Non-damaging retinal laser therapy in chronic central serous chorioretinopathy.

PURPOSE: To investigate the functional and anatomical outcomes of non-damaging retinal laser therapy (NRT), in cases with chronic central serous chorioretinopathy (CSCR). METHODS: Twenty-three eyes of 23 treatment-naïve chronic CSCR patients were included in this study. The irradiation of 577 nm yellow light was conducted on the serous detachment area after switching over to the NRT algorithm. Anatomical and functional changes after treatments were investigated. RESULTS: The mean age of the subjects was 48.68 ± 5.93 years (41-61). The mean best-corrected visual acuity (BCVA) and the mean central macular thickness (CMT) values were 0.42 ± 0.12logMAR (0.20-0.70) and 315.69 ± 61.25 µm (223-444) before NRT; and 0.28 ± 0.11logMAR (0.10-0.50) and 223.26 ± 60.91 µm (134-336) at the 2nd month follow-up visit (p < 0.001, for both). At the 2nd-month follow-up visit after NRT, complete resorption of subretinal fluid was observed in 18 eyes (78.3%) and incomplete resorption in five eyes (21.7%). Worse values of BCVA and CMT before NRT were found as increased risk for incomplete resorption (p = 0.002 and ρ = 0.612 for BCVA, and p < 0.001 and ρ = 0.715 for CMT). CONCLUSION: Significant functional and anatomical improvements can be observed in the early period after NRT in patients with chronic CSCR. Patients having worse baseline BCVA and CMT have increased risk for incomplete resorption.

Effects of the epiretinal membrane on the outcomes of intravitreal dexamethasone implantation for macular edema secondary to branch retinal vein occlusion / Os efeitos de uma membrana epirretiniana nos resultados da implantação de dexametasona intravítrea para edema macular secundário à oclusão de ramo da veia retiniana

ABSTRACT Purpose: To investigate the effects of epiretinal membrane formation on the clinical outcomes of intravitreal dexamethasone implantation for macular edema secondary to branch retinal vein occlusion. Methods: This retrospective interventional case series includes the treatment of naive patients with macular edema secondary to non-ischemic branch retinal vein occlusion who underwent intravitreal dexamethasone implantation. The patients were divided into two groups as follows: Group 1 (n=25), comprised of patients with macular edema secondary to branch retinal vein occlusion without epiretinal membrane, and Group 2 (n=16), comprised of patients with macular edema secondary to branch retinal vein occlusion with an epiretinal membrane. Corrected visual acuity, central macular thickness, and central macular volume values were measured before and after treatment. The clinical outcomes of the groups were compared. Results: Mean age and male-to-female ratio were similar between the two groups (p>0.05, for both). The baseline and final corrected visual acuity values, central macular thickness, and central macular volumes of the groups were similar (p>0.05, for all). All the parameters were significantly improved after intravitreal dexamethasone implantation treatment (p<0.001, for all). The changes in central macular thickness and volume were also similar (p>0.05, for both). The mean number of intravitreal dexamethasone implantations was 2.1 ± 1.0 (range, 1-4) in Group 1 and 3.0 ± 1.2 (range, 1-5) in Group 2 (p=0.043). Conclusion: Epiretinal membrane formation had no effects on the baseline and final clinical parameters, including corrected visual acuity and central macular thickness and volume. The only parameter affected by the presence of epiretinal membrane formation is the number of intravitreal dexamethasone implantations, a greater number of which is needed for macular edema secondary to branch retinal vein occlusion with an epiretinal membrane.

