Bone Marrow-derived Mesenchymal Stem Cell Therapy in Retinitis Pigmentosa.

BACKGROUND: To determine the effectiveness of bone marrow-derived mesenchymal stem cell therapy on visual acuity and visual field in patients with retinitis pigmentosa. OBJECTIVE: Stem cell treatment in retinitis pigmentosa provides improvement in visual acuity and visual field. METHOD: Forty-seven eyes of 27 patients diagnosed with retinitis pigmentosa were included in our study. Allogeneic bone marrow-derived mesenchymal stem cells were administered by deep subtenon injection. Complete routine ophthalmological examinations, optical coherence tomography (Zeiss, Cirrus HD-OCT) measurements, and visual field (Humphrey perimetry, 30-2) tests were performed on all patients before the treatment and on the 1st, 3rd, and 6th month after treatment. The best corrected visual acuities of the patients were determined by the Snellen chart and converted to logMAR. Visual evoked potential (VEP) and electroretinogram (ERG) examinations of the patients before the treatment and on the 6th month after the treatment were performed (Metrovision) data were compared. RESULTS: Visual acuities were 0.74 ± 0.49 logMAR before treatment and 0.61 ± 0.46 logMAR after treatment. Visual acuity had a statistically significant increase (p < 0.001). The visual field deviation was found to be -27.16 ± 5.77 dB before treatment and -26.59 ± 5.96 dB after treatment (p = 0.005). The ganglion cell layer was 46.26 ± 12.87 µm before treatment and 52.47 ± 12.26 µm after treatment (p = 0.003). There was a significant improvement in Pattern VEP 120º P100 amplitude compared to that before the treatment (4.43 ± 2.42 µV) and that after the treatment (5.09 ± 2.86 µV) (p = 0.013). ERG latency measurements were 18.33 ± 15.39 µV before treatment and 20.87 ± 18.64 µV after treatment for scotopic 0.01 (p = 0.02). ERG latency measurements for scotopic 3.0 were 20.75 ± 26.31 µV before treatment and 23.10 ± 28.60 µV after treatment (p = 0.014). CONCLUSION: Retinitis pigmentosa is a progressive, inherited disease that can result in severe vision loss. In retinitis pigmentosa, the application of bone marrow-derived mesenchymal stem cells by deep subtenon injection has positive effects on visual function. No systemic or ophthalmic side effects were detected in the patients during the 6-month follow-up period.

Mother-child interactions among children with visual impairment: Addressing maternal attachment style, depression-anxiety symptoms, and child's behavioral problems.

OBJECTIVE: The birth of a visually impaired child leads to stress, disappointment, and medical challenges for the family due to the economic and financial costs, unmet expectations of other family members, and social embarrassment-isolation of the family from society. In these families, mothers are exposed to the stressors more often than other family members, because, in most families, they are the primary caregivers. In this study, we examined the relationship between maternal attachment styles, maternal depression and anxiety levels, and behavioral problems of children with visual impairment. METHODS: This is a case-control study. In the study group, there were 35 children with visual impairment, and in the control group, there were 31 healthy children. All mothers completed adult attachment style dimensions scales, beck depression, and anxiety inventories, and the aberrant behaviour checklist. RESULTS: Our results demonstrated that children with visual impairment have higher levels of behavior problems including irritability, stereotypic behavior, and inappropriate speech when compared with healthy controls. Contrary to our expectations depression and anxiety, scores of mothers were similar, also, there was not a difference in terms of maternal attachment types. Interestingly, there was a positive relationship between secure attachment and depression among mothers of the visual impairment group. In other words, securely attached mothers were more depressive. On the other hand, there was a positive relationship between anxious/ambivalent attachment and the child's irritability. CONCLUSION: The relationship between maternal depression and secure attachment could be a consequence of higher maternal sensitivity due to a child's impairment and should be evaluated in future studies.

Evaluation of electrophysiological changes in migraine with visual aura.

