Circulating miRNAs and their functional genetic variants in pseudoexfoliative glaucoma: potential of miR-146a-5p as a diagnostic biomarker.

PURPOSE: The etiology and pathogenesis of pseudoexfoliation syndrome (PEX) and its advancement into pseudoexfoliative glaucoma (PEG) are not fully understood. In this study, we aimed to evaluate the possible role played by two circulating microRNAs (miR-146a-5p and miR-196a-5p) in plasma and their functional genetic variants MIR146A rs2910164 and MIR196A2 rs11614913 in susceptibility to PEG or PEX. METHODS: Plasma miRNA relative expression of 27 patients with PEG, 25 patients with PEX and 27 controls was determined using quantitative RT-PCR, and fold change was calculated using the 2-ΔΔCt method. Genotyping of 300 patients with PEG, 300 patients with PEX, and 300 controls was performed using a PCR-restriction fragment length polymorphism analysis. RESULT: Plasma miR-146a-5p relative expression was significantly elevated in patients with PEG (3.9-fold) (P < .000) and patients with PEX (2.7-fold) relative to controls (P = .001). The diagnostic ability of plasma miR-146a-5p expression fold change was good for discriminating PEG vs. controls (AUC = 0.897, P < .000), and the optimal decision threshold was 1.83 (sensitivity = 74%, specificity = 93%). Plasma miR-196a-5p relative expression did not differ significantly between study groups. No significant difference in terms of the minor allele frequency or the distribution of genotypes for MIR146A rs2910164 G/C or MIR196A2 rs11614913 C/T was observed between study groups. CONCLUSIONS: Circulating miR-146a-5p can contribute to the risk of PEX/PEG. Therefore, we propose that plasma miR-146a-5p can be developed as a potential biomarker for the minimally invasive diagnoses of PEX/PEG and as a potential therapeutic target with further studies.

A Myopic Normative Database for Retinal Nerve Fiber Layer Thickness Using Optical Coherence Tomography.

PRCIS: The purpose of this study was to determine changes in optical coherence tomography (OCT) color codes after applying a myopic normative database. The diagnostic performance of the retinal nerve fiber layer analysis improved with the use of this database. PURPOSE: To evaluate the peripapillary retinal nerve fiber layer (pRNFL) OCT color codes based on a newly generated myopic normative database in comparison to the built-in normative database. MATERIALS AND METHODS: A total of 371 subjects were included in this validation study in an attempt to generate a myopic normative database. Eighty myopic glaucomatous and 80 myopic healthy eyes were evaluated to determine the diagnostic performance of this database. The distribution of the color codes was investigated among the groups with reference to the built-in and myopic normative databases, and the 2 databases were compared in terms of abnormal color code frequency. The diagnostic performance of the myopic database was presented with sensitivity, specificity and area under the receiver operating characteristic curve values. RESULTS: The agreement between the databases decreased with increasing myopia degree. The distribution of the color codes of the built-in software significantly differed among the study groups in all sectors ( P =0.009 for the temporal sector and P <0.001 for the remaining sectors). When the myopic database was used, there were no longer significant differences among the groups for the temporosuperior, temporoinferior, temporal, and nasal sectors ( P =0.561, 0.299, 0.201, and 0.089, respectively). After applying the myopic normative database, the specificity of the pRNFL color codes increased from 70.1% to 90.2%, and the area under the receiver operating characteristic curve value from 0.851 to 0.945. CONCLUSIONS: The use of a myopic normative database for pRNFL using SD-OCT significantly decreased differences among myopia severity groups, and may help to more reliably assess glaucoma in myopic eyes.

Uveitis as a Confounding Factor in Retinal Nerve Fiber Layer Analysis Using Optical Coherence Tomography.

PURPOSE: To investigate the retinal nerve fiber layer thickness (RNFLT) in uveitic eyes and search for the associations with uveitis activity, etiology and location. METHODS: The files of 76 patients with uveitis and 76 controls were scanned. Associations of RNFLT were analyzed using generalized linear models. RESULTS: The RNFLT was significantly higher in patients with uveitis (p < .001). Active uveitis patients had a thicker RNFL than the controls and the patients with quiescent uveitis (p < .001). Anterior uveitis was associated with thinner RNFL in global and inferotemporal quadrant (p = .011 and 0.013, respectively). Thickening of RNFL was associated with posterior uveitis and Behçet's disease in all quadrants (p < .001) and idiopathic uveitis in the superonasal and nasal quadrants (p = .001). CONCLUSION: Active uveitis, as well as posterior uveitis and Behcet's disease-associated uveitis, is a major confounding factor in RNFL analysis and therefore detection of glaucoma.

Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma.

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.

A Case of Multiple Optic Disc Pits: 21-Year Follow-up

Optic disc pits (ODP) are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. The use of optic coherence tomography has critical benefits in the follow-up of patients who are at the amblyogenic age. The aim of this study is to present a case of double ODP in the right eye and single ODP in the left eye in a partially accommodative esotropia patient followed for 21 years. To our knowledge, multiple ODP has never been described in a patient with partially accommodative esotropia.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers in patients with papilledema due to idiopathic intracranial hypertension.

Purpose: The aim of this study was to investigate the role of inflammation in the pathogenesis of idiopathic intracranial hypertension (IIH) using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as inflammation markers. Methods: The files of 33 IIH patients and 33 controls were screened for this retrospective study. For each patient, the NLR and PLR values were calculated using a single fasting blood sample. For both eyes, papilledema (PE) grades, best-corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) measurements were recorded along with the demographic data, including body mass index (BMI), and complete neurological and ophthalmological findings. Comparisons between the two groups and between the IIH patients with and without PE were made. The associations of NLR and PLR with all other parameters were analyzed independently from age, gender, and BMI. Results: NLR and PLR were higher in patients with IIH than controls (P < 0.05). They were also higher in patients with PE (P < 0.05) in the IIH group. NLR and PLR were found to be associated with BCVA (P < 0.001 and P = 0.023, respectively), global RNFLT (P = 0.004 and 0.012, respectively), RNFLT of the temporal quadrant (P < 0.001 and P = 0.042, respectively) and PE grade (P < 0.001 and P = 0.035, respectively). Conclusion: The NLR and PLR values and their associations with BCVA, RNFLT, and PE support the hypothesis that inflammation is a very important component of the pathogenesis of IIH.

Alterations in the Retinal Nerve Fiber Layer Thickness Color Map in Non-Glaucomatous Eyes with Myopia.

Objectives: To determine the normal values for retinal nerve fiber layer thickness (RNFLT) in myopic patients without glaucoma and analyze the changes in their color map. Materials and Methods: A total of 245 eyes without glaucoma were included in the study. According to the degree of myopia, the cases were divided into 4 groups: control group (+1.00/-1.00 D; n=70), Group 1 (-1.00/-3.00 D; n=50), Group 2 (-3.00/-6.00 D; n=75), and Group 3 (>-6.00 D; n=50). Intra-group comparisons were performed in terms of superotemporal, superonasal, nasal, inferonasal, inferotemporal, temporal, and global RNFLT (Heidelberg Spectralis, Optic Coherence Tomography, Germany) and the color coding of these quadrants (green: within normal limits, yellow: borderline, red: outside normal limits). Results: All groups were similar in age and gender (p>0.05). As the degree of myopia increased, RNFLT became thinner in the upper and lower temporal and upper and lower nasal quadrants (p<0.01). The rate of measurements considered borderline and outside normal limit in at least 1 quadrant was higher in groups with higher myopia for all quadrants (p<0.05). This rate was found to be 8/70 (11.4%) for the control group, 9/50 (18.0%) for Group 1, 21/75 (28.0%) for Group 2, and 33/50 (66.0%) for Group 3 (p<0.01). Conclusion: The high rate of RNFLT classified as borderline or outside normal limits in myopic patients is a finding to which clinicians should pay attention in order not to make a misdiagnosis, especially in cases of suspected glaucoma.

Comparative study of retinal nerve fibre layer thickness and retinal peripapillary capillary plexus microvascular vessel density: structure-function relationship analysis in glaucoma.

