Evaluation of Central and Peripheral Retinal Vascular Changes in the Fellow Eyes of Patients with Unilateral Retinal Vein Occlusions

Objectives: To evaluate the subtle peripheral retinal and macular vascular changes in the fellow eyes of patients with unilateral retinal vein occlusion (RVO). Materials and Methods: This retrospective study included 53 patients with unilateral RVO and 44 age-matched controls. The frequency of peripheral retinal vascular pathologies in both eyes was evaluated using high quality ultra-wide field fluorescein angiography (UWFFA). Macular vascular density, flow area, and foveal avascular zone measurements from optical coherence tomography angiography (OCTA) were analyzed together with laser flare photometry values in patients and controls. Results: Peripheral retinal vascular pathologies were detected on UWFFA in the fellow eyes of 36 (67.9%) patients. No significant central vascular pathologies were detected on OCTA and there was no significant difference in OCTA parameters between the fellow eyes and the controls. Flare values did not differ significantly between the control and the fellow eyes. Conclusion: Two thirds of the fellow eyes of unilateral RVO patients had subtle peripheral retinal vascular changes, while there was no significant microvascular change detected with OCTA in the macula. This suggests that vascular changes caused by systemic vascular disorders probably first start in the peripheral retina of the fellow eyes of patients with RVO.

Surgical Treatment of Bullous Exudative Retinal Detachment Secondary to Atypical Bilateral Central Serous Chorioretinopathy

This study aimed to report the diagnostic process, treatment, and follow-up of a patient with bullous exudative retinal detachment (RD) associated with an atypical variant of bilateral central serous chorioretinopathy (CSCR). A 28-year-old woman was referred to our clinic for total bullous RD in the right eye with a vision level of light perception only. She had been previously diagnosed with idiopathic uveal effusion syndrome and treated with systemic corticosteroid therapy with no response, and was referred to us for scleral window surgery. Four-quadrant scleral window surgery with external drainage of the subretinal fluid was performed, resulting in a transient partial attachment of the retina. RD started to progress again within 3 weeks, which prompted comprehensive imaging together with more advanced systemic workup for systemic lupus erythematosus and other rheumatological and immunological diseases. Systemic corticosteroid therapy was initiated during this period but did not stop the progression and was discontinued after a short time. Fluorescein angiography and indocyanine green angiography revealed multifocal choroidal leakage foci and large choroidal vessels without any intraocular inflammation findings and led to the diagnosis of atypical CSCR. Pars plana vitrectomy (PPV), internal drainage of the subretinal fluid, endolaser to the focal leakage areas, and intravitreal aflibercept injection were performed. Visual acuity increased to 0.8 within 8 months after the surgery with no recurrence. Bullous exudative RD is a very rare and atypical form of CSCR, and a favorable outcome can be obtained with PPV and surgical drainage of subretinal fluid followed by laser photocoagulation.

Bilateral acute Iris transillumination after COVID-19 pneumonia.

PURPOSE: To report the diagnosis, treatment and follow-up of a case of bilateral acute iris transillumination (BAIT) developed after COVID-19 pneumonia. METHOD: Case report. CASE: A 66-year-old male patient with COVID-19 pneumonia received systemic treatments of favipiravir, prednisolone, moxifloxacin and piperacillin-tazobactam during hospitalization. The patient applied to our clinic with the complaint of blurred vision 20 days after the diagnosis of COVID-19. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.5 in the left eye. In the anterior segment examination; ciliary injection, intense pigment dispersion in the anterior chamber, pigment deposits on the lens and iris, 2-3 + cells in the anterior chamber, posterior synechia, and 360 degrees diffuse iris transillumination were observed in both eyes. The pupillary response to light was weak. Bilateral fundus examination were normal. In the anterior chamber sample; HSV, VZV, CMV and Toxoplasma PCR were negative. Bilateral acute iris transillumination (BAIT) diagnosed in the patient and topical 0.1% dexamethasone and topical 1% cyclopentolate were started. In the follow-up, visual acuity increased 1.0 in both eyes, there were no cells in the anterior chamber, and the pigment dispersion was still continuing despite a decrease. CONCLUSION: BAIT, which can usually be seen after upper respiratory tract infections, can also be seen after covid 19 pneumonia and be kept in mind as a possible eye involvement in patients with COVID-19 infection.

