Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography.

AIM: To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and non-diabetic patients with epiretinal membrane (ERM) with the help of optical coherence tomography angiography (OCT-A) and compare them with healthy control subjects. METHODS: In this prospective, cross-sectional study, a total of 165 eyes were evaluated, including 50 eyes of patients with diabetic ERM, 54 eyes of idiopathic ERM (iERM) patients, and 61 eyes of healthy controls. Macula and disc angiography was performed by OCT-A. Macular vessel density (VD) ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region. Statistical calculations were evaluated at the 95% confidence interval. RESULTS: Macula superficial VD values of ERM cases were lower than that in the control group, while foveal VD was higher in ERM cases. Macula deep VD values of ERM cases were lower in all quadrants, except the fovea. The width of the foveal avascular zone (FAZ) area was significantly lower in the ERM groups, and the FAZ width was lowest in iERM group. Macula superficial VD ratio was significantly higher in the ERM groups, but there was no significant difference between ERM groups. Macula deep VD ratio was significantly higher in the iERM group than in the control group. CONCLUSION: Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation, as well as their effect on retinal vascular structures. If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A, then, OCT-A can be used as a guide for ERM prognosis.

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch.

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 µm) when compared to the AFB (450.5 ± 122.6 µm) and RNB (442 ± 116 µm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments.

Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months.

PURPOSE: This study aimed to report the visual and anatomical outcomes of intravitreal anti-VEGF treatment for diabetic macular edema (DME) in a real-world clinical setting from Turkey over 36 months. METHODS: This is a retrospective, multicenter (7 sites) study. The medical records of 1072 eyes (both previously treated and naive eyes) of 706 consecutive patients with visual impairment due to center-involving DME treated with intravitreal anti-VEGF injections between April 2007 and February 2017 were reviewed. The eyes were divided into mutually exclusive three groups based on the duration of follow-up (12, 24, or 36 months). Primary outcome measures were changes in visual acuity (VA) and central macular thickness (CMT) from baseline to final visit in each cohort, frequency of visits and intravitreal anti-VEGF injections. As secondary endpoints, VA outcomes were assessed in subgroups stratified by baseline VA [<70 ETDRS letters and ≥70 ETDRS letters] and loading dose status of anti-VEGF injections. RESULTS: VA increased by a mean of 8.2 letters (12-month cohort, p < 0.001), 5.3 letters (24-month cohort, p < 0.001), and 4.4 letters (36-month cohort, p = 0.017) at final visits. The eyes with <70 VA letters achieved more significant VA improvement at final visits in all cohorts compared with eyes with >70 VA letters (p < 0.001). The mean decreases in CMT from baseline to last visits at 12-, 24-, and 36- month cohorts were -100.5 µm, -107.7 µm, and -114.3 µm, respectively (p < 0.001). The mean number of injections given were 4.6, 2.3, and 1.8 during years 1 to 3, respectively. Patients who received loading dose showed greater VA gains than those who did not in all follow-up cohorts. CONCLUSION: Our study revealed that anti-VEGF treatment improved VA and CMT over a follow-up of 36 months. Although these real-life VA outcomes following anti-VEGF therapy for DME were similar to other real-life studies, they were inferior to those noted in randomized controlled trials, mainly due to undertreatment.

Multifocal Electroretinogram Alterations after Intravitreal Ranibizumab Treatment in Diabetic Macular Edema.

Objectives: To assess multifocal electroretinogram (mf-ERG) values in patients with diabetic macular edema (DME) who were treated with intravitreal ranibizumab (IVR). Methods: Thirty eyes of patients with DME, who underwent three consecutive monthly injections of IVR and as required thereafter, were evaluated. Best corrected visual acuity (BCVA) (log MAR), optical coherence tomography (OCT) features [diameters of cyst and subretinal fluid, hyperreflective dots (HRDs)], and mf-ERG were evaluated at baseline, 1 month, and 6 months throughout the follow-up period. The correlation of mf-ERG values and OCT features, BCVA, and the duration of disease were investigated. Results: In the study group, the baseline P1 and N1 amplitudes were significantly lower than the control group, and P1 and N1 implicit times were significantly higher in patients with DME than in the control group in all rings (All p<0.05) The mean response density (P1 amplitude, nV/deg2) values increased over 6 months in rings 1, 2, and 3 (p<0.001, p=0.003, p=0.006). There was a negative correlation between the diameter of the cyst and the initial response density of P1 (for horizontal diameter: r=-0.658, p=0.03; for vertical diameter: r=-0.597, p=0.037; for the area of the cyst, r=-0.603, p=0.021). There was a significant negative correlation between the subretinal fluid and HRD reduction and the response density of P1 increase (all p<0.05). At baseline and 6 months, the correlation between BCVA and the P1 and N1 amplitude of the central ring was significant (for baseline P1: r=-0.649, p=0.01; for N1: r=-0.575, p=0.02; for 6-month P1, r=-0.603, p<0.001; for N1: r=-0.591, p=0.005). Conclusion: The combination of OCT and mf-ERG can be used to evaluate the functional recovery in DME.

