The relationship of retinopathy of prematurity with brain-derivated neurotrophic factor, vascular endotelial growth factor-A, endothelial PAD domain protein 1 and nitric oxide synthase 3 gene polymorphisms.

BACKGROUND: In addition to risk factors such as low birth weight and uncontrolled oxygen therapy, genetic predisposition is also thought to play a role in the development of retinopathy of prematurity (ROP). In our study, we aimed to analyze single-nucleotide polymorphisms (SNPs) in VEGFA, EPAS1, BDNF and NOS3 genes in infants who develop ROP. MATERIALS AND METHODS: Seventy-five mild-moderate and 73 severe ROP cases were included in this study. Eleven different SNPs regions that located in VEGFA, EPAS1, BDNF and NOS3 genes were analysed by SnapShot technique and compared between two groups by the multiple logistic regression analysis. RESULTS: Statistically significant results were obtained in 8 of the 11 SNPs. It was observed that the excess of mutant alleles in four (VEGFA rs2010963 and rs3025039, EPAS1 rs13419896, NOS3 rs2070744) of these regions increased ROP severity and treatment requirement (p < .001, p < .001, p = .022, p = .004, respectively) while the excess of mutant alleles in the other four regions (VEGFA rs833061, BDNF rs7929344, EPAS1 rs1867785 and rs1868085) showed that ROP severtiy was milder and eliminated the need for treatment (p < .001, p = .019, p = .017, p = .017, respectively). CONCLUSIONS: Considering the results of our study, it was seen that besides the known environmental and demographic factors in ROP pathogenesis, genetic predisposition also had an effect on the clinic and course of ROP. Polymorphisms of VEGFA rs2010963 and rs3025039, EPAS1 rs13419896, NOS3 rs2070744 were found to be associated with severe ROP. More studies involving different populations cases are needed to confirm these findings and enlighten the etiology of ROP.

Evaluation of Peripheral Retinal Changes on Ultra-Widefield Fundus Autofluorescence Images of Patients with Age-Related Macular Degeneration

Objectives: Age-related macular degeneration (AMD) is the most common cause of central vision loss in individuals aged 65 years and older in developed countries. Earlier imaging systems did not enable visualization of the peripheral retina in diseases affecting the macula. With the introduction of new-generation devices, the peripheral retina is easily visualized. In our study, we aimed to evaluate the incidence of peripheral retinal changes in the color and autofluorescence fundus images of patients with AMD. Materials and Methods: In the study group, 550 eyes of 277 patients who were diagnosed with AMD and 90 eyes of 45 healthy patients in the control group were evaluated. An ultra-wide-angle imaging device was used to record standard 200° color and autofluorescence fovea-centered fundus images followed by superior and inferior fundus images obtained using the device's fixation light. The fundus images were examined in 3 sections: zone 1, zone 2, and zone 3. Results: Evaluation of color fundus images revealed peripheral retinal changes in 67.8% of the 550 AMD eyes and 47.8% of the healthy eyes. Drusen was the most common peripheral retinal change. Evaluation of autofluorescence images revealed peripheral autofluorescence changes in 39.6% of the AMD eyes and 28.9% of the healthy eyes. Hypoautofluorescence was the most common autofluorescence change. Conclusion: Peripheral retinal changes were more common in AMD patients than the control group, indicating that AMD is not only a macular disease, but can affect the entire retina. Future prospective studies will elucidate the relationship between these peripheral retinal changes and patients' genetic features and their importance in prognosis, diagnosis, and treatment.

Coexistence of Peripheral Retinal Diseases with Macular Hole

Objectives: To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole. Materials and Methods: The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskisehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated. Results: Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient. Conclusion: This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.

The Relationship Between Vasoproliferative Tumor and Uveitis in a Multiple Sclerosis Patient: A Case Report and Review of the Literature

Vasoproliferative retinal tumor (VPRT) is a rare, benign lesion with a variable clinical course depending on the individual. Favorable outcomes are obtained with early diagnosis and treatment of patients with VPRT. In this case report, we present a case of concomitant VPRT and multiple sclerosis along with our management of uveitis and secondary glaucoma that presumably developed following cryotherapy for VPRT.