Surgical outcomes of posterior persistent fetal vasculature syndrome: cases with tent-shaped and closed funnel-shaped retinal detachment.

BACKGROUND/OBJECTIVES: To determine the role of vitreoretinal surgery (VRS) for two different forms of posterior persistent fetal vasculature syndrome (PFVS); with tent-shaped tractional retinal detachment (TRD) and closed funnel-shaped TRD. SUBJECTS/METHODS: Retrospective, single surgeon, consecutive case series of 52 eyes of 44 patients with posterior PFVS who underwent VRS. Cases were divided into "tent-shaped TRD" and "funnel-shaped TRD" groups based on the preoperative TRD configuration. Associated anomalies, functional and anatomical outcomes were evaluated. The cosmetic appearance was defined as poor if there was phthisis bulbi, gross buphthalmos, or corneal opacification; acceptable if there was apparent leukocoria; and excellent if none were noted at the last follow-up. RESULTS: Thirty eyes of 29 patients presented with tent-shaped TRD; 70% of which obtained counting fingers or better vision and 90% showed significant reversal of tenting achieving retinal reattachment. The cosmetic appearance was excellent in 87%. Two eyes (7%) became phthisic. Twenty-two eyes of 15 patients presented with funnel-shaped TRD and leukocoria; 45% achieved LP vision and 70% of patients with bilateral pathology had LP in at least one eye. The cosmetic appearance was acceptable to excellent in 73%. Three eyes (14%) became phthisic, one (5%) of which required enucleation. The median follow-up time was 16 (6-71) months. CONCLUSIONS: VRS often provides functional vision and anatomy in posterior PFVS with tent-shaped TRD morphology. In the funnel-shaped TRD morphology, where no treatment has historically been recommended, surgery may be considered with an aim of restoring light perception and globe preservation, particularly in bilateral cases.

COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM AT PEDIATRIC AGE: Surgical Versus Conservative Approach.

PURPOSE: To report outcomes of pediatric patients with combined hamartoma of the retina and the retina pigment epithelium followed up conservatively or after pars plana vitrectomy. METHODS: This retrospective multicenter study included 62 eyes of 59 pediatric patients with combined hamartoma of the retina and the retina pigment epithelium from 13 different international centers with an average age of 7.7 ± 4.7 (0.3-17) years at the time of the diagnosis and having undergone pars plana vitrectomy or followed conservatively. At baseline and each visit, visual acuity values, optical coherence tomography for features and central foveal thickness, and tumor location were noted. Lesions were called as Zone 1, if it involves the macular and peripapillary areas, and the others were called as Zone 2 lesions. RESULTS: Twenty-one eyes of 20 patients in the intervention group and 41 eyes of 39 patients in the conservative group were followed for a mean of 36.2 ± 40.4 (6-182) months. Best-corrected visual acuity improved in 11 (68.8%) of 16 eyes in the intervention group and 4 (12.9%) of 31 eyes in the conservative group ( P < 0.001). The mean central foveal thickness decreased from 602.0 ± 164.9 µ m to 451.2 ± 184.3 µ m in the intervention group, while it increased from 709.5 ± 344.2 µ m to 791.0 ± 452.1 µ m in Zone 1 eyes of the conservative group. Posterior location of tumor, irregular configuration of the foveal contour and ellipsoid Zone defect in optical coherence tomography, subretinal exudate and prominent vascular tortuosity were associated with poor visual acuity. CONCLUSION: Vitreoretinal surgery is safe and effective in improving vision and reducing retinal distortion in Zone 1 combined hamartoma of the retina and the retina pigment epithelium in children.

Analysis of corneal biomechanical properties 25 years after myopic photorefractive keratectomy.

