retinal detachment develops, but fovea is preserved. The present study aims to evaluate the effect of the first treatment choice (laser photocoagulation (LPC) or intravitreal ranibizumab (IVR)) applied in this critical phase on the prognosis of the disease. METHODS: Records of patients diagnosed with stage 4A ROP and whose first treatment was applied in our clinic were evaluated retrospectively. All patients were referred to our clinic for the treatment of advanced ROP . While group 1 was composed of the patients who were administered LPC as first treatment, group 2 included patients where IVR was applied as first treatment. The patients in both groups were referred to surgical treatment in the presence of progression. RESULTS: The present study included a total of 31 eyes in 16 patients with stage 4A ROP. Eighteen eyes of nine patients in group 1 were first applied LPC, and 13 eyes of seven patients in group 2 were first applied intravitreal ranibizumab. While anatomic outcomes of ten eyes in both groups were favorable, eight eyes in group 1 and three eyes in group 2 displayed progression and were referred to vitreoretinal surgery. CONCLUSIONS: Laser and/or IVR treatment may be effective as a non-surgical treatment for stage 4A ROP. Especially stage 4A ROP until 6 clock hours can regress without surgical treatment. However, in stage 4A with involvement wider than 6 clock hours, non-surgical regression is difficult. Prospective controlled large series studies are necessary.

Results of intravitreal ranibizumab treatment for retinopathy of prematurity in infants.

PURPOSE: To assess the results of intravitreal ranibizumab treatment for retinopathy of prematurity (ROP) in infants. METHODS: A single-institution, retrospective consecutive case series. RESULTS: Thirty-one patients who received ranibizumab treatment for ROP were evaluated in this study. The mean follow-up time was 14 ± 1.37 months. Vascularization of the peripheral retina had completed with delay in the majority of cases and also avascular areas were present in the peripheral retinas of five infants at one year of age. Although recurrence of ROP developed in 14 infants after single-dose ranibizumab treatment, only four infants received additional treatment due to recurrence of ROP requiring treatment. No serious ocular complications were reported, but, two infants died in this series. CONCLUSION: Even so ranibizumab treatment is an effective therapy for ROP in early period, close monitoring after injection is necessary due to the high incidence of recurrence. In addition, questions remain regarding the systemic safety of ranibizumab. Further studies are needed to study the systemic and ocular side effects of ranibizumab.

Occurrence of intraocular air bubbles during intravitreal injections for retinopathy of prematurity.

This study aims to present five cases with retinopathy of prematurity (ROP) who were found to have intraocular air bubbles after intravitreal injection (IVI) treatment. The medical records of 148 infants who underwent IVI for ROP were retrospectively reviewed and the ones who demonstrated post-injection intraocular air bubble formation were recruited. Of the 148 patients (31 babies received ranibizumab, 20 babies received aflibercept, 97 babies received bevacizumab), five were found to have intraocular air bubbles right after the IVI. Two infants received intravitreal ranibizumab and three received intravitreal bevacizumab injections. Although intraocular pressure increased temporarily, no intraocular sterile or infective reactions were observed in the postoperative period. The air bubble was found to resorb spontaneously within 72 h. The occurrence rate of the intravitreal air bubbles in our series was 3.37 % despite previously not been reported in the literature. Due to the intravitreal air injection risk, it is important to be more careful while preparing the intravitreal medication before treatment in premature babies.

Results of therapeutic penetrating keratoplasty for bacterial and fungal keratitis.

PURPOSE: This study aimed to report the results of therapeutic penetrating keratoplasty (TPKP) performed at early and late stage of keratitis. METHODS: The study involved patients who underwent TPKP surgery due to bacterial, fungal, or mixed (bacterial and fungal) keratitis. The patients were divided into two groups. Group 1 (13 patients) was the patients operated at early stage of corneal abscess formation or in 15 days after the start of keratitis and group 2 (12 patients) was the patients operated at late stage of keratitis or after at least 15 days after the initial appearance of symptoms. Preoperative clinical signs and postoperative results were presented. RESULTS: At the end of the follow-up period, 13 (100 %) of grafts in the early TPKP group and 10 (83.3 %) of grafts in the late TPKP group remained clear (p = 0.125). Recurrence of infection at last visit after TPKP was 0 (0 %) of cases in group 1, and was 2 (16.7 %) of cases in group 2 (p = 0.125) Therapeutic success was achieved and the eyes were preserved in 23 patients of both groups. Evisceration was performed for a case and phthisis bulbi was seen in a case in group 2. The groups were statistically different regarding the presence of postoperative complications (p = 0.015). CONCLUSION: TPKP performed in cases that do not respond medical treatment, in the early phase of the disease, before the lesions reach to limbus and without waiting corneal perforation, may yield better clinical results and less postoperative complications.