The analysis of posterior segment findings in term and premature infants using RetCam images.

OBJECTIVE: To analyze posterior segment findings in term and premature infants using the RetCam image database. METHODS: RetCam images taken of infants born between January 2012 and December 2015 were reviewed. Group 1 included infants with posterior segment findings other than retinopathy of prematurity (ROP). Group 2 included infants with mild-to-severe ROP. The baseline characteristics, anterior segment findings, and percentage of infants who received treatment were compared among the 2 groups. RESULTS: In total, 331 out of 3440 infants (9.6%) were included. The major diagnoses in group 1 (n = 75) were retinal hemorrhages in 26, optic nerve pathologies in 14, findings associated with a metabolic disease in 6, ocular tumors in 5, persistent hyperplastic primary vitreous in 4, and familial exudative vitreoretinopathy in 4 cases. The mean birth weight (g) (2481.9 ± 700.5 in group 1 vs 1090.5 ± 330.9 in group 2), gestational age (weeks) (35.9 ± 3.4 in group 1 vs 28.2 ± 2.4 in group 2), and postmenstrual age at initial examination (35.9 ± 3.4 in group 1 vs 28.2 ± 2.4 in group 2) were significantly different among the 2 groups (p < 0.001). Thirteen out of 75 cases in group 1 and 124 out of 256 ROP cases received therapy (p < 0.001). Anterior segment pathologies were found in 13.3% of group 1 versus 7.8% of group 2 infants (p = 0.216). CONCLUSIONS: A considerable number of infants suffered from posterior segment disorders other than ROP. The majority of these infants were term babies. Routine fundus screening may be recommended in all newborns to diagnose all posterior segment pathologies other than ROP.

The macular findings on spectral-domain optical coherence tomography in premature infants with or without retinopathy of prematurity.

The purpose of the study was to present spectral-domain optical coherence tomography (OCT) findings in premature infants with or without mild-to-severe retinopathy of prematurity (ROP). Seventy-two infants born <37 weeks of gestation were analyzed, prospectively. Group 1 (n = 18) included infants without ROP. Infants with stage 1, 2, or 3 ROP without indication for treatment formed the second group (n = 15). Group 3 (n = 21) included threshold cases, who would receive laser photocoagulation (LPC) after OCT examinations. Group 4 (n = 18) had already received LPC. The mean central foveal thickness (CFT) (µm) in right eyes was 194.27 ± 19.93, 207.67 ± 25.44, 224.29 ± 21.42, and 222.00 ± 37.80, for groups 1, 2, 3, and 4, respectively (p = 0.01). The presence of a well-formed foveal pit was documented in 60 % of right and 67 % of left eyes in group 1, while a well-formed foveal pit was observed in 14 % of right and 16 % of left eyes in group 3 (p < 0.05). Cystoid macular edema (CME) was shown in 29 % of right and 21 % of left eyes in group 3 (p < 0.05 for right eyes). CME was observed in two of right and left eyes in group 4. Epiretinal membrane (ERM) was shown in one right eye in group 3, two right and four left eyes in group 4 (p < 0.05 for left eyes). Thicker CFT, CME, and failure of a well-formed foveal pit could be related to the severity of ROP. The development of ERM could be the consequence of LPC.

Bilateral Coats' Disease Combined with Retinopathy of Prematurity.