PURPOSE: The purpose of this study was to evaluate the electrical responses in the retina and cortex of migraine patients with electrophysiological tests and compare with healthy controls. MATERIALS AND METHODS: This prospective study included 18 migraine patients with visual aura and 28 healthy controls. Pattern-reversal visual evoked potentials (VEP) and flash electroretinography (fERG) of migraine patients during the headache-free period were compared with healthy controls. RESULTS: There were statistically significant differences in VEP results: P100 and N75 amplitudes increased significantly (P = 0.025 and P = 0.007 respectively) and P100 latency decreased significantly in migraine patients (P = 0.022). Furthermore, fERG scotopic combined cone and rod amplitude increased significantly in migraine patients (P = 0.01). CONCLUSION: Migraine brain displays abnormal visual evoked responses in between migraine attacks. In migraine eye, scotopic cone and rod response increased. The results of this study support the hyperexcitability of the retina and cortex in patients with migraine.

Evaluation of migraine patients with optical coherence tomography angiography.

PURPOSE: To compare optical coherence tomography angiography (OCTA) findings in cases with migraine and healthy controls. METHODS: Thirty-eight eyes of 19 patients with migraine with aura and 38 eyes of 19 healthy subjects were enrolled in this prospective and comparative study. All patients and healthy controls were evaluated with OCTA (Triton, Topcon®, Tokyo, Japan). Central macular thickness (CMT), optic disc parameters (such as retinal nerve fibre layer [RNFL] thickness and rim and disc areas), foveal avascular zone (FAZ) and parafoveal superficial vessel density (VD) measurements were analysed. RESULTS: The optic disc rim area was significantly larger in the migraine group compared to the control group (p = 0.009). In OCTA measurements, the FAZ area was significantly larger in migraine patients (p = 0.001). The parafoveal superficial VD measurements were found to be lower in the migraine patients in all quadrants, but not statistically significant. Weak negative correlations were found between superior parafoveal VD and disease duration in migraine patients. CONCLUSION: Migraine with aura was associated with optic disc rim changes, but without any remarkable foveal vascular decrements. It is possible for migraine to cause structural changes due to its chronic nature.

Evaluation of amblyopic eyes with optical coherence tomography angiography and electrophysiological tests.

Purpose: To investigate the structural and functional changes of the retina and optic nerve in amblyopia. Methods: Eighteen patients with unilateral anisometropic amblyopia and 27 age-matched healthy controls were involved in this study. All patients underwent optical coherence tomography angiography (OCTA), pattern visual evoked potential (pVEP), and flash electroretinogram (fERG). Results: There was no statistically significant difference in terms of the foveal avascular zone (FAZ), perifoveal superficial density, whole superficial density, parafoveal deep density, perifoveal deep density among the eyes (P > 0 0.05). Significant differences were found only in superficial capillary plexus (SCP) vessel density in whole (P = 0.029) and parafoveal (P = 0.008) image. In electrophysiological tests, while VEP latencies of the amblyopic eyes increased compared to nonamblyopic eyes and controls (P = 0.027), VEP amplitudes decreased in amblyopic and nonamblyopic eyes compared to controls (P = 0.01), amplitudes of the rod (P = 0.027) and cones (P < 0.001) also decreased in amblyopic eyes compared to nonamblyopic and healthy eyes. When we assessed the correlation between the parameters of OCTA and electrophysiological test, only a significant correlation was found between parafoveal SCP vessel density and VEP amplitudes (r = 0.341). Conclusion: We found a significant decrease only in SCP vessel density of the OCTA parameters in amblyopic eyes compared to healthy eyes. We detected a significant relationship between parafoveal SCP vessel density and VEP parameters, which might be associated with the underlying pathophysiology of the amblyopia.

Optical coherence tomography and neurodegeneration in epilepsy.

PURPOSE: To compare optical coherence tomography measurements; central macular thickness, ganglion cell complex, and retinal nerve fiber layer thickness in patients with epilepsy versus healthy controls. METHODS: We evaluated 28 eyes of 28 patients with epilepsy and 34 eyes of 34 healthy subjects. Central macular thickness, ganglion cell complex, and retinal nerve fiber layer thickness measurements were performed by spectral-domain optical coherence tomography. RESULTS: Superior and superotemporal quadrant ganglion cell complex, average, and superior quadrant retinal nerve fiber layer thickness measurements were significantly lower in epilepsy group compared to healthy control subjects. Central macular thickness was significantly lower in polytherapy group compared to monotherapy group. Ganglion cell complex and retinal nerve fiber layer thickness measurements were not significantly different between polytherapy and monotherapy groups. CONCLUSION: The present study shows that epileptic patients taking antiepileptic drugs have reduced ganglion cell complex and retinal nerve fiber layer thickness compared to healthy controls. This can be related to the epileptic process in the brain. Optical coherence tomography may be a useful tool for showing the neurodegeneration in patients with epilepsy.

Optic Nerve Parameters in Obese Children as Measured by Spectral Domain Optical Coherence Tomography.

PURPOSE: To investigate whether an association exists between obesity and optic nerve parameters. METHODS: This was a prospective comparative study including 125 eyes of 63 obese and 122 eyes of 62 healthy pediatric subjects. Optic nerve measurements were performed using the Cirrus spectral domain optical coherence tomograph (SD-OCT). RESULTS: The disc area, cup volume, mean and vertical C/D ratio, inferior and temporal RNFL thickness values were significantly higher in the control group than the obese group; however, age, sex, mean, superior and nasal RNFL thickness and rim area measurements were not statistically significantly different between the two groups. Age was significantly negatively correlated with temporal RNFL thickness in the obese group. Girls had significantly higher rim area, mean and superior RNFL thickness, and lower cup volume and vertical C/D ratio than boys in the obese group. CONCLUSION: These results could be helpful in the diagnosis and follow-up of obese children.

Analysis of multiple sclerosis patients with electrophysiological and structural tests.

We aimed to analyze the effects of progressive myelin loss and neurodegeneration seen in patients with multiple sclerosis (MS) on visual tract with electrophysiological and structural tests. Fifty-one patients diagnosed with MS in the Neurology Department were followed up in neuro-ophthalmology outpatient clinic irrespective of their visual symptoms, and were included in our study. The patients were classified as the ones with the history of optic neuritis (group II) and ones without the history (group I) of optic neuritis. The data, including clinical presentation, retinal nerve fiber layer thickness (RNFLT) measurements, pattern visual evoked potential (pVEP) and flash electro retino grams (ERG) test results, were recorded. In our study, comparison of pVEP test latencies of groups I and II with each other, and with those of healthy subjects revealed statistically significant differences (p < 0.05). The analysis of rod functions on ERG did not show any significant changes (p > 0.05). However, both groups showed significantly decreased cone b-wave amplitudes, elongation of latencies, and decreased flicker amplitudes on cone and flicker potentials obtained after light adaptation (p < 0.05). There was significant thinning in RNFLT of the both groups when compared to the normal standards. The difference between two groups was statistically significant (p < 0.05). Axon loss is seen in the optic nerve with subclinical or acute optic neuritis in patients with MS. RNFLT analysis and electrophysiological tests are of great importance in diagnosis of MS, as well as to determine progression and to direct neuroprotective therapy in patients diagnosed with MS. Objective analysis methods gain more importance in the diagnosis and follow-up of MS patients, parallel to technological advancements.

Relationship between perceived parenting style with anxiety levels and loneliness in visually impaired children and adolescents

Abstract Background Visual impairment is a risk factor for psychiatric disorders in the affected children and adolescents, but there are only a limited number of studies concerning the mental health characteristics of visually impaired children and adolescents. Objective The aim of this study was to determine levels of loneliness and anxiety in visually impaired children and adolescents, to analyze parenting style perceived by visually impaired children and adolescents, to compare those with typically controls. Methods The study included 40 children and adolescents with visually impairment and 34 control group without visual impairment. Sociodemographic data form, the UCLA loneliness scale, and the State-Trait Anxiety Inventory for Children were used in both groups. The parenting Style Scale was used to determine perceived parental attitudes. Results This study found more loneliness and trait anxiety levels in visually impaired children and adolescents compared to the control group. Authoritative parenting style was the most frequent type of parental attitude in the visually impaired group. In visual impairment group, loneliness level was higher in subgroups of authoritative and permissive-indulgent parenting style. However, level of trait anxiety was higher in authoritative parenting style subgroup compared to the control group. Discussion The results of this study showed higher loneliness and anxiety levels in visually impaired children and adolescents. Further studies are needed to determine psychopathological risks in this population.