BACKGROUND: To investigate whether the retinal peripapillary capillary plexus vessel density (RPCP VD) or the retinal nerve fibre layer thickness (RNFLT) is better in showing the structure-function relationship in glaucoma. METHODS: Sixty-seven patients with primary open-angle glaucoma (POAG) in one eye and no visual field loss in fellow eye were included in this study. The scans of RPCP VD and RNFLT, and the standard automated perimetry data [including mean deviation (MD), pattern standard deviation (PSD), sector-based pattern deviation (PD) values] were analysed and compared. RESULTS: The global RNFLT was associated with MD (P = 0.035). RNFLTs of the superotemporal, superonasal, inferotemporal and inferonasal quadrants were associated with the corresponding PD (P = 0.004, <0.001, 0.002 and 0.012). The global RPCP VD was found to be associated with MD and PSD (P = 0.030 and 0.049, respectively). RPCP VD of the superotemporal quadrant was associated with PD of the corresponding quadrant, as well as with PSD (P = 0.003 and 0.043, respectively). Remaining RPCP VD values were only associated with the PD values of the corresponding quadrants (P < 0.05). The associations of the RPCP VD with PD were stronger than those of the RNFLT with PD [RPCP VD vs RNFLT: R2 = 0.624 vs 0.558 (P < 0.001 for both) for the superotemporal, 0.649 vs 0.552 for the superonasal (P < 0.001 for both), 0.598 vs 0.427 for the inferotemporal (P < 0.001 for both), 0.581 vs 0.408 for the inferonasal (P < 0.001 for both), 0.594 vs 0.068 (P < 0.001 vs 0.098) for the temporal, and 0.338 vs 0.195 (P < 0.001 vs 0.004) for the nasal quadrants]. CONCLUSION: In conclusion, the VD of RPCP was more informative in terms of the structure-function relationship in POAG. Future prospective follow-up studies with larger sample sizes are required to confirm the findings.

Adherence to glaucoma medication, illness perceptions, and beliefs about glaucoma: Attitudinal perspectives among Turkish population.

PURPOSE: To evaluate the topical glaucoma eye drops adherence prevalence and its association with beliefs and illness perceptions about glaucoma in Turkey. We also aimed to explore the factors linked to patients' total, voluntary, and involuntary non-adherence to medication in different patient attitudes. MATERIAL AND METHODS: A prospective study with cross-sectional design which included a total of 317 glaucoma patients who completed questionnaires. We assessed the adherence to medication, illness perceptions, and the beliefs about the glaucoma treatment by the "Reported Adherence to Medication scale," "the Brief Illness Perception Questionnaire," and "the Beliefs about Medicine-Specific Questionnaire," respectively. According to the RAM scale, voluntary and involuntary non-adherence scores were also distinguished. Different adherence categories in RAM scale were compared with perception and belief measures. Patient attitudes were assessed from the BMQ. We also performed attitudinal type comparisons with different adherence groups. RESULTS: The full adherence prevelance to glaucoma medication was 40%. The proportion of voluntary and involuntary non-adherence was 26% and 57%, respectively. The adherence groups were similar in terms of belief measures but statistically different according to illness perceptions (consequences (p = 0.002), timeline (p = 0.008), personal control (p = 0.001), identity (p = 0.019), concerns (p = 0.003)), and attitude types (ambivalent (p = 0.030) and accepting (p = 0.029)). CONCLUSION: New strategies are required to improve patient adherence to glaucoma medication in Turkey. The beliefs about the glaucoma treatment and illness perceptions are also needed to be enhanced.

The agreement between optical coherence tomography angiography and non-mydriatic retinal camera in estimating the optic nerve head parameters and relations with the peripapillary vessel density in primary open-angle glaucoma.

BACKGROUND/OBJECTIVES: To investigate the agreement between optical coherence tomography angiography (OCT-A) and non-mydriatic retinal camera (NMRC) in estimating the optic nerve head (ONH) parameters and evaluate the associations between peripapillary vessel density (VD) with ONH parameters assessed by both devices. METHODS: The OCT-A and NMRC images of 262 participants (138 eyes were diagnosed with POAG, 63 were glaucoma suspect, and 61 were healthy subjects) were screened retrospectively. The vertical cup-to-disc ratio (VCDR), cup-to-disc area ratio (CDAR), rim area (RA), disc area (DA), and cup volume (CV) were recorded using both devices. Peripapillary VD data were also recorded using OCT-A. The intraclass correlation coefficient (ICC) and Bland-Altman plots were obtained to investigate the agreement between the devices. Age- and intraocular pressure (IOP)-corrected associations between the VD and ONH parameters measured by the two devices were analyzed using linear regression models. RESULTS: ICC revealed excellent agreement for VCDR and CDAR, but poor agreement for RA, DA, and CV (ICC = 0.801, 0.793, 0.445, 0.298, and 0.527, respectively). The Bland-Altman plots showed poor agreement for VCDR and CDAR with a large span of limits of agreement (0.500 and 0.528, respectively) and significant proportional biases (P < 0.05). VD was found to be strongly associated with the VCDR and CDAR measurements of both devices (P < 0.001), but the associations were stronger for the measurements of NMRC. CONCLUSIONS: The disagreement between the devices should be considered in clinical practice. The associations between the VD and ONH parameters proved once again the importance of the ONH parameters in terms of the management of glaucoma patients.