PURPOSE: To evaluate corneal biomechanical changes using Corvis ST in patients treated with photorefractive keratectomy (PRK) 25 years ago. METHODS: In this study, 32 post-PRK and 38 normal eyes underwent Corvis ST (CST) assessments. The measured CST factors were: time of highest concavity (HC), time of applanation 1 (AT1), time of applanation 2 (AT2), length of applanation 1 (AL1), length of applanation 2 (AL2), velocity of applanation 1 (AV1), velocity of applanation 2 (AV2), deformation amplitude (DA), peak distance (PD), integrated radius (IR), Ambrosio relational thickness horizontal (ARTh), stiffness parameter at first applanation (SP-A1), DA ratio (2 mm), Belin/Ambrosio enhanced ectasia display (BAD) and corneal biomechanical index (CBI). RESULTS: The mean [± standard deviation (SD)] age was 51.4 ± 7.36 years in PRK, 51.4 ± 3.62 in control group. PRK was performed 24.69 ± 1.78 years ago. ARTh, SP-A1, AT1, AL1, and AL2 were lower in PRK. PD, AT2, DA ratio (2 mm), and IR were statistically higher in PRK (P < 0.01). In PRK and control group the mean value of CBI was 0.91 ± 0.11 and 0.50 ± 0.27 (P < 0.001), and mean value of BAD was 3.34 ± 1.53 and 1.1 ± 0.70 (P < 0.001). In PRK 71.9% of eyes were classed "high risk CBI plus diseased BAD" and 25% remained in the "high risk CBI and normal BAD" group. CONCLUSIONS: In this study, most of the post-PRK eyes which were clinically and topographically normal were classified as "high risk CBI plus diseased BAD" and had significantly worse CBI and BAD values than the control group. This leads to the conclusion that CBI and BAD alone are not appropriate to evaluate post-PRK ectasia.

Correlation of Clinical Aqueous Flare Grading to Semi-Automated Flare Measurements Using Laser Flare Photometry.

PURPOSE: To compare laser flare photometry (LFP) measurements of aqueous flare with Standardization of Uveitis Nomenclature (SUN) and modified SUN grading. METHODS: In this prospective study with multicenter design, uveitis patients were classified according to SUN and modified SUN grading scales. LFP was performed with Kowa FM-700 flaremeter. Mean LFP values were compared with SUN and MSUN scores. RESULTS: The study included 475 LFP measurements, of which 216, 48, 150, 31, 28 and 2 had 0, 0.5+, 1+, 1.5+, 2+ and 3+ flare, respectively. LFP values were significantly different between each two consecutive steps for both clinical gradings (all P < .05). Cut-off values for modified SUN grading steps were defined as 5.7, 9.7, 15.7 and 43.2 for 0/0.5+, 0.5+/ 1+, 1+/1.5+ and 1.5/2+ borders of clinical flare, respectively. CONCLUSIONS: LFP proves to be an objective measurement in analyzing aqueous flare comparable to both SUN and MSUN clinical grading systems.

Effect of Fundus Fluorescein Angiography on Semiautomated Aqueous Flare Measurements.

PURPOSE: To evaluate the effects of fluorescein fundus angiography (FFA) on semiautomated aqueous flare measurements. METHODS: Laser flare photometer (LFP) measurements was performed at baseline, 30 min, and 4 h after the intravenous administration of sodium fluorescein dye. FFA was performed immediately after the baseline LFP measurement. LFP values at 30 min and 4 h after FFA were compared to baseline values. Mean change in LFP measurements at 30 min and 4 hafter baseline was compared between FFA arm and controls. RESULTS: The mean flare measurement in the FFA and control arm dropped 6% (p value = 0.002) and 9% (p value = 0.04), respectively. Mean change in LFP measurement at 30 min and 4 h after baseline was not significant between FFA arm and controls. CONCLUSIONS: Administration of fluorescein dye does not increase LFP values. The decrease in the LFP measurement following FFA may be attributed to dilation drops.

Transepithelial Diluted Alcohol and Iontophoresis-Assisted Corneal Crosslinking for Progressive Keratoconus in Adults: 4-Year Clinical Results.

PURPOSE: The aim of this study was to compare the 4-year clinical outcomes of transepithelial diluted alcohol and iontophoresis-assisted corneal crosslinking (DAI-CXL) and standard corneal crosslinking (S-CXL) in adults with progressive keratoconus. METHODS: This retrospective study included 36 eyes of 36 keratoconic patients who underwent DAI-CXL (n = 18) or S-CXL (n = 18). Best spectacle-corrected visual acuity (BSCVA) and corneal topography parameters were analyzed at baseline and at 1, 2, 3, and 4 years of follow-up. Corneal demarcation line depth (DLD) at 1 month was measured, and the relation of DLD with corneal thickness (DL%) was assessed. RESULTS: BSCVA improved significantly only in S-CXL (P = 0.01). A significant decrease in maximum keratometry and mean keratometry occurred at 4 years in both groups (all P < 0.05), and these changes were similar in both groups (all P > 0.05). There was a significant reduction in the thinnest corneal thickness in S-CXL (P = 0.01); however, the mean thinnest corneal thickness in DAI-CXL remained stable (P = 0.094). Higher-order aberrations and coma aberration decreased significantly in both groups at 4 years (all P < 0.05), with a higher decrease in S-CXL (all P < 0.05). Spherical aberration showed a significant reduction only in S-CXL (P = 0.005). In contrast to the similar mean DLD in both groups, DL% in DAI-CXL was significantly greater than that in S-CXL (P = 0.032). There were no correlations between the improvement in BSCVA, maximum keratometry, mean keratometry, higher-order aberrations, and the mean DLD and DL% (all P > 0.05). CONCLUSIONS: DAI-CXL was as effective as S-CXL in arresting the progression of keratoconus and showed similar clinical results to S-CXL at the 4-year follow-up.

Silicone Oil Droplets in the Schlemm's Canal: A Surprise during Prolene Hemi-gonioscopy-assisted Transluminal Trabeculotomy (Hemi-GATT).

AIM AND OBJECTIVE: To report a case with emulsified silicone oil (SO) droplets in the Schlemm's canal (SC), encountered during prolene hemi-gonioscopy-assisted transluminal trabeculotomy (hemi-GATT). BACKGROUND: In cases with a history of previous pars plana vitrectomy (PPV) with SO tamponade and then SO removal; glaucoma might occur secondary to the presence of emulsified SO droplets. Minimal invasive glaucoma surgeries targeting trabecular meshwork such as GATT surgery might be an ideal treatment option in these cases. CASE DESCRIPTION: A 57-year-old man presented with uncontrolled intraocular pressure (IOP) and topical anti-glaucoma drug intolerance in his left eye. The patient had a history of PPV with SO tamponade and then intravitreal SO removal 5 years ago. He had a history of Ahmed glaucoma valve (AGV) implantation 2 years ago for the treatment of secondary glaucoma but he was still using topical anti-glaucoma medication. However, IOP was measured as 17 in the left eye. Hemi-gonioscopy-assisted transluminal trabeculotomy was performed successfully to get the patient off medication. During the surgery, SC was full of SO droplets. CONCLUSION: The presence of SO droplets in the SC might contribute to the development of secondary glaucoma after PPV and SO removal. This might be another surgical indication for GATT surgery in these risky eyes. HOW TO CITE THIS ARTICLE: Aktas Z, Bölük CE, Gurelik G. Silicone Oil Droplets in the Schlemm's Canal: A Surprise during Prolene Hemi-gonioscopy-assisted Transluminal Trabeculotomy (Hemi-GATT). J Curr Glaucoma Pract 2021;15(1):40-43.

Optical coherence tomography angiography markers associated with treatment response in neovascular age-related macular degeneration.

PURPOSE: To investigate whether qualitative and quantitative features of choroidal neovascular membranes are associated with anti-vascular endothelial growth factor treatment response in patients with neovascular age-related macular degeneration. METHODS: A total of 41 eyes were included in this cross-sectional observational study and divided into "good responders" and "poor responders" based on the long-term functional changes, frequency of recurrent choroidal neovascular activity, and injection need. Enface optical coherence tomography angiography images were obtained and qualitative features of choroidal neovascular membranes were described based on vessel network density. Then, quantitative measurements including vessel area, vessel length, junction density, and lacunarity were calculated using validated software (ImageJ and AngioTool). Chi-square tests, t-test, or Mann-Whitney U tests were used for group comparisons, and intraclass correlation coefficients were calculated for reliability assessment of quantitative analyses. RESULTS: Twenty-two eyes treated by a median of 9 (3-24) anti-vascular endothelial growth factor injections at a median follow-up of 41 (12-89) months were categorized as good responders, 19 treated by a median of 26 (11-46) injections at a median follow-up of 44.5 (12-84) months as poor responders. Good responder group mostly had loose network (45.5%), and poor responders mostly had dense network (47.7%). The difference was not statistically significant (p = 0.25). The size of the lesion was 2.7 times greater at baseline (p = 0.04) and 1.7 times greater at final examination in the poor responder group (p = 0.04). Lacunarity index, showing lesion heterogeneity, was higher in good responders (p = 0.018) than poor responders. Other quantitative vascular features did not significantly differ between the groups (p > 0.05). CONCLUSION: Long-term remodeling of chronically treated choroidal neovascular may be non-invasively and reproducibly investigated using optical coherence tomography angiography. Quantitative analysis and lacunarity index, in particular, may be used as a measure of vessel maturation and guide treatment strategies in neovascular age-related macular degeneration.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments.

PURPOSE: To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). METHODS: The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. SURGICAL TECHNIQUE: After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. RESULTS: The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. CONCLUSION: Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.

Sustained Elevation of Intraocular Pressure After Administration of Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Patients With and Without Pseudoexfoliation Syndrome.

PRéCIS:: Intravitreal anti-vascular endothelial growth factor therapy resulted in sustained elevation of intraocular pressure (IOP) in 18.6% of patients with coexisting age-related macular degeneration and pseudoexfoliation (PXF) syndrome. The development of sustained elevation of IOP after ~19 injections reflected the cumulative effect of anti-vascular endothelial growth factor injections on IOP. PURPOSE: The purpose of this study was to compare the long-term effect of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) therapies on IOP in patients with and without PXF syndrome. DESIGN: This was a retrospective comparative study. PATIENTS AND METHODS: Data from 412 eyes of 206 patients diagnosed with unilateral neovascular age-related macular degeneration, treated with IVR or IVB, and followed-up for at least 6 months, were retrospectively reviewed. Seventy treated and 70 untreated fellow eyes of 70 patients with bilateral PXF syndrome, and 136 treated and 136 untreated fellow eyes of 136 patients without PXF syndrome were included in this study. Demographic information, clinical findings, total number of IVR and IVB injections, and IOP values at each visit were recorded. Sustained elevation of IOP (SE-IOP) was defined as either an IOP >21 mm Hg or a ≥5 mm Hg increase in IOP from baseline for at least 2 consecutive visits. Baseline and final IOP values in each group were compared using the paired sample t test, and IOP changes in the groups were compared using split-plot analysis of variance. Multivariate logistic regression analysis was used to evaluate the influence of variables on the development of SE-IOP. RESULTS: The mean (±SD) age of the patients was 77.53±3.78 years (range, 70 to 83 y), and the mean follow-up was 28.50±16.51 months (range, 6 to 58 mo). The mean number of injections was 15.56±8.01 (range, 5 to 36). The mean baseline and final IOP in treated eyes were 14.82±3.08 and 16.50±3.11 mm Hg, respectively (P<0.001). A higher incidence of SE-IOP and higher final IOP values were observed in PXF-positive eyes receiving IVB compared with the other groups. Seven of the patients required antiglaucomatous treatment. Multivariate logistic regression analysis revealed an increased odds ratio (4.90; P=0.016) of SE-IOP in PXF-positive eyes compared with PXF-negative eyes. CONCLUSION: IVB therapy may cause greater increases in IOP in patients with PXF syndrome. The co-accumulation of PXF material and bevacizumab particles on the trabecular meshwork should be further investigated.