Comparing the effects of two different contact lenses on corneal re-epithelialization after corneal collagen cross-linking.

OBJECTIVE: To investigate whether keratoconus (KC) patients who applied the corneal collagen cross-linking (CXL) and two different contact lens (CL) showed any differences in complaints and findings following the CXL. METHODS: This prospective, comparative, double-blind clinical study involved 60 eyes of 60 patients (38 female and 22 male). At the end of the CXL procedure, CL (Balafilcon A) was inserted in 29 patients (Group-1) while CL with different material content (Hioxifilcon A) designed for therapeutic/bandage purposes were inserted in 31 patients (Group-2). RESULTS: On the 1st and 3th day after the CXL, there were no statistically significant differences between the groups in terms of the postoperative symptoms. On the 3th day after the CXL, all cases of both two groups were found to complete the corneal re-epithelialization. There was more PE ratio in the patients who had allergic conjunctivitis. CONCLUSIONS: With the use of Balafilcon A and Hioxifilcon A lens materials, KC patients who underwent the CXL were found to have similar symptoms and clinical findings after the CXL. However, epithelial staining and PE were observed more in KC cases accompanied by allergic conjunctivitis.

The Process of Retinal Vascularization after Anti-VEGF Treatment in Retinopathy of Prematurity: A Comparison Study between Ranibizumab and Bevacizumab.

PURPOSE: To compare the effects on the process of retinal vascularization of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) in the treatment of severe retinopathy of prematurity. METHODS: The present study is a bi-centered retrospective study. While 44 eyes of 22 patients in group 1 were applied 0.625 mg bevacizumab, 46 eyes of 23 patients in group 2 were applied 0.25 mg ranibizumab. Retinal vascularization was evaluated clinically. RESULTS: The mean time for completion of vascularization was found to be postmenstrual 55.93 ± 4.13 weeks in group 1 and 56.30 ± 4.30 weeks in group 2. There were significant differences in the recurrence prevalence between the two groups. The prevalence of recurrence was found to be significantly higher in the ranibizumab group than in the bevacizumab group (p = 0.023). CONCLUSIONS: The study showed that after IVR or IVB treatment, vascularization could be completed with delay; there were no differences in this delay time between the ranibizumab and bevacizumab groups. Besides, avascular areas may remain in the peripheral retina, and additional treatment may be necessary after IVB or IVR treatment. When the treatment was applied as monotherapy, more recurrence was observed in the ranibizumab group.

Systemic exposure to aflibercept after intravitreal injection in premature neonates with retinopathy of prematurity: results from the FIREFLEYE randomized phase 3 study.

BACKGROUND: There are no data on pharmacokinetics, pharmacodynamics, and immunogenicity of intravitreal aflibercept in preterm infants with retinopathy of prematurity (ROP). FIREFLEYE compared aflibercept 0.4 mg/eye and laser photocoagulation in infants with acute-phase ROP requiring treatment. METHODS: Infants (gestational age ≤32 weeks or birthweight ≤1500 g) with treatment-requiring ROP in ≥1 eye were randomized 2:1 to receive aflibercept 0.4 mg or laser photocoagulation at baseline in this 24-week, randomized, open-label, noninferiority, phase 3 study. Endpoints include concentrations of free and adjusted bound aflibercept in plasma, pharmacokinetic/pharmacodynamic exploration of systemic anti-vascular endothelial growth factor effects, and immunogenicity. RESULTS: Of 113 treated infants, 75 received aflibercept 0.4 mg per eye at baseline (mean chronological age: 10.4 weeks), mostly bilaterally (71 infants), and with 1 injection/eye (120/146 eyes). Concentrations of free aflibercept were highly variable, with maximum concentration at day 1, declining thereafter. Plasma concentrations of adjusted bound (pharmacologically inactive) aflibercept increased from day 1 to week 4, decreasing up to week 24. Six infants experienced treatment-emergent serious adverse events within 30 days of treatment; aflibercept concentrations were within the range observed in other infants. There was no pattern between free and adjusted bound aflibercept concentrations and blood pressure changes up to week 4. A low-titer (1:30), non-neutralizing, treatment-emergent anti-drug antibody response was reported in 1 infant, though was not clinically relevant. CONCLUSIONS: 24-week data suggest intravitreal aflibercept for treatment of acute-phase ROP is not associated with clinically relevant effects on blood pressure, further systemic adverse events, or immunogenicity. GOV IDENTIFIER: NCT04004208.