Agreement Between Standard Optical Coherence Tomography and Optical Coherence Tomography-Based Angiography in Estimating Retinal Nerve Fiber Layer Thickness

Objectives: To investigate the agreement between optical coherence tomography (OCT) and OCT-based angiography (OCT-A) in estimating retinal nerve fiber layer thickness (RNFLT) and evaluate the associations between peripapillary vessel density (VD) and RNFLT measurements obtained with both devices. Materials and Methods: The AngioVue (Optovue Inc., Fremont, CA, USA) and Spectralis (Heidelberg Engineering, Heidelberg, Germany) images of 325 patients were screened retrospectively. RNFLT values were recorded using both devices. The intraclass correlation coefficient (ICC) and Bland-Altman plots were obtained to investigate the agreement between the devices. Age- and intraocular pressure-corrected associations between VD and RNFLT measured by the two devices were analyzed using linear regression models. Results: ICC revealed excellent agreement for global, superior, inferior, and temporal RNFLT and good agreement for the nasal quadrant (ICC=0.895, 0.936, 0.923, 0.887, and 0.614, respectively). The Bland-Altman plots showed poor agreement for all measurements with a large span of limits of agreement and significant proportional bias (p<0.05). VD was found to be strongly associated with the RNFLT measurements of both devices (p<0.001). Conclusion: The disagreement between the devices should be considered in clinical practice, and the data should not be used interchangeably. The association of the peripapillary VD with RNFLT using both devices indicated that RNFLT assessed by the AngioVue could be used in glaucoma management along with VD.

Does Dry Eye Affect Repeatability of Corneal Topography Measurements?

Objectives: The purpose of this study was to assess the repeatability of corneal topography measurements in dry eye patients and healthy controls. Materials and Methods: Participants underwent consecutive corneal topography measurements (Sirius; Costruzione Strumenti Oftalmici, Florence, Italy). Two images with acquisition quality higher than 90% were accepted. The following parameters were evaluated: minimum and central corneal thickness, aqueous depth, apex curvature, anterior chamber volume, horizontal anterior chamber diameter, iridocorneal angle, cornea volume, and average simulated keratometry. Repeatability was assessed by calculating intra-class correlation coefficient. Results: Thirty-three patients with dry eye syndrome and 40 healthy controls were enrolled to the study. The groups were similar in terms of age (39 [18-65] vs. 30.5 [18-65] years, p=0.198) and gender (M/F: 4/29 vs. 8/32, p=0.366). Intra-class correlation coefficients among all topography parameters within both groups showed excellent repeatability (>0.90). Conclusion: The anterior segment measurements provided by the Sirius corneal topography system were highly repeatable for dry eye patients and are sufficiently reliable for clinical practice and research.

Association of retinal vein occlusion, homocysteine, and the thrombophilic mutations in a Turkish population: A case-control study.

PURPOSE: To compare homocysteine and thrombophilic mutations for the methylenetetrahydrofolate reductase (MTHFR) C677T, factor V Leiden, and prothrombin G20210A between retinal vein occlusion (RVO) and healthy controls in a Turkish population. MATERIALS AND METHODS: Forty-nine subjects with RVO were compared for homocysteine status and the MTHFR C677T, prothrombin G20210A, and factor V Leiden mutations with those of 68 healthy controls. Then, the groups were subdivided into two subgroups according to age (less than 50 years old, equal to or more than 50 years old) and were further compared. RESULTS: Mean plasma level of homocysteine was similar, but the frequency of hyperhomocysteinemia was significantly higher in the RVO group when compared with the control group (22.5% and 8.8%, respectively, p = 0.037). The frequency of all thrombophilic mutations was similar between the groups (p > 0.05). The frequency of all thrombophilic mutations and homocysteine levels was also similar between age subgroups (p > 0.05). Only hyperhomocysteinemia was significantly different between subgroups (p = 0.037); the frequency of hyperhomocysteinemia was significantly different in RVO patients less than 50 years old (22.7%) from that in healthy controls less than 50 years old (11.1%). Two RVO patients (4.1%) with bilateral involvement had MTHFR C677T mutation. CONCLUSIONS: Screening for thrombophilic mutations such as MTHFR C677T, factor V Leiden, and prothrombin G20210A in RVO patients at all ages seems to be unnecessary and not cost-effective. However, thrombophilic disorders should be screened selectively, focusing on young individuals, especially with bilateral involvement, without additional cardiovascular risk factors, or a family history of thrombosis.