Purpose. To report a case of bilateral Coats' disease combined with retinopathy of prematurity (ROP). Case. Retinal vascularization was complete in the right eye, whereas zone III, stage 3 ROP and preplus disease were observed in the left eye at 43 weeks of postmenstrual age (PMA) in a 31-week premature, 1200-g neonate. Intraretinal exudates developed and retinal hemorrhages increased in the left eye at 51 weeks of PMA. Diode laser photocoagulation (LP) was applied to the left eye. Exudates involved the macula, and telangiectatic changes developed one month following LP. Additional LP was applied to the left eye combined with intravitreal bevacizumab (IVB) injection at 55 weeks of PMA. Disease regressed one month after the additional therapy. At the 14-month examination of the baby, telangiectatic changes and intraretinal exudates were observed in the right eye. Diode LP was applied to the right eye combined with IVB injection. Exudates did not resolve completely, and cryotherapy was applied one month following LP. Retinal findings regressed three months following the cryotherapy. Conclusion. This is the first report of presumed bilateral Coats' disease combined with ROP. If Coats' disease could be diagnosed at early stages, it would be a disease associated with better prognosis.

A rare association of intravitreal bevacizumab injection with double ridge formation in retinopathy of prematurity.

A second anterior ridge formed 8 weeks after therapy in a case of zone II, stage 3 retinopathy of prematurity, which was treated with intravitreal bevacizumab injection alone. The clinical appearance was defined as "double ridge." Retinopathy of prematurity cases treated only with intravitreal bevacizumab injections may progress; therefore, close follow-up is recommended.

The effects of mild-to-severe retinopathy of prematurity on the development of refractive errors and strabismus.

PURPOSE: To investigate the effects of mild-to-severe retinopathy of prematurity (ROP) on refractive state and the incidence of strabismus. MATERIALS AND METHODS: Infants born ≤32 weeks of gestation were prospectively evaluated. Inclusion criteria were a follow-up of at least 6 months and at least stage 1 ROP. Group 1 included stage 1 ROP cases. Cases with stage 2 or 3 ROP without indication for treatment formed the second group. Group 3 included cases who received treatment for ROP. Logistic regression, adjusted for birth weight and gestational age, and multiple comparison tests were used to compare outcomes among groups. RESULTS: The mean follow-up time was 20.9 ± 6.6 months. In the first (n = 21), second (n = 22), and third groups (n = 23), the right spherical equivalents (SE) were 1.17 ± 1.33, -0.18 ± 3.09, and -1.08 ± 4.05 diopters, and the left SEs were 1.23 ± 1.34, -0.09 ± 3.24, and -1.46 ± 4.02 diopters, respectively (p = 0.026 for right SE and 0.008 for left SE). The incidences of anisometropia were 3/21, 4/22, and 11/23 in the first, second, and third groups, respectively (adjusted odds ratios [aOR] for group 3 vs 1 = 5.39, aOR for group 3 vs 2 = 4.06). Strabismus developed in 7/21, 6/22, and 10/23 in groups one, two, and three, respectively (aOR for group 3 vs 1 = 2.06, aOR for group 3 vs 2 = 2.27). Eighteen of these were esotropias. CONCLUSIONS: Refractive errors and strabismus were associated with mild-to-severe ROP. Esotropia was the most frequent type of strabismus.

Chorioretinitis as a first sign of SSPE.

Subacute sclerosing panencephalitis (SSPE) is a progressive neurodegenerative disorder. Ocular involvement in SSPE has been well known and might be seen in 42 to 50% of the patients. Visual findings are generally seen at stage III with neurological abnormalities. Ophthalmologic involvement might be preceding typical SSPE symptoms.

Vision, retinal thickness, and foveal avascular zone size after intravitreal bevacizumab for diabetic macular edema.