Use of viscoelastic substance for preventing Descemet's membrane rupture in deep anterior lamellar keratoplasty.

PURPOSE: This study aimed to investigate the effect of using a viscoelastic substance in Descemet's membrane rupture in "double bubble" deep anterior lamellar keratoplasty. METHODS: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet's membrane perforation rate was compared between groups. RESULTS: Perforation of the Descemet's membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet's membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). CONCLUSIONS: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet's membrane perforation in deep anterior lamellar keratoplasty.

Cardiovascular assessment after treatment for retinopathy of prematurity: a comparative study between anti-VEGF agent (aflibercept) and laser.

OBJECTIVE: The aim of this study was to compare the cardiac effects and aortic arterial indices following intravitreal aflibercept treatment or diode laser photocoagulation for the treatment of retinopathy of prematurity (ROP) in infants. METHODS: This single-centre, retrospective study was conducted in infants who were administered laser photocoagulation (LPC) or intravitreal aflibercept (IVA) treatment as initial treatment and had completed at least one year of corrected age. The patients were evaluated in terms of aortic elastic parameters, right and left ventricular systolic and diastolic function using conventional, pulsed Doppler and tissue Doppler imaging (TDI) echocardiographic parameters. RESULTS: Fifteen infants were in the LPC group, 16 in the IVA group, and 20 in the control group. Although there were some statistically significant differences in terms of pulsed and TDI echocardiographic parameters between the treatment and control groups, these values could not clearly be adopted as a diastolic dysfunction and myocardial performance indices were not influenced. The aortic elastic parameters were impaired in both LPC and IVA groups compared to the control group. Consequently, we observed only minor differences between the treatment groups, which may suggest subtle changes due to the anti-angiogenic treatment. CONCLUSIONS: Although favourable and promising outcomes were obtained with intravitreal injection of anti-vascular endothelial growth factor agents for the treatment of ROP, concerns have been raised about potential systemic side effects, including potential cardiovascular side effects caused by these agents. The small reduction in right ventricular Doppler velocities could probably be explained by the use of anti-angiogenic or laser treatment in infants.

Evaluation of Foveal Avascular Zone and Capillary Plexus in Smokers Using Optical Coherence Tomography Angiography.

PURPOSE: To evaluate the macular microvasculature in smokers in comparison to healthy subjects using optical coherence tomography angiography (OCTA). METHODS: Fifty chronic, regular smokers and 50 healthy non-smokers, as a control group, were recruited for the study. Foveal avascular zone (FAZ) area (mm2) and vessel density (VD) (%) in the superficial (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS: FAZ area was 0.424 ± 0.100 mm2 in the smoker group and 0.333 ± 0.093 mm2 in the non-smoking control group (P = 0.002). The deep foveal VD was 31.76 ± 6.33% in the smoker group and 53.09 ± 5.88% in the non-smoking control group (P = 0.006). Superficial foveal and parafoveal, deep parafoveal VD were not statistically different between the groups (P = 0.120), (P = 0.337), (P = 0.287), respectively. CONCLUSION: In our study, there was an enlargement of FAZ and reduction of foveal VD at DCP in the eyes of smokers compared with non-smoking adults.

Evaluation of Foveal Avascular Zone and Capillary Plexuses in Diabetic Patients by Optical Coherence Tomography Angiography.

PURPOSE: To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. METHODS: Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm²), deep VD (%) and deep AVZ area (mm²) were evaluated via optic coherence tomography angiography. RESULTS: Superficial AVZ was 0.438 ± 0.05 mm² in the DM group, 0.246 ± 0.022 mm² in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm² in the DM group, and 0.342 ± 0.022 mm² in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm² in the DM group, and 34.86 ± 0.75 mm² in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm² in the DM group, and 33.47 ± 0.56 mm² in the control group (p < 0.001). CONCLUSIONS: In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.