Fixation Characteristics of Severe Amblyopia Subtypes: Which One is Worse?

PURPOSE: To determine differences in macular sensitivity and fixation patterns in different subtypes of severe amblyopia. METHODS: This case-control study enrolled a total of 73 male adults, including 18 with pure strabismic severe amblyopia, 19 with pure anisometropic severe amblyopia, 18 with mixed (strabismic plus anizometropic) severe amblyopia, and 18 healthy controls. MP-1 microperimetry was used to evaluate macular sensitivity, location of fixation, and stability of fixation. RESULTS: Mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in all amblyopia subtypes when compared with healthy controls. Intergroup comparisons between amblyopia subtypes revealed that mean macular sensitivity, stability of fixation, and location of fixation were significantly worse in pure strabismic and mixed amblyopic eyes when compared with pure anisometropic amblyopic eyes. CONCLUSIONS: Strabismus seems to be a worse prognostic factor in severe amblyopia than anisometropia in terms of fixation characteristics and retinal sensitivity.

Retinal Nerve Fiber Layer and Peripapillary Choroidal Thicknesses in Non-Glaucomatous Unilateral Optic Atrophy Compared with Unilateral Advanced Pseudoexfoliative Glaucoma.

PURPOSE: To investigate retinal nerve fiber layer thickness (RNFL-T) and peripapillary choroidal thickness (PC-T) in non-glaucomatous optic atrophy (OA) patients in comparison with unaffected and control eyes, furthermore, to compare thickness profiles with unilateral pseudoexfoliative advanced glaucoma. MATERIALS AND METHODS: Thirty-three eyes with OA (Group A), 33 unaffected fellow eyes (Group B), 25 right eyes of 25 control subjects (Group C), and 15 eyes with advanced glaucoma (Group D) were enrolled. RNFL-T was measured in six regions by spectral-domain optical coherence tomography. Enhanced depth imaging optical coherence tomography was obtained to evaluate PC-T in corresponding regions. RESULTS: RNFL-T was significantly lower in Group A than in Groups B and C globally and at all peripapillary regions (all p < 0.001). P-CT in Group A was significantly lower globally (p = 0.03) and in three regions (temporal, p = 0.001; temporal-superior, p = 0.01; and nasal-inferior, p = 0.037) versus Group C. However, it was significantly thinner than in Group B in all regions (temporal, p = 0.02; temporal-superior, p = 0.013; nasal-superior, p = 0.044; nasal, p = 0.02; nasal-inferior, p < 0.001; and temporal-inferior, p < 0.001) and globally (p < 0.001). In Group A RNFL-T (thicker superiorly and inferiorly; thinner temporally and nasally) and PC-T (superior > temporal > nasal > inferior) profiles were almost identical to that in unaffected fellow eyes and control eyes. However, Group D showed different patterns with less regional differences in RNFL-T, and the greatest value of PC-T in nasal quadrant. CONCLUSIONS: Besides retinal nerve fiber layer thinning, non-glaucomatous OA is associated with choroidal thinning. The RNFL-T and PC-T profiles in advanced glaucoma eyes differed from the common patterns seen among OA eyes, unaffected fellow eyes, and control eyes.

The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema.

OBJECTIVE: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema. MATERIALS AND METHODS: A total of 60 eyes from 60 consecutive patients who received 0.5 mg/0.05 ml IVIs of bevacizumab (n = 30, IVB group) or 1.25 mg/0.05 ml ranibizumab (n = 30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared. RESULTS: The groups were matched for age (p = 0.11) and gender (p = 0.32). There was no significant difference in endothelial cell count (IVB group, p = 0.66; IVR group, p = 0.74), pleomorphism (IVB group, p = 0.44; IVR group, p = 0.88) and polymegathism (IVB group, p = 0.21; IVR group, p = 0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p = 0.15; IVR group, p = 0.58) before injection or 1 month after the first and third injections. CONCLUSION: Monthly 1.25 mg/0.05 ml IVIs of bevacizumab or 0.5 mg/0.05 ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.

Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis / Eficácia do aflibercept em pacientes portadores de degeneração macular relacionada à idade exsudativa com resistência completa e taquifilaxia ao ranibizumab

ABSTRACT Purpose: The present study compared the efficacy of aflibercept for neovascular age-related macular degeneration (NV-AMD) in patients with complete ranibizumab resistance and tachyphylaxis. Methods: Forty-four eyes of 38 neovascular age-related macular degeneration patients were evaluated. Eyes were divided into a complete resistance group (n=23 eyes) and tachyphylaxis group (n=21 eyes). Results: After three injections, eight (38.1%) patients in the tachyphylaxis group and nine (39.1%) in the complete resistance group presented with macular dryness. After the first injection of aflibercept, the mean visual acuity improved significantly in the tachyphylaxis group (p=0.018) but remained unchanged in the complete resistance group (p=0.37). There was a non-significant trend towards improved mean visual acuity in both groups after the second and third injections relative to the acuity at the final visit for ranibizumab treatment. In the tachyphylaxis group, the presence of subfoveal pigmented epithelium detachment (PED) decreased significantly after intravitreal aflibercept treatment. Conclusions: Although treatment with aflibercept yielded generally positive anatomical results in both groups, no significant increase in visual acuity was achieved.

RESUMO Objetivo: O presente estudo comparou a eficácia do aflibercept na degeneração macular neovascular relacionada à idade (NV-AMD) com de resistência completa ao ranibizumab e taquifilaxia ao ranibizumab. Método: Quarenta e quatro olhos de 38 pacientes com degeneração macular neovascular relacionada à idade foram inscritos. Eles foram divididos em dois grupos: grupo de resistência completa (n=23 olhos) e grupo taquifilaxia (n=21 olhos). Resultados: Depois de três injeções, 8 (38,1%) olhos no grupo de taquifilaxia e 9 (39,1%) olhos no grupo de resistência completa, apresentaram mácula seca. Após a primeira injeção de aflibercept, a acuidade visual média melhorou significativamente no grupo taquifilaxia (p=0,018) e manteve-se inalterada no grupo de resistência completa (p=0,37). Houve uma tendência de melhora da acuidade visual média em ambos os grupos após a segunda e terceira injeções em comparação com a última visita do tratamento com ranibizumab, mas isso não foi estatisticamente significativo. A presença de descolamento do epitélio pimentado subfoveal (PED) em olhos com taquifilaxia ao ranibizumab diminuiu significativamente após o tratamento aflibercept intravítreo. Conclusões: Embora o tratamento com aflibercept tenha mostrado resultados anatômicos positivas em ambos os grupos, não foi obtida melhora significativa da acuidade visual.

Ophthalmic pathologies in female subjects with bilateralcongenital sensorineural hearing loss.

BACKGROUND/AIM: The high prevalence of ophthalmologic pathologies in hearing-disabled subjects necessitates early screening of other sensory deficits, especially visual function. The aim of this study is to determine the frequency and clinical characteristics of ophthalmic pathologies in patients with congenital bilateral sensorineural hearing loss (SNHL). MATERIALS AND METHODS: This descriptive study is a prospective analysis of 78 young female SNHL subjects who were examined at a tertiary care university hospital with a detailed ophthalmic examination, including electroretinography (ERG) and visual field tests as needed. RESULTS: The mean age was 19.00 ± 1.69 years (range: 15 to 24 years). A total of 39 cases (50%) had at least one ocular pathology. Refractive errors were the leading problem, found in 35 patients (44.9%). Anterior segment examination revealed heterochromia iridis or Waardenburg syndrome in 2 cases (2.56%). Dilated fundus examination revealed retinal pathologies in 15 cases (19.23%), including retinitis pigmentosa or Usher's syndrome in 8 cases (10.25%). Most of the Usher's syndrome cases (87.5%) had consanguinity. CONCLUSION: Screening for congenital SNHL in the early years of life and routine yearly follow-ups are essential for maximizing the rehabilitation of this disabled group. The high rate of visually debilitating syndromic ocular pathologies associated with high frequency of consanguinity doubles the importance.