Intravitreal Dexamethasone Implant in the Treatment of Non-infectious Uveitis

Objectives: To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis. Materials and Methods: The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively. Results: Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet's uveitis. (17 patients, 27.4%) The most common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 µm at baseline to 288, 311, and 302 µm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up. Conclusion: Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.

Evaluation of Long-Term Corneal Morphology After Photorefractive Keratectomy by In Vivo Confocal Microscopy and Specular Microscopy; 20-Year Follow-Up.

PURPOSE: To evaluate long-term corneal morphological changes after photorefractive keratectomy (PRK) using in vivo confocal microscopy (IVCM) and specular microscopy. METHODS: This comparative case-control study included 16 eyes of 8 patients who underwent PRK for mild to moderate myopia 20 years ago and 30 eyes of 15 sex- and age-matched healthy controls. Corneal epithelial cells, sub-basal nerves, keratocytes (anterior, midstromal, and posterior), and endothelial cells were evaluated in both groups 10 and 20 years after surgery. Long-term visual outcomes were also recorded. RESULTS: In vivo confocal microscopy examination revealed similar epithelial morphology, sub-basal nerve fiber morphology/density, mid/posterior stromal keratocyte density, and endothelial cell density between PRK patients and controls at their 10th and 20th year follow-up. Anterior stromal keratocyte density was lower at 10th year; however, it reached to control group value at 20th year follow-up. Extracellular matrix reflectivity was slightly higher, and there was a trace subepithelial corneal haze in PRK group (milder in 20th year than 10th year) compared with controls. At the 20th year, uncorrected distance visual acuity was 20/20 or more in 6 eyes (37.5%), 20/40 or more in 16 eyes (100%), and all eyes had corrected distance visual acuity of 20/20 or better (spherical equivalent -0.31±0.37 D). CONCLUSIONS: Photorefractive keratectomy in low to moderate myopia seems to be safe and effective method in the long term with preserving corneal morphology (including anterior stromal keratocyte and sub-basal nerve fiber density) and refractive outcomes as shown in this study. In appropriate patients, this method can be considered confidently.

Choroidal thickness in macular holes.

PURPOSE: To determine the association between choroidal thickness (CT) and anatomic success in closed and open macular holes (MHs) following surgery. METHODS: One hundred and thirty-six eyes of 136 patients who underwent surgery due to primary MH were included in this study. Choroidal thickness was measured from various points (subfoveal, temporal, nasal, superior and inferior 1500 µm from the center of the fovea) in both eyes with MH and fellow eyes. We determined associations among the duration of symptoms, MH dimensions and CTs from various points with anatomic success and correlations between CT and MH dimensions and duration of symptoms. RESULTS: Choroidal thickness was significantly lower in eyes with MH than fellow eyes in both open and closed MHs. Base diameter [p = 0.025, odds ratio (OR) = 0.428], minimum hole diameter (p = 0.030, OR = 0.211) and duration of symptoms [p = 0.034, OR = 0.443] were significantly associated with anatomic success. However, CTs from various points were not associated with anatomic success despite a significant preoperative subfoveal CT difference between open and closed MHs (198 ± 21 µm in open MHs and 230 ± 30 µm in closed MHs; p < 0.001). Preoperative subfoveal CT was moderately correlated with base diameter (r = - 0.505, p < 0.001), minimum hole diameter (r = - 0.518, p < 0.001) and duration of symptoms (r = - 0.510, p < 0.001). CONCLUSIONS: Failed MHs were associated with larger hole dimensions (base diameter and minimum hole diameter) and longer duration of symptoms. Preoperative subfoveal CT was thinner in open MHs, but there was no association with anatomic success. Choroidal thinning may be linked to larger and chronic MHs.

A Novel Surgical Method to Treat Chronic Ocular Hypotony.