INTRODUCTION: To investigate three monthly intravitreal bevacizumab (IVB) injections effects in chronic diabetic macular edema (DME). METHODS: A prospective, noncomparative study in which inclusion criteria were; DME with central macular thickness (CMT) of at least 250 µm, and no treatment for diabetic retinopathy (DR) within 4 months before the first injection. All eyes received three monthly 1.25 mg IVB injections. CMT by optical coherence tomography, visual acuity (VA), foveal avascular zone (FAZ) greatest linear dimension (GLD), and area of FAZ by fundus fluorescein angiography were documented initially and 1 month after last injection. Outcomes (P<0.05 were significant) and correlations (r values) were analyzed. RESULTS: A total of 29 eyes of 29 patients (group 1, 19 female, 10 male), aged 60.7±6.6 years were analyzed. The patients were split into two groups; group 2 included 15 mild-to-moderate nonproliferative DR, and group 3 included 14 more-severe DR. VA gain was significant in all groups (P<0.05). Mean CMT decrease was approximately 46, 36, and 55 µm in groups 1, 2, and 3, respectively (P<0.05 only in group 1). A 0.045-mm2 increase in FAZ area was obtained in group 1 (P<0.05). In group 2, an increase in GLD and area of FAZ was 0.048 mm and 0.058 mm2, respectively (P<0.05), whereas in group 3, FAZ enlargement was nonsignificant. VA and CMT were significantly correlated (r values=0.5-0.6), except for the final VA-final CMT in group 2. FAZ dimensions and other parameters (VA and CMT) were noncorrelated. CONCLUSION: According to the authors' short-term results, three monthly IVB injections can be used for chronic DME regardless of VA, CMT, or FAZ dimensions, despite the FAZ enlargement encountered, especially in cases with milder DR.

Intravitreal bevacizumab following laser therapy for severe retinopathy of prematurity.

Trial of intravitreal bevacizumab injection in 7 eyes of 4 infants with continued retinopathy of prematurity progression despite previous laser therapy was reported. Six of the eyes benefited from the therapy. Intravitreal bevacizumab injection may be an alternative therapy in progressive stage 3 retinopathy of prematurity despite laser photocoagulation.

Retinopathy of prematurity: screening guidelines need to be reevaluated for developing countries.

PURPOSE: Timely screening of premature babies is an important initial step in the management of retinopathy of prematurity (ROP) as earlier treatment results in improved visual prognosis. Screening criteria for ROP currently recommended by the American Academy of Pediatrics may not be applicable in developing countries. The aim of the present study is to find out the incidence of ROP in infants with a gestational age (GA) of > or = 32 weeks in Eskisehir, Turkey, to provide information to assist in determining screening criteria. METHODS: A total of 96 infants with a GA of 32-35 weeks who were referred for ROP between January 1, 2004, and December 31, 2008, were studied. ROP screening, follow-up, and appropriate therapies were applied. RESULTS: During ROP screening, there were 42 of 96 (43.8%) infants with no ROP. A total of 54/96 (56.2%) infants were noted to have ROP. Among all infants, 7 (7.3%) had threshold ROP. Two infants with threshold disease were born at the 32nd, 2 at the 33rd, and 3 at the 34th week of gestation. The mean birthweight was 1857.9 (range 1060-3200) grams. CONCLUSIONS. In our study, it was found that more mature infants may also develop threshold ROP and require early treatment. After more information is gained and widespread screening, screening protocols covering more mature infants can be designed especially for developing countries.

Long-term results of bare sclera, limbal-conjunctival autograft and amniotic membrane graft techniques in primary pterygium excisions.

PURPOSE: To compare the long-term follow-up results of the bare sclera technique (BST), limbal-conjunctival autograft technique (LCAT) and amniotic membrane graft technique (AMGT) in primary pterygium excisions. MATERIALS AND METHODS: In this study, 48 eyes of 48 patients who underwent pterygium surgery using BST (group 1), 63 eyes of 63 patients who underwent pterygium surgery using LCAT (group 2) and 52 eyes of 52 patients who underwent pterygium surgery using AMGT (group 3) were compared with respect to corneal epithelialization, recurrence and complication of the procedures. The mean ages of the groups were 47.88 +/- 14.21 years in group 1, 49.63 +/- 14.42 years in group 2 and 47.92 +/- 15.52 years in group 3. Patients were followed up to 72.39 +/- 11.03 months in group 1, 69.91 +/- 12.41 months in group 2 and 61.43 +/- 9.83 months in group 3. RESULTS: Postoperative corneal epithelialization was completed in 5.62 +/- 1.74 days in group 1, 4.33 +/- 0.91 days in group 2 and 4.79 +/- 1.39 days in group 3. Corneal epithelialization time was earlier in group 2 than in groups 1 (p < 0.01) and 3 (p < 0.05). Recurrences were detected in 19 eyes (39.58%) in group 1, 11 eyes (14.29%) in group 2 and 12 eyes (23.08%) in group 3. The recurrence rate was significantly lower in group 2 than in groups 1 and 3 (p < 0.001). Postoperative complications were not seen in any of the groups. Graft retraction and necrosis were not detected in the LCAT and AMGT groups during the follow-up period. CONCLUSIONS: LCAT was found to be a more effective procedure than BST and AMGT, with decreased recurrence rates after pterygium excision. Limbal-conjunctival autograft seems to be a useful treatment in pterygium surgery due to higher success rates and lower recurrence rates. Amniotic membrane grafts may be an alternative surgical technique for pterygium treatment for patients with or without glaucoma who might need glaucoma surgery in the future.

The surgical treatment of congenital divided nevus of the eyelid: a case report and review of the literature.

We describe a 16-year-old male patient with congenital divided nevus of the eyelids who underwent surgical management using musculocutaneous and tarsoconjunctival flap, and discuss the alternative surgical approaches in the light of the literature. Musculocutaneous flap in conjunction with a tarsoconjunctical flap can be considered as a suitable surgical approach in the management of divided nevus. The patient's age, gender, the diameter of the lesion, and involvement degree of the entire tarsus, must be kept in mind before the surgery. If the surgical treatment method is tailored for the patient, a better cosmesis can be achieved.

The relationship between the breast arterial calcification detected by mammography and the hypertensive retinopathy in hypertensive women.

OBJECTIVE: The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. MATERIALS AND METHODS: Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. RESULTS: Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were > or = 60 years old. CONCLUSION: The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.

The relationship between plasma MMP-9 and TIMP-2 levels and intraocular pressure elevation in diabetic patients after intravitreal triamcinolone injection.

PURPOSE: To find out the relationship between steroid-induced intraocular pressure (IOP) rise and the plasma levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of MMP-2 (TIMP-2) in diabetic patients who underwent intravitreal triamcinolone acetonide (IVTA) injection for the treatment of diabetic macular edema. SUBJECTS AND METHODS: A total of 34 patients with diabetic macular edema who were treated with IVTA and 17 healthy subjects who served as control group for plasma MMP and TIMP levels were participated. Before IVTA treatment, patients and control subjects underwent complete ophthalmologic examination, including best-corrected visual acuity, slit-lamp biomicroscopy, IOP measurement with Goldmann applanation tonometry, and indirect ophthalmoscopy; and peripheral blood samples were collected from each study participants. Plasma levels of MMP-9, TIMP-2, and HbA1c levels were measured. Patients were seen 1, 6, 12, and 24 weeks after treatment and then every 6 months for up to 1 year for probable IOP rise. Patients were divided into 2 groups as having nonproliferative or proliferative diabetic retinopathy. These 2 groups were further classified according to their IOP levels as normal or elevated IOP (>21 mm Hg). RESULTS: The mean age of diabetic group of patients (n=34) and healthy control subjects (n=17) were 57.6+/-10.2 years (range: 22 to 70 y) and 53.1+/-10.3 years (range: 29 to 68 y), respectively. Seventeen (50%) diabetic patients had developed elevated IOP after a mean 2.2 months after IVTA injection. MMP-9 and TIMP-2 levels were found to be significantly higher in the diabetic groups with and without elevated IOP when compared with control group (P<0.001). MMP-9/TIMP-2 did not change significantly among the groups. Logistic regression analysis showed that only higher plasma TIMP-2 levels increase the risk of IOP elevation after IVTA injection in proliferative diabetic retinopathy (odds ratio=1.06, P<0.05). No significant relationship was found between IOP rise and HbA1c levels. CONCLUSIONS: The high levels of TIMP in diabetic patients might have a role on steroid-induced IOP rise. The key pathogenetic events that up-regulate TIMP levels should be investigated in steroid IOP rise in diabetics.