RESUMO Objetivo: Investigar os efeitos da formação de uma membrana epirretiniana nos resultados clínicos da implantação intravítrea de dexametasona para edema macular secundário à oclusão de um ramo da veia retiniana. Métodos: Esta série retrospectiva de casos intervencionais inclui o tratamento de indivíduos com edema macular secundário à oclusão não isquêmica de um ramo da veia retiniana, sem tratamento prévio e que foram submetidos a implantação intravítrea de dexametasona. Os indivíduos foram divididos em dois grupos: Grupo 1 (n=25), composto por indivíduos com edema macular secundário à oclusão de um ramo da veia retiniana sem a presença de uma membrana epirretiniana, e Grupo 2 (n=16), composto por indivíduos com edema macular secundário à oclusão de um ramo da veia retiniana com a presença de uma membrana epirretiniana. Os valores da acuidade visual corrigida, espessura macular central e volume macular central foram obtidos antes e após o tratamento. Os resultados clínicos dos grupos foram comparados. Resultados: A média de idade e a proporção entre homens e mulheres foram semelhantes nos dois grupos (p>0,05 para ambos os valores). Os valores iniciais e finais da acuidade visual corrigida, espessura macular central e volume macular central foram semelhantes nos dois grupos (p>0,05 para todos os valores). Todos os parâmetros melhoraram significativamente após o tratamento com implante de dexametasona intravítrea (p<0,001 para todos os parâmetros) e as alterações na espessura macular central e no volume macular central também foram semelhantes (p>0,05 para ambos os valores). O número médio de implantações intravítreas de dexametasona foi 2,1 ± 1,0 (faixa de 1-4) no Grupo 1 e 3,0 ± 1,2 (faixa de 1-5) no Grupo 2 (p=0,043). Conclusão: A formação de uma membrana epirretiniana não tem efeitos sobre os parâmetros clínicos iniciais e finais, incluindo a acuidade visual corrigida, a espessura macular central e o volume macular central. O único parâmetro afetado pela formação de uma membrana epirretiniana é o número de implantações intravítreas de dexametasona, sendo necessário um número maior de implantações em casos de edema macular secundário à oclusão de um ramo da veia retiniana com a presença de uma membrana epirretiniana.

Long-term Outcomes of Submacular Perfluorocarbon Liquid Removal with Internal Limiting Membrane Peeling and Transretinal Aspiration.

BACKGROUND: An important complication associated with perfluorocarbon liquid (PFCL) use during pars plana vitrectomy (PPV) is its retention in the submacular area. The aim of this study was to present the long-term outcomes of the surgical method used in this study to remove submacular PFCL and to shed light on the advantages and disadvantages compared to other methods. MATERIAL AND METHODS: This is a retrospective, single-center, observational study. Patients who underwent surgical intervention due to submacular PFCL were included in this study. The surgical procedural includes internal limiting membrane (ILM) peeling, transretinal aspiration of submacular PCFL with a 25/27-gauge soft-tipped cannula, then perfluoropropane (C3F8) gas tamponade, and facedown positioning for 5 days. The long-term anatomical and functional outcomes were evaluated with an ophthalmological examination and optical coherence tomography (OCT). OUTCOMES: A total of 15 patients with submacular PFCL were included in this study, and the mean age of the patients was 64.33 ± 10.36 years (47 - 83). The localization of submacular PFCL was subfoveal in nine patients (60.00%), non-subfoveal in four patients (26.67%), and both subfoveal and non-subfoveal in two patients (13.33%). The mean time of submacular PFCL diagnosis was 4.86 ± 1.02 weeks (2 - 8) and the mean time of the surgery was 9.80 ± 1.17 weeks (8 - 14). Complete removal of submacular PFCL was achieved in all cases (100%) and no significant treatment-associated complications were observed. The mean follow-up time was 37.60 ± 14.00 months (18 - 60) and the best-corrected visual acuity was significantly improved (p = 0.001). At the end of the follow-up time, prominent ellipsoid zone disruption was observed in six patients (40.00%), while in nine patients (60.00%), there was no prominent ellipsoid zone disruption. CONCLUSIONS: The surgical procedural for submacular PFCL removal is a reasonable option and improves visual acuity in the long term without any significant treatment-associated complications.

Effects of the epiretinal membrane on the outcomes of intravitreal dexamethasone implantation for macular edema secondary to branch retinal vein occlusion.

PURPOSE: To investigate the effects of epiretinal membrane formation on the clinical outcomes of intravitreal dexamethasone implantation for macular edema secondary to branch retinal vein occlusion. METHODS: This retrospective interventional case series includes the treatment of naive patients with macular edema secondary to non-ischemic branch retinal vein occlusion who underwent intravitreal dexamethasone implantation. The patients were divided into two groups as follows: Group 1 (n=25), comprised of patients with macular edema secondary to branch retinal vein occlusion without epiretinal membrane, and Group 2 (n=16), comprised of patients with macular edema secondary to branch retinal vein occlusion with an epiretinal membrane. Corrected visual acuity, central macular thickness, and central macular volume values were measured before and after treatment. The clinical outcomes of the groups were compared. RESULTS: Mean age and male-to-female ratio were similar between the two groups (p>0.05, for both). The baseline and final corrected visual acuity values, central macular thickness, and central macular volumes of the groups were similar (p>0.05, for all). All the parameters were significantly improved after intravitreal dexamethasone implantation treatment (p<0.001, for all). The changes in central macular thickness and volume were also similar (p>0.05, for both). The mean number of intravitreal dexamethasone implantations was 2.1 ± 1.0 (range, 1-4) in Group 1 and 3.0 ± 1.2 (range, 1-5) in Group 2 (p=0.043). CONCLUSION: Epiretinal membrane formation had no effects on the baseline and final clinical parameters, including corrected visual acuity and central macular thickness and volume. The only parameter affected by the presence of epiretinal membrane formation is the number of intravitreal dexamethasone implantations, a greater number of which is needed for macular edema secondary to branch retinal vein occlusion with an epiretinal membrane.