BACKGROUND AND OBJECTIVES: To assess the effect of a novel surgical method for the treatment of chronic ocular hypotony (COH). The surgical method involves partially blocking the iridocorneal angle and decreasing aqueous humor outflow. A capsular tension ring (CTR) is placed in the iridocorneal angle. PATIENTS AND METHODS: Thirteen eyes of 13 patients were included in this retrospective, interventional case series. All of the eyes had severe ocular hypotony with a diagnosis of hypotony after vitreoretinal surgery or glaucoma filtration surgery. A CTR was placed in the iridocorneal angle via a corneal incision. The follow-up period was at least 1 year. Main outcome measurement was intraocular pressure (IOP). RESULTS: IOP increased in all of the eyes. The increase in IOP persisted during the follow-up period. Visual acuity increased or stabilized in all of the eyes. No ocular complications were noted due to the procedure. CONCLUSIONS: The authors have described a novel and simple technique for the setting of IOP in COH. Mechanical obstruction of aqueous humor outflow with a CTR can increase IOP and stabilize or improve vision in eyes with COH for a follow-up time longer than 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e56-e60.].

Single-Nucleotide Polymorphisms in IL23R-IL12RB2 (rs1495965) Are Highly Prevalent in Patients with Behcet's Uveitis and Vary Between Populations.

Purpose: To test the frequency of single-nucleotide polymorphisms in the IL-10, IL23R-IL12RB2 genes in patients with Behcet's uveitis. Methods: Blood samples were collected from 89 Israeli and Turkish patients, and from healthy control subjects of different origins. Genomic DNA was extracted from peripheral blood leukocytes and genotyped. Results: The risk allele, A, in rs1800871, of IL-10 gene was highly prevalent in Behcet's uveitis and healthy control samples alike; highest among the Turkish groups. Prevalence of G allele, in rs1495965, in the IL23R-IL12RB2 gene was high in Behcet's uveitis patients, and among healthy Turkish and Israelis of Middle Eastern origin, while lower among the other Israeli control group (77.9%, 78.9%, 27.8%, respectively, P < 0.001). Conclusion: Our findings highlight the differences between populations and may account for the increased prevalence of the disease among Turkish and Israelis of Middle Eastern origin. Further studies are required to map other healthy and affected populations.

Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

Objectives: To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyes. Materials and Methods: Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded. Results: Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 µm at baseline to 310, 368±34 and 375 µm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections. Conclusion: Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

Argon laser-assisted hypotony model in the rabbit.

To investigate whether ocular hypotony formation with 360 degrees endocyclophotocoagulation is possible. Twelve male New Zealand White rabbits were used. Entire ciliary body epithelium was destructed with green laser photocoagulation after pars plana lensectomy and anterior vitrectomy in six rabbits. Endocyclophotocoagulation was not performed to the remaining six rabbits (control group). Intraocular pressure (IOP) was measured preoperatively and followed up everyday in the first week and weekly until the end of month one. All of the rabbits were sacrificed and ciliary bodies were left for gross and light microscopic examination. Mean baseline IOPs were similar in laser and non-laser group (14.8 ± 1.4 (range 12.2-17.3) vs 14.4 ± 1.4 (range 12.2-15.9), p = 0.650). Mean IOP was 6.6 ± 0.45 mmHg (range 5.9-7.1) in the laser group and 11.5 ± 1.2 mmHg (range 10.2-13.4) in the non-laser group in postoperative day 1. IOP was below 4 mmHg in all eyes on the second day and after in laser group. In the macroscopic evaluation, the entire ciliary body had a white (loss of pigmentation) and atrophic appearance in all of the eyes in the laser-treated group compared to non-laser group. In the laser group, light microscopic examination demonstrated a severe 360 degrees disruption of ciliary processes. Ciliary processes were covered with fibrin exudation consisting of fibroblasts. There was a mild inflammation with disruption or atrophy of ciliary body epithelium with cystic vacuolar degeneration. Three hundred sixty degrees endocyclophotocoagulation yielded severe ciliary epithelium damage. IOP reduction started very early and continued in hypotonic levels during follow up period.