The correlation of hyperopia and choroidal thickness, vessel diameter and area.

OBJECTIVE: This study evaluates the effect of axial length and hyperopia error on macular choroidal thickness as well as choroidal vessel lumen diameter and area with EDI-OCT in short eyes. MATERIALS AND METHODS: The study includes 64 volunteers who are over 18 years of ages and applied to Eye Clinic of Ankara Training and Research Hospital. Choroidal thickness, choroidal vessel lumen diameter and areas were measured with Spectralis® OCT device using EDI technique. RESULTS: The study group included 44 volunteers with hyperopic refractive error, and control group included 20 emmetropic volunteers. Macular choroid was statistically significantly thicker in all quadrants as the hyperopia error increased (p < 0.001). There was a statistically significant negative correlation between axial lengths and macular choroidal thicknesses in all quadrants (p < 0.001). There was a statistically significant difference in choroidal vessel lumen diameter and area between hyperopia groups for both large and small vessels (p < 0.01). The relationships between mean axial length and mean large choroidal vessel diameter and mean area measurements were negatively correlated and they were statistically significant. On the other hand, there was no such negative correlation with small choroidal vessels that have small diameter and area. CONCLUSION: Macular choroid thickens as the hyperopic error increases as well as axial length decreases in short eyes. The diameters and areas of noticeable large choroidal vessels in EDI-OCT also increase. These findings in EDI-OCT measurements may play a role in developing population nomograms, as a correcting parameter and in understanding the pathophysiology of certain diseases in short eyes.

Long-term results of cataract surgery in patients with anterior uveitis.

PURPOSE: This study was aimed to assess the long-term results of phacoemulsification and posterior chamber intraocular lens implantation in patients with anterior uveitis. METHODS: Patients with complicated cataract secondary to anterior uveitis who underwent phacoemulsification and posterior chamber intraocular lens implantation were included in this study. Long-term results and all complications were evaluated throughout the postoperative 4 years. RESULTS: A total of 55 eyes of 48 patients were identified in this study. Cases with anterior uveitis were categorised into four aetiologic groups. Of the 55 eyes, 22 (19 patients) had idiopathic anterior uveitis, 10 (9 patients) had viral anterior uveitis, 10 (9 patients) had Fuchs' anterior uveitis and 13 (11 patients) had anterior uveitis associated with collagen vascular diseases. Preoperative macular oedema was more frequent (63.6%) in the idiopathic group than in the other groups (p < 0.001). The success rates of the best corrected visual acuity of 20/40 or better ranged from 80.0 to 100.0% in the groups. While postoperative increased intraocular pressure rate was statistically significantly higher in the Fuchs' group (p = 0.047), there was no statistically significant difference in other complication rates between the groups. CONCLUSIONS: The long-term outcomes of phacoemulsification with intraocular lens implantation in patients with uveitic cataract were satisfactory with excellent visual acuity and relatively low complication rates.

Primary and secondary implantation of scleral-fixated posterior chamber intraocular lenses in adult patients.

PURPOSE: The purpose of this study is to evaluate and to compare the results of primary and secondary scleral-fixated posterior chamber intraocular lens (PCIOL) implantations in adult patients. MATERIALS AND METHODS: A retrospective analysis of scleral-fixated PCIOLs-implanted during (primary group) or after (secondary group) cataract surgery was performed. The median follow-up time of 96 patients was 6 months (minimum: 6; maximum: 35 months). Outcome measures were indications, corrected distance visual acuity (CDVA), change in visual acuity and complications. RESULTS: A total of 37 patients (38.5%) had primary implantations and 59 (61.5%) had secondary implantations. Penetrating keratoplasty was combined with secondary implantation in 13 cases. The median post-operative CDVA was 0.5 in decimal notation in both groups (P = 0.576). The CDVA improved by at least one Snellen line or remained unchanged in 35 eyes (94.6%) in the primary group and in 52 eyes (88.1%) in the secondary group (P = 0.263). Eyes with CDVA of 0.5 or higher were 62.2% (n = 23) in the primary group and 67.8% (n = 40) in the secondary group post-operatively (P = 0.066). The difference in early and late complications were not statistically significant between groups (P = 0.637, P = 0.154, respectively). Regarding late complications, 30 eyes (81%) in the primary group and 40 eyes (67.9%) in the secondary group had no complications (P = 0.154). CONCLUSION: Both primary and secondary scleral-fixated PCIOL implantations can provide favorable visual outcomes with lower complication rates. An important consideration is the appropriate timing for scleral fixation, taking into account the patient's characteristics and the course of the operation.

Scleral-fixated posterior chamber intraocular lens implantation in pediatric and adult patients.

PURPOSE: To evaluate the results of scleral-fixated posterior chamber intraocular lenses (SFIOL) in pediatric and adult patients. METHODS: We carried out a retrospective analysis of 129 eyes of 120 patients (adult group, n = 96; pediatric group, n = 24) who underwent SFIOL implantation. Outcome measures were indications, corrected distance visual acuity (CDVA), change in visual acuity, and complications. RESULTS: The median follow-up time was six months (minimum: 6; maximum: 55 months). The median preoperative CDVAs were similar between the groups (p = 0,253). The median postoperative CDVA was 0.2 (min: hand motion; max: 0.8) in pediatric patients and 0.5 (min: hand motion; max: 1.0) in adult patients in decimal notation, (p = 0.017). The CDVA improved at least one Snellen line or remained unchanged in all pediatric eyes, and in 87 (90.6%) adult eyes. The change in visual acuity was similar between the groups (p = 0.296). CONCLUSION: In both pediatric and adult patients, SFIOL implantation ends with favorable outcomes over the short term.

Serum lipid profile in diabetic macular edema.

PURPOSE: To evaluate the correlation of lipid profile and clinical presentation of macular edema in Type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS: The study included 20 patients with chronic diabetic macular edema and plaque-like hard exudates (Group 1), 20 patients with diabetic macular edema (Group 2), and 20 DM patients but without retinopathy (Group 3). Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Sample t test was used to evaluate the association between the fasting serum lipid [total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL)], glycosylated hemoglobin (HbA1c), fasting blood glucose, creatinine levels, and the clinical findings. P values <.05 were considered statistically significant. RESULTS: There was no difference between fasting serum lipids and HbA1c levels. Duration of diabetes was shorter in Group 3 than in Groups 1 and 2. Patients in Group 1 had longer duration of diabetes than others (P<.05). Creatinine levels in Group 1 were higher than in other groups (P<.05). Although there was no correlation between fasting blood glucose and HbA1c levels, HbA1c was higher in all three groups from the baseline-normal limits (P<.05). CONCLUSION: No correlation was found between serum lipid levels and macular edema severity, but the duration of diabetes was demonstrated as a significant factor in the progression of macular edema. High HbA1c levels in all patients highlight the importance of intense glycemic control in diabetic patients.

Bilateral leukocoria in infant with afibrinogenemia.

PURPOSE: To report a bilateral leukocoria case in a patient suffering from afibrinogenemia. METHODS: An observational case where congenital afibrinogenemia was presented with bilateral retinal and vitreous hemorrhages that proceeded to vitreoretinal surgery was presented. In addition, complete ophthalmic and radiological examinations and vitreoretinal surgery were performed. RESULTS: Right eye had a complete recovery while the left eye showed serious proliferative vitreoretinopathy and shortened retina. Three years after the surgery clinical examination showed that the right eye was aphacic with an attached retina and clear ocular media while the left eye was phtysic. CONCLUSION: We recommend broad clotting profile for infants suffering from vitreous or retinal hemorrhages with no obvious physical abuse. Our present case furthermore implies that afibrinogenemia can lie beneath the pathogenesis of bilateral leukocoria and should alert physician for the presence of an afibrinogenemia among several types of bleeding predispositions.