Cumulative dissipated energy in eyes with and without corneal opacity.

Objective: To compare ultrasonic energy delivered into the eye [cumulative dissipated energy, (CDE)] and frequencies of required auxiliary surgical methods during phacoemulsification surgery in eyes with and without corneal opacity. Methods: The study was designed as a retrospective comparative observational study. The study group [Corneal Opacity Group, (COG)] was comprised of 31 eyes of 31 cataract patients with corneal opacity. Only nebular and macular corneal opacities (according to slit-lamp based classification of Agrawal) were included in the study. The control group (CG) was comprised of 40 eyes of 40 cataract patients without corneal opacity. The CDE values were obtained using the Centurion system (Alcon, Fort Worth, TX) and the patients were followed-up postoperatively for a period of one month. Results: The mean age of the subjects was 71.46 ± 8.86 years (52-89) in COG and 66.12 ± 5.96 years (55-80) in CG (p >0.05). In COG, the most common etiologic factors were trauma, keratitis, and degenerative diseases. The mean CDE value was 15.16 ± 8.71 (2.20-42.65) in COG and 10.04 ± 6.28 (3.77-31.80) in CG and it was found as significantly higher in COG (p=0.003). Some auxiliary surgical methods including posterior synechiolysis and anterior capsule staining were more commonly performed in COG (p=0.044 and p=0.040, respectively). No intraoperative or postoperative complication was observed. Conclusion: More ultrasonic energy is delivered into the eye and more auxiliary surgical methods are needed in cataract patients with corneal opacity who underwent phacoemulsification. Abbreviations: CDE = Cumulative dissipated energy, COG = Corneal Opacity Group, CG = Control group, IOL = Intraocular lens, LOCS = Lens Opacities Classification System, BCVA = best-corrected visual acuity, SRK/T = Sanders, Retzlaff, and Kraff theoretical, OVD = ophthalmic viscosurgical device, SPSS = Statistical Package for the Social Sciences.

The Effect of ChromaGen Contact Lenses on Corneal Clarity: A Corneal Densitometry.

Objectives: The purpose of this study is to investigate the effect of ChromaGen contact lens (CCL) on corneal clarity, expressed through the measurement of corneal densitometry (CD) values. Methods: This study included 22 eyes of 22 patients with congenital red-green color vision deficiency who were admitted to our clinic for the CCL trial. After a detailed ophthalmological examination and CD measurement with Pentacam HR (Oculus Optikgerate GmbH, Wetzlar, Germany), the most appropriate CCLs were defined through pseudoisochromatic plates and inserted for 2 h. The CD measurement was repeated after the removal of the CCL. Comparison was made of CD values before and after the insertion of the most appropriate CCL. The after-CCL/before-CCL ratio was calculated, and the effect of CCL type on this ratio was investigated. Results: The after-CCL values were higher in the anterior, central, posterior, and total thickness of the 0-2 mm concentric zone (p=0.044, p=0.040, p=0.021, and p=0.032, respectively) when compared to the before-CCL values. There was no statistically significant difference between before-CCL and after-CCL values in any layer of the 2-6, 6-10, and 10-12 mm concentric zones (p>0.05, for all). After-CCL/before-CCL ratios were similar in the Magenta2 (M2), Magenta3 (M3), and Violet3 (V3) types of CCLs (p>0.017). Conclusion: Usage for 2 h of CCL was observed to increase CD values in all layers of the 0-2 mm concentric zone irrespective of the type of CCL. Further studies with longer follow-up are required to determine the long-term effects and detect differing effects of CCL with different base curves.

Conjunctival Histopathological Changes in Children With Vitamin D Deficiency.

PURPOSE: The aim of this study was to investigate tear function-associated clinical findings and conjunctival histopathological changes in children with vitamin D (Vit-D) deficiency. METHODS: This study used a prospective case-control design. Group 1 (n=38) comprised pediatric patients with Vit-D deficiency, and group 2 (n=45) was the control group. Tear break-up times (TBUTs), Schirmer-1 test measurements, ocular surface disease index (OSDI) scores, and conjunctival impression cytology (CIC) results of the groups were compared. RESULTS: The participant demographic characteristics, including the mean age and the male-to-female ratio, were similar (P>0.05). The median TBUT and Schirmer-1 test measurement were 10 s (5-15) and 12 mm (6-19) in group 1 and 11 s (6-16) and 15 mm (8-21) in group 2 (P=0.004 and P=0.013, respectively). The median OSDI scores were 16 (10-20) in group 1 and 17 (10-21) in group 2 (P=0.092). According to the CIC, 25 samples in group 1 and 40 samples in group 2 were categorized as grade 0, 11 samples in group 1 and 5 samples in group 2 were categorized as grade 1, and 2 samples in group 1 and no sample in group 2 were categorized as grade 2 (P=0.027). CONCLUSION: Significant conjunctival histopathological changes occur in children with Vit-D deficiency, and these changes have effects on some tear function-associated clinical findings including the Schirmer-1 test and TBUT measurements.

Association between ocular trauma and attention-deficit/hyperactivity disorder in adult patients.

Purpose: To investigate the potential relationship between ocular trauma and attention-deficit/hyperactivity disorder (ADHD)-related clinical outcomes in adults. Methods: This prospective case-control study included 108 ocular trauma patients and 90 age-sex-matched healthy control. The ocular trauma group was separated into the subgroups home accident, outdoor activity, and work related in terms of the reasons for ocular trauma, and as ocular surface problems, blunt trauma-related, and open globe injury in terms of the clinical findings. The ADHD-related clinical outcomes were evaluated using the Wender-Utah Rating Scale (WURS). The outcomes were compared between ocular trauma and control groups, and ocular trauma subgroups. Results: The demographic characteristics of ocular trauma groups and controls were similar (P > 0.05, for all). In comparison to the control group, the ocular trauma group had higher total WURS score and WURS subscale scores, but not significantly (P > 0.05, for all). According to comparisons of the subgroups separated by the reasons, there was significant difference in the mean behavioral problems/impulsivity scores in favor of outdoor activities (P = 0.015). On the other hand, the mean scores for WURS subscales of the subgroups separated by the clinical findings were similar (P > 0.05, for all). Conclusion: WURS scores in ocular trauma patients are similar to control; however, the score in behavioral problems/impulsivity subscales is higher for ocular trauma caused by outdoor activities.

Changes in Intraocular Pressure and Ocular Biometry After Blepharoplasty.

PURPOSE: To investigate the effects of blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. METHODS: A total of 112 eyelids of 56 patients undergoing bilateral blepharoplasty due to upper eyelid dermatochalasis was included. The patients were classified into three groups according to margin reflex distance (MRD) (Group 1 >4 mm MRD, Group 2 2-4 mm MRD, and Group 3 <2 mm MRD). The IOP and ocular biometric parameters obtained baseline and postoperative 3rd month were compared. RESULTS: The demographic characteristics of the groups were similar (p > 0.05, for all). IOP (p = 0.002) and central corneal thickness (p = 0.038) increased in Group 3. The mean amount of the increase in IOP was 0.95mmHg. The keratometric values increased in all groups and corneal astigmatism was also increased in Group 2 and Group 3 (p < 0.001, for all). The mean amount of the increase in corneal astigmatism was 0.54D in Group 3. Anterior chamber depth and axial length did not change (p > 0.05, for all). The intraocular lens powers calculated by six different formulas decreased in Group 3 (p < 0.001, for all), and the mean amount of the decrease was 0.40D. CONCLUSIONS: Clinicians should be aware of the potential change in IOP and ocular biometric parameters in patients who underwent blepharoplasty. If a patient has glaucoma risk factors, close follow-up is needed after blepharoplasty. Change in strategy or timing may also be needed for dermatochalasis patients when planning corneal refractive surgery or cataract surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-term Complications of Conventional and Chandelier-Assisted Scleral Buckle for Primary Repair of Rhegmatogenous Retinal Detachment.

Purpose: To compare the outcomes of conventional indirect ophthalmoscopy and wide-angled visualization with chandelier endo-illumination methods in scleral buckle surgery by focusing on postoperative complications in the postoperative long-term period. Methods: In this retrospective comparative study, patients who underwent scleral buckle surgery due to rhegmatogenous retinal detachment were included in the study. Conventional scleral buckle surgery using indirect ophthalmoscopy was performed in Group 1, and wide-angled visualization with chandelier endo-illumination method in scleral buckle surgery was performed in Group 2. The outcomes of the two methods were compared. Results: The demographic and baseline clinical characteristics of the groups were similar (P > 0.05, for all). The mean follow-up time was 70.47 ± 20.32 weeks (52-116) in Group 1 and 64.89 ± 18.12 weeks (52-100) in Group 2 (P > 0.05). There was no significant difference in the mean postoperative best-corrected visual acuity and redetachment rates of the groups (P > 0.05, for both). The cumulative rate of postoperative complications was more frequent in Group 1 (P = 0.011) despite being not significant in one-by-one comparison of the complications including epiretinal membrane, proliferative vitreoretinopathy, glaucoma, cystoid macular edema, foveal atrophy, gaze restriction, and macular hole (P > 0.05, for all). Conclusion: Using wide-angled visualization with chandelier endo-illumination in scleral buckle surgery, favorable surgical outcomes can be achieved in the postoperative long-term period with fewer complications.

Evaluation of Retinal Structure in Pediatric Subjects With Vitamin D Deficiency.

PURPOSE: To quantitatively evaluate the retinal structural parameters of pediatric patients who were determined to be deficient in vitamin D. DESIGN: Prospective, cross-sectional study. METHODS: Retinal structural parameters, including the peripapillary retinal nerve fiber layer (RNFL), central macula, retinal layer, and choroidal thicknesses, central retinal artery equivalent (CRAE), and central retinal vein equivalent (CRVE), in pediatric subjects with vitamin D deficiency (group 1) and those without (group 2) were compared. RESULTS: Group 1 comprised 70 individuals, while group 2 comprised 80 individuals. The mean peripapillary RNFL (except for the nasal superior sector [P = .037]), central macula, and retinal layer thicknesses were also determined to be similar in both groups (P > .05 for both groups). The mean choroidal thickness was lower in the subfoveal (P = .006) and nasal 3000-µm-diameter areas (P = .004) in group 1. The mean CRAE was determined to be lower (P = .031) and the CRVE was higher in group 1 (P = .005); it was determined that there was a significant correlation between the vitamin D level and both the CRAE (r = 0.447, P < .001) and CRVE (r = -0.320, P = .013). CONCLUSION: Choroidal thinning, a decrease in the CRAE, and increase in the CRVE were structural changes that occurred in the pediatric subjects who had vitamin D deficiency. The alterations in these parameters became more prominent in pediatric subjects who were determined to have lower vitamin D levels.

Characteristics of work-related eye trauma in construction and manufacturing industries.

CLINICAL RELEVANCE: Knowledge of work-related eye trauma in the construction and manufacturing industries will facilitate planning of policies and practices to protect against such occurrences. BACKGROUND: The aim of this study was to compare demographic, epidemiological, and clinical characteristics of work-related eye trauma in workers in the construction and manufacturing industries. METHODS: Medical board disability reports of subjects who experienced work-related eye trauma were investigated in this retrospective comparative study. Subjects were separated into two groups - construction and manufacturing - and the demographic, epidemiologic, and clinical characteristics within the two groups were compared. RESULTS: The construction group included 138 eyes of 132 subjects and the manufacturing group included 82 eyes of 77 subjects. Demographic characteristics of the groups were similar (p > 0.05). The number of work-related eye trauma incidents was found as decreased during winter in construction (p < 0.001), but a similar trend was not found in manufacturing (p > 0.05). Head traumas as reason for work-related eye trauma (p < 0.001), and concomitant systemic diseases including bone fracture and traumatic brain injuries (p < 0.001 and p = 0.012) were significantly associated with eye trauma in manufacturing. Open globe injury was more common in construction (p = 0.046), and chemical injury was more common in manufacturing (p < 0.001). Retinal detachment was more prevalent in construction (p = 0.042). Hand motion or worse final visual acuity was more prevalent in manufacturing (p = 0.007) and the final visual acuity better than 6/60 was more prevalent in construction (p = 0.045). CONCLUSION: Chemical injuries are more common in manufacturing, whereas open globe injuries and retinal detachments occur more frequently in construction. Permanent low vision and blindness are more commonly associated with work-related eye trauma in manufacturing.

Serum Levels of Thyroid Hormone, Vitamin B12, Vitamin D3, Folic Acid, and Ferritin in Chalazion.

PURPOSE: To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between chalazion patients and control. METHODS: 18-65-year-old chalazion patients and controls were included. The peripheric blood sampling results were investigated. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of chalazion and control groups were compared. RESULTS: The male-to-female ratio was 41/107 in chalazion group and 52/106 in control group (p > .05).The mean age was 37.123 ± 13.252 years (18-65) and 39.912 ± 13.747 years (18-65) in the groups, respectively (p > .05).The mean value of vitamin B12 was 304.894 ± 131.592 pg/mL (122.700-985.300) in chalazion group and 353.200 ± 184.341 pg/mL (134.800-1127.000) in control group (p = .038).The mean values of FT3, FT4, TSH, vitamin D3, folic acid, and ferritin levels were similar between the groups (p > .05 for all). CONCLUSION: This study reports that chalazion patients have less serum vitamin B12 level than healthy subjects.

Vitreoretinal Surgery amid Coronavirus Disease 2019 Pandemic Restrictions.

PURPOSE: To define the characteristics of vitreoretinal surgeries amid coronavirus disease 2019 (COVID-19) pandemic restrictions in Turkey. METHODS: This descriptive, cross-sectional study was conducted for vitreoretinal surgeries during the 10-week period (during this period, all elective surgeries were postponed across the country by the order of the Republic of Turkey Ministry of Health) in a single tertiary referral hospital in Ankara, Turkey. The number of surgeries, surgical indications, risk factors, etiological factors, and associated conditions were investigated and compared with the clinical features of the patients who underwent vitreoretinal surgery in the same period of the recent year. RESULTS: During this period, vitreoretinal surgery was performed more commonly for the male population (P < 0.001). The number of vitreoretinal surgeries was statistically significantly correlated with the number of COVID-19 cases (P = 0.006 and r = -0.791 for weekly numbers of new surgeries and cases, and P < 0.001 and r = 0.929 for cumulative numbers of surgeries and cases). Diabetes mellitus in 26 patients (32.9%) was the most common systemic comorbidity. The most common indication for vitreoretinal surgery was rhegmatogenous retinal detachment in 44 patients (55.7%) followed by diabetic retinopathy complications in 21 patients (26.6%). No one was operated on for vitreoretinal interface disorders during this period, and the rate of rhegmatogenous retinal detachment was higher than the same period of the recent year (P = 0.003). CONCLUSIONS: Amid COVID-19 pandemic restrictions in Turkey, the number of vitreoretinal surgeries was inversely associated with the number of confirmed COVID-19 cases. The male population needed more vitreoretinal surgery, and rhegmatogenous retinal detachment was the most common indication for all patients.

Comparison of phaco time parameters in eyes with and without glaucoma filtration surgery due to pseudoexfoliation glaucoma.

PURPOSE: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. METHODS: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. RESULTS: The mean ages and male-to-female ratios of the groups were similar (p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups (p > 0.05, for all). Some surgical manipulations, including pupillary stretching (p = 0.004), pupillary membrane peeling (p = 0.021), iris hook using (p = 0.041), and capsular tension ring implantation (p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar (p > 0.05, for both), the mean APP value was significantly lower in Group 2 (p = 0.011). CONCLUSION: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.

The impact of optic disk morphological characteristics on peripapillary retinal nerve fiber layer thickness in non-glaucomatous subjects with high myopia.

BACKGROUND: To analyze peripapillary retinal nerve fiber layer (pRNFL) thickness (pRNFLT) alterations in non-glaucomatous eyes with high myopia (HM), and to describe its relationship with some optic disk (OD) morphologic features. METHODS: A cross-sectional case-control study includes 185 Caucasian subjects with HM and 122 healthy controls. Results of the pRNFLT analysis provided by optical coherence tomography were compared between the HM and control group, and the effects of some morphological features of OD, including tilt, OD radius, and peripapillary chorioretinal atrophy (pCRA) extension, on pRNFLT analysis were investigated. RESULTS: The mean pRNFL of the HM group was significantly thinner than the control group in the inferior (p <0.001), superior (p <0.001), and nasal (p = 0.001) quadrants. In the HM group, the superior quadrant pRNFL was significantly thinner in the tilted OD subgroup compared to the non-tilted OD subgroup (p <0.001). The mean pRNFLT was negatively correlated with pCRA extension in the inferior (r =-0.209 and p = 0.020), superior (r =-0.308 and p <0.001), and nasal (r =-0.235 and p = 0.008) quadrants. CONCLUSIONS: In non-glaucomatous Caucasian subjects with HM, pRNFL is thinner compared to controls in the inferior, superior, and nasal quadrants, and this thinning is negatively correlated with pCRA extension. Superior quadrant pRNFL is also thinner in tilted OD than non-tilted OD. The morphological characteristics of OD in non-glaucomatous eyes with HM are closely associated with the results of pRNFLT analysis.

Use of automated quantitative pupillometric evaluation for monitoring the severity of diabetic retinopathy.

PURPOSE: We aimed to evaluate the use of automated quantitative static and dynamic pupillometry in screening patients with type 2 diabetes mellitus and different stages of diabetic retinopathy. METHOD: 155 patients with type 2 diabetes mellitus (diabetes mellitus group) were included in this study and another 145 age- and sex-matched healthy individuals to serve as the control group. The diabetes mellitus group was divided into three subgroups: diabetes mellitus without diabetic retinopathy (No-diabetic retinopathy), nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy. Static and dynamic pupillometry were performed using a rotating Scheimpflug camera with a topography-based system. RESULTS: In terms of pupil diameter in both static and dynamic pupillometry (p<0.05), statistically significant differences were observed between the diabetes mellitus and control groups and also between the subgroups No-diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy subgroups. But it was noted that No-diabetic retinopathy and nonproliferative diabetic retinopathy groups have showed similarities in the findings derived from static pupillometry under mesopic and photopic conditions. The two groups also appeared similar at all points during the dynamic pupillometry (p>0.05). However, it could be concluded that the proliferative diabetic retinopathy group was significantly different from the rest of the subgroups, No-diabetic retinopathy and nonproliferative diabetic retinopathy groups, in terms of all the static pupillometry measurements (p<0.05). The average speed of dilation was also significantly different between the diabetes mellitus and control groups and among the diabetes mellitus subgroups (p<0.001). While weak to moderate significant correlations were found between all pupil diameters in static and dynamic pupillometry with the duration of diabetes mellitus (p<0.05 for all), the HbA1c values showed no statistically significant correlations with any of the investigated static and dynamic pupil diameters (p>0.05 for all). CONCLUSION: This study revealed that the measurements derived from automated pupillometry are altered in patients with type 2 diabetes mellitus. The presence of nonproliferative diabetic retinopathy does not have a negative effect on pupillometry findings, but with proliferative diabetic retinopathy, significant alterations were observed. These results suggest that using automated quantitative pupillometry may be useful in verifying the severity of diabetic retinopathy.

Retrospective investigation of peripheric blood sampling in pediatric chalazion patients.

PURPOSE: To compare serum thyroid hormone, vitamin B12, vitamin D3, folic acid, and ferritin levels between pediatric chalazion patients and healthy children. METHODS: Under 18-year-old chalazion patients and age- and sex-matched healthy controls were included into this retrospective case-control study. The peripheric blood sampling results obtained within six months from ophthalmological examination were investigated for statistical analysis. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), vitamin B12, vitamin D3, folic acid, and ferritin levels of the chalazion and control groups were compared. RESULTS: The male-to-female ratio was 8/28 in the chalazion group and 22/48 in the control group (p > 0.05). The mean age was 13.891 ± 3.924 years (3-17) and 12.346 ± 3.963 years (4-17) in the groups, respectively (p > 0.05). The mean time between ophthalmological examination and peripheric blood sampling was 3.012 ± 2.201 months (0-6) and 2.092 ± 1.906 months (0-6) in the groups, respectively (p > 0.05). The mean value of ferritin was 18.641 ± 8.971 µg/L (5.900-38.600) in the chalazion group and 35.455 ± 24.561 µg/L (11.850-106.100) in the control group (p = 0.019). The mean values of FT3, FT4, TSH, vitamin B12, vitamin D3, and folic acid levels were similar between the groups (p > 0.05 for all). CONCLUSION: This study reports that pediatric chalazion patients have lower serum ferritin level than healthy children.

Use of automated quantitative pupillometric evaluation for monitoring the severity of diabetic retinopathy / Uso da pupilometria quantitativa automatizada no monitoramento da severidade da retinopatia diabética

ABSTRACT Purpose: We aimed to evaluate the use of automated quantitative static and dynamic pupillometry in screening patients with type 2 diabetes mellitus and different stages of diabetic retinopathy. Method: 155 patients with type 2 diabetes mellitus (diabetes mellitus group) were included in this study and another 145 age- and sex-matched healthy individuals to serve as the control group. The diabetes mellitus group was divided into three subgroups: diabetes mellitus without diabetic retinopathy (No-diabetic retinopathy), nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy. Static and dynamic pupillometry were performed using a rotating Scheimpflug camera with a topography-based system. Results: In terms of pupil diameter in both static and dynamic pupillometry (p<0.05), statistically significant differences were observed between the diabetes mellitus and control groups and also between the subgroups No-diabetic retinopathy, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy subgroups. But it was noted that No-diabetic retinopathy and nonproliferative diabetic retinopathy groups have showed similarities in the findings derived from static pupillometry under mesopic and photopic conditions. The two groups also appeared similar at all points during the dynamic pupillometry (p>0.05). However, it could be concluded that the proliferative diabetic retinopathy group was significantly different from the rest of the subgroups, No-diabetic retinopathy and nonproliferative diabetic retinopathy groups, in terms of all the static pupillometry measurements (p<0.05). The average speed of dilation was also significantly different between the diabetes mellitus and control groups and among the diabetes mellitus subgroups (p<0.001). While weak to moderate significant correlations were found between all pupil diameters in static and dynamic pupillometry with the duration of diabetes mellitus (p<0.05 for all), the HbA1c values showed no statistically significant correlations with any of the investigated static and dynamic pupil diameters (p>0.05 for all). Conclusion: This study revealed that the measurements derived from automated pupillometry are altered in patients with type 2 diabetes mellitus. The presence of nonproliferative diabetic retinopathy does not have a negative effect on pupillometry findings, but with proliferative diabetic retinopathy, significant alterations were observed. These results suggest that using automated quantitative pupillometry may be useful in verifying the severity of diabetic retinopathy.

RESUMO Objetivos: Procuramos avaliar o uso da pupilometria estática e dinâmica quantitativa automatizada na triagem de pacientes com diabetes mellitus tipo 2 e em di­ferentes estágios de retinopatia diabética. Métodos: Cento e cinquenta e cinco pacientes com diabetes mellitus tipo 2 (grupo com diabetes mellitus) foram incluídos neste estudo e outros 145 controles saudáveis pareados por idade e sexo para server como grupo controle. O grupo com diabetes mellitus foi dividido em três subgrupos: diabetes mellitus sem retinopatia diabética (retinopatia não diabética), retinopatia diabética não proliferativa e retinopatia diabética proliferativa. A pupilometria estática e dinâmica foi realizada utilizando uma camera rotative Scheimpflug com um sistema baseado em topografia. Resultados: Em termos de diâmetro da pupila, tanto na pupilometria estática quanto na dinâmica (p<0,05), foram observadas diferenças estatisticamente significantes entre os grupos diabetes mellitus e controle e também entre os subgrupos retinopatia não diabética, retinopatia diabética não proliferativa e retinopatia diabética proliferativa. Mas foi observado que os grupos de retinopatia não diabética e retinopatia diabética não proliferativa mostraram semelhanças nos achados derivados da pupilometria estática em condições mesópicas e fotópicas. Os dois grupos também pareciam semelhantes em todos os pontos durante a pupilometria dinâmica (p>0,05). No entanto, pode-se concluir que o grupo de retinopatia diabética proliferative foi sugnificativamente diferente do restante dos subgrupos, retinopatia não diabética e retinopatia diabética não proliferativa, em termos de todas as medidas de pupilometris estática (p<0,05). A velocidade média de dilatação também foi significativamente diferente entre os grupos diabetes mellitus e controle, e entre os subgrupos diabetes mellitus (p<0,001). Enquanto correlações significativas fracas a moderadas foram encontradas entre todos os diâmetros da pupila na pupilometria estática e dinâmica com a duração do diabetes mellitus (p<0,05 para todos), os valores de HbA1c não mostraram correlações estatisticamente significantes com nenhum dos diâmetros da pupila estática e dinâmica investigados (p>0,05 para todos). Conclusão: Este estudo revelou que as medidas derivadas da pupilometria automatizada estão alteradas em pacientes com diabetes mellitus tipo 2. A presença de retinopatia diabética não proliferativa não afeