Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity.

PURPOSE: To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment. METHODS: This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS: Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both). CONCLUSIONS: Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.

Comparison of choroidal structural changes between term and preterm children with and without retinopathy of prematurity.

PURPOSE: To evaluate the effects of prematurity and retinopathy of prematurity (ROP) treatment on choroidal structure using the image binarization method and compare with term children. METHODS: Children aged 6-11 years were included in this prospective case-control study. There were 36 (72 eyes) term children and 52 (103 eyes) preterm children included in the study. Subfoveal choroidal thickness (SFCT) and choroidal thickness (CT) at 500, 1500, and 2500 µm temporal and nasal from the fovea were measured. Images were binarized using the Image J program. The choroidal vascularity index (CVI) was calculated by dividing the luminal area by the total subfoveal choroidal area. RESULTS: There was no significant difference in SCFT between children born at term (290.44±57.617 µm) and preterm (288±69.270 µm) (p = 0.800). CVI was found to be significantly higher in term children (71.90±2.60 %) than in preterm children (69.58±2.72 %) (p<0.001), and the difference was also significant when compared to preterm children without ROP (p = 0.033). In the preterm subgroups, although CVI was higher in preterm children without ROP (70.42±2.24 %) than in those with spontaneous regression (69.34±3.30 %) and those treated with laser photocoagulation (68.91±2.35 %), there was no significant difference (p = 0.330, p = 0.089 respectively). CVI was similar between children with spontaneous regression and those treated with laser photocoagulation (p = 0.909). CVI and logMAR best corrected visual acuity (BCVA) were inversely correlated (r=-0.295 p<0.001). CONCLUSION: Reduced CVI in preterm children indicates that prematurity is related to the choroid. Choroidal vascularity index appears to be a more reliable marker than CT for evaluating the relationship between choroid and ROP.

Dural Carotid-cavernous Fistula Mimicking Thyroid Orbitopathy.

In this study, we aim to present a case with dural carotid-cavernous fistula mimicking thyroid orbitopathy. The differential diagnosis of red-eye is very coamplex, and the caregiver should distinguish between all diagnoses.

The adverse effects of valproic acid on visual functions in the treatment of retinitis pigmentosa.

PURPOSE: To evaluate the efficacy and safety of valproic acid (VPA) treatment in patients with retinitis pigmentosa (RP). METHODS: A total of 48 eyes of 24 patients (13 males, 11 females) with RP prescribed VPA were included. The length of VPA treatment was 6-12 months (mean 9.4 months). Parameters evaluated were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]), visual field analyses (VFAs) with Humprey automated perimetry, multifocal electroretinography (ERG) with Roland-RETI scan, and VPA side effects. RESULTS: Mean age was 34.3 ± 10.3 years (range 18-56 years). Fifteen of the patients (30 eyes) had two ERG and VFA tracings, allowing comparison between baseline and follow-up (range 6-12 months). Mean BCVA before and after VPA therapy was 0.36 ± 0.38 and 0.36 ± 0.37 logMAR, respectively (P = 0.32). Quantitative perimetric indices including mean deviation and pattern standard deviation were not significantly changed after VPA therapy (P > 0.05). P1 amplitudes (in terms of nV/deg2 and mV) of ERG waves were significantly decreased in the rings 1, 3, and 4 after VPA therapy (P < 0.05). Regarding the N1 amplitudes, the only significant decrease was observed in area 1 (P = 0.03). In addition, N1 latency was significantly increased in area 3 after VPA therapy (P = 0.04). CONCLUSIONS: VPA therapy did not have any significant benefit on BCVA and VFA. In addition, it may be associated with decline in some ERG parameters. Therefore, physicians should avoid prescribing VPA for RP until its safety and efficacy are appropriately evaluated.

Isolated Schwannoma of the Upper Eyelid Margin in a 50-year-old Male.

Schwannomas (neurilemmomas) are benign neurogenic tumours of peripheral nerves. They originate from Schwann cells, which form the neural sheath. Although Schwannomas and neurofibromas are the most common primary peripheral nerve tumours, Schwannomas are rarely observed in ophthalmic areas. When they occur, ocular Schwannomas are usually located in the orbit, uveal tract and conjunctiva. Isolated eyelid Schwannomas are reported infrequently. Herein, we describe a case of eyelid Schwannoma in a 50-year-old man. The diagnosis of Schwannoma was made after the eyelid mass was removed by excisional biopsy, so this entity should be included in the differential diagnosis of eyelid margin tumours.

Acute effects of caffeine on choroidal thickness and ocular pulse amplitude.

OBJECTIVE: To explore ocular changes in healthy people after caffeine consumption. METHODS: This prospective observational study was carried out with students of the Turgut Özal University Medical Faculty from May 15 to 15 December 2014. Enrolled in the study were 17 healthy subjects (n = 17 eyes), with a median age of 24 (IQR 1), ranging between 21 and 26 years. The control group (6 females, 11 males) aged between 23 and 28 (median 25 years [IQR 4.75]). For study, one eye from each participant was randomly selected. To obviate the effect of diurnal variations, tests were performed at the same time of the day (10:00 a.m.-12:00 p.m.). Each subject was given an ophthalmologic examination before the study to exclude those with undiagnosed ocular disease. Version 6.0 Cirrus high-definition optical coherence tomography (HD-OCT) (Carl Zeiss Meditec, Dublin, CA) was used to measure CT at the fovea, and 1500 µm nasal and 1500 µm temporal to the fovea. After baseline OCT measurements, participants were asked to have 200 mg oral caffeine intake or a placebo capsule (200 mg lactose powder). Two further OCT measurements were applied at the first and fourth hours of caffeine intake. All participants also had intraocular pressure (IOP) and ocular pulse amplitude (OPA) measurements recorded before, first and fourth hours of caffeine intake. IOP and OPA were measured using the dynamic contour tonometry (DCT) (Swiss Micro Technology AG, Port, Switzerland). RESULTS: The groups showed no significant difference by means of age, gender, spherical refraction and axial length (p > 0.05). Baseline choroidal thickness measurements of the study and control group showed no significant difference. Oral caffeine intake caused a significant reduction in choroidal thickness compared with baseline, at all three measurement points, (p < 0.05). There were no significant changes in IOP and OPA measurements compared with the baseline values (p > 0.05). The choroidal thickness still continued to decrease for at least 4 h following caffeine intake; whereas, the difference between 1 and 4 h was not statistically significant (p > 0.05). However, choroidal thicknesses, IOP and OPA values of the control group revealed no significant difference at all points when comparing measurements at baseline with 1 and 4 h after placebo intake (p > 0.05). CONCLUSIONS: We found no significant change in IOP and OPA following oral 200 mg caffeine intake, while CT significantly decreased, for at least 4 h.

Choroidal thickness measurement in healthy pediatric population using Cirrus HD optical coherence tomography.

PURPOSE: To investigate the association between central choroidal thickness (CT), axial length (AL), age, gender, and refractive error in a healthy pediatric population using optical coherence tomography (OCT). METHODS: This institutional study involved 137 healthy children (57 boys, 80 girls) aged between 4 and 18 years. Each child underwent a dilated eye examination, cycloplegic refraction, and AL measurement using a Nidek AL-Scan optical biometer. The central foveal thickness (CFT) and CT were measured using Cirrus high definition (HD)-OCT. The right eye of each subject was selected for analysis. RESULTS: The mean age of the children was 10.0 ± 4.7 years (range, 4-18 years). The mean spherical equivalent (SE) was -0.24 ± 1.24 diopters (D) (range, -2.00 D to +2.25 D). The mean AL was 23.1 ± 1.2 mm (range, 20-27 mm). The mean central CT was 388.2 ± 50.0 µm and was not correlated with age, gender, AL, or refractive error. CONCLUSION: The data provide a pediatric normative database of CT using enhanced depth imaging OCT. This information may be useful in the diagnosis and monitoring of retino-choroidal diseases in children.

Comparison of anterior chamber depth measurements of Nidek AL-Scan and Galilei Dual Scheimpflug Analyzer.

PURPOSE: We aimed to compare anterior chamber depth (ACD) measurements between the Nidek AL-Scan and the Galilei Dual Scheimpflug Analyzer. SETTING: Turgut Ozal University Medical Faculty, Ankara, Turkey. DESIGN: Prospective masked bilateral randomized study. METHODS: Sixty-three individual patient eyes with normal ocular examination findings and no prior ocular surgery were analyzed. Paired two-tailed t-test was used to evaluate agreement between devices. Interobserver repeatability was evaluated in 22 patients using intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: The mean ± standard deviation (SD) ACD for Nidek and Galilei was 3.57 ± 0.29 (range from 2.92 to 4.32) and 3.65 ± 0.29 (range from 3.01 to 4.40), respectively. Comparing the two instruments using paired samples t-test, a statistically significant difference was found between the measurements obtained for ACD (P = 0). Two observers' intraclass correlation coefficients (ICC) were 0.996 for Nidek and 0.968 for Galilei. For Nidek, ACD mean difference was 0mm (P < 0.001); 95% limits of agreement was from -0.05 to 0.05. For Galilei ACD mean difference was -0.01 mm (P < 0.001); 95% limits of agreement was from -0.14 to 0.12. The Galilei Dual Scheimpflug Analyzer measured longer ACD values than the Nidek AL-Scan. CONCLUSION: This comparative study showed that the difference in ACD between the measurements of the Nidek AL-Scan and the Galilei Dual Scheimpflug Analyzer was statistically significant but clinically it was negligible. Further studies are needed, especially on IOL calculation formulas that include ACD and its effect on postoperative spherical equivalent values.

Evaluation of Choroidal Thickness in Amblyopia Using Enhanced Depth Imaging Optical Coherence Tomography.

PURPOSE: To evaluate the choroidal thickness (CT) in hyperopic anisometropic amblyopic eyes, fellow non-amblyopic eyes, and age-matched normal eyes, using spectral-domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: In total 53 subjects (17.8 ± 11.0 years, mean ± SD) with hyperopic anisometropic amblyopia (AE) and 53 age-matched controls (17.7 ± 11.0 years) were included in this prospective study. Each subject underwent a dilated eye examination, cycloplegic refraction and axial length (AL) measurement using Nidek AL-Scan optical biometer (Nidek CO, Aichi, Japan). The CT of subfoveal area and at a radius of 1 and 3 mm around the fovea was determined using the enhanced depth imaging program of a SD-OCT (Cirrus HD OCT, Carl-Zeiss Meditec, Dublin, CA). CT, AL and spherical equivalent refraction (SER) of the amblyopic eyes were compared to that of the fellow and control eyes. RESULTS: The mean subfoveal CT was 305.6 ± 26.0 µm in the amblyopic eyes, 282.6 ± 30.7 µm in the fellow eyes and 280.1 ± 8.8 in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p < 0.001). There was a significant negative correlation between the subfoveal CT and the AL in amblyopic (r = -0.298, p=0.03) eyes but not in the control and fellow eyes. CONCLUSIONS: The subfoveal choroid of eyes with hyperopic AE is significantly thicker than that of the fellow eye and the age-matched controls. Hence, CT seems to be effected in AE.

Effect of smoking on retina nerve fiber layer and ganglion cell-inner plexiform layer complex.

PURPOSE: The aim of this study is to show the effects of smoking on retina layers, especially retina nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer complex (GCIPL). MATERIALS AND METHODS: Participants smoking for more than 10 years at least 1 pack of cigarettes a day and a control group, both including participants between ages of 20 and 50 years with no other systemic or ocular diseases were studied. After normality tests, an independent sample t test was used to analyze the differences in age, sex, spherical equivalent (SE), intraocular pressure (IOP), axial length (AL), GCIPL and RNFL values between the groups. RESULTS: There were 44 participants in each group. There were 32 (62.5%) men and 12(37.5%) women in smokers and 36 (77.88%) men and 8 (22.22%) women in control group. Mean ages were 39.85 ± 8.41 and 38.66 ± 10.47 years, mean spherical equivalent (SE) values were -0.15 ± 0.4 and 0 ± 0.29 dioptries in smokers and control groups, respectively. The IOP, AXL, GCIPL and RNFL values were 17.58 ± 3.41 mmHg, 23.69 ± 0.56 mm, 84.3 ± 5.83 µm and 92.3 ± 3.51 µm in the smokers group and 18.5 ± 2.91 mmHg, 23.45 ± 0.72 mm, 86.11 ± 8.02 µm and 97.66 ± 8.23 µm in the control group. The inferior, superior, nasal and temporal values of RNFL quadrants were 123.18 ± 26.14, 117.05 ± 5.51, 64.95 ± 8.67 and 63.5 ± 6.88 µm in the smokers group and 130.81 ± 11.8, 123.55 ± 11.03, 72.44 ± 9.84 and 58.44 ± 7.48 µm in the control group. There were no significant difference of age, sex, SE, IOP, AXL and GCIPL values between the smokers and control groups (p > 0.05). The mean RNFL was significantly thinner in the smokers group compared to controls (p = 0.03, independent t test). Inferior and superior quadrants of RNFL decreased in smokers group (p = 0.01 and p = 0.03, respectively) but temporal and nasal quadrants did not seem to be changed (p = 0.96 and p = 0.07, respectively). DISCUSSION: Smoking may affect RNFL thickness but not GCIPL.

Effects of cigarette smoking on choroidal and retinal thickness and ocular pulse amplitude.

BACKGROUND: In our study, we aimed to show the effects of smoking on choroidal thickness and ocular pulse amplitude. It is known that the anatomy and physiologic functions of the choroid is important in ocular diseases like glaucoma and age-related macular degeneration. Choroidal thickness is measured by the spectral domain optical coherence tomography (SD-OCT). The ocular pulse amplitude (OPA) is the difference between the systolic and diastolic intraocular pressure (IOP) and it is an index of choroidal perfusion. DESIGN: This was a cross-sectional prospective observational study at the Turgut Ozal University Hospital setting. PARTICIPANTS: The test subjects were divided into two groups: the smokers group which consisted in 24 participants (20 male, 4 female) and the control group with 22 participants (16 male, 6 female). METHODS: The participants underwent full ophthalmological examination including best-corrected visual acuity (BCVA), spherical equivalent (SE) values of refractive errors, intraocular pressure (IOP), ocular pulse amplitude (OPA), central corneal thickness (CCT), axial length (AL) and choroidal thickness. The IOP and the OPA were measured with the dynamic contour tonometer. The CCT and the AL were measured with the Nidek AL-Scan (Nidek Co., Ltd., Gamagori, Japan). The choroidal thickness was measured by the Cirrus high-definition optical coherence tomography (Cirrus Version 6.0; Carl Zeiss Meditec, Dublin, CA). RESULTS: Gender did not differ significantly between the groups (p = 0.12). The age, SE, IOP, OPA, CCT and AL did not differ significantly in smokers and control groups (p = 0.12, p = 0.37, p = 0.54, p = 0.80, p = 0.56 and p = 0.82, respectively). The nasal, temporal, central retinal (p = 021, p = 021, p = 0.11) and nasal, temporal, central choroidal thicknesses (p = 0.80, p = 0.39, p = 0.75) did not differ significantly between smokers and control groups. CONCLUSIONS: We could not find a significant difference in OPA, retinal and choroidal thicknesses between smokers and non smokers. Further studies including histopathological changes in larger groups are needed to show the effect of smoking on choroidal thickness especially in patients with ocular diseases like age-related macular degeneration.

Brilliant Blue G assisted epiretinal membrane surgery.

We report intensely staining epiretinal membrane (ERM) with Brilliant Blue G (BBG) under air for two minutes. ERM peeling was performed in 21 cases. After removal of posterior hyaloid, 0.2 mL BBG was first applied on the macula, to stain ERM under air conditions for 2 minutes. Internal limiting membrane (ILM) was intensely stained and peeled in all cases following ERM removal. In 4 cases, the ERM was also observed to be intensely stained with BBG and peeled with an ILM forceps. Postoperatively, the ganglion cell layer thickness was lower in three of the cases, however VA improved in all cases and multifocal electroretinogram revealed no toxicity. Light microscopy of ERM revealed masses of cells whereas; the ILM did not. The increased staining characteristics of ERM and ILM may be resulted from longer contact time of BBG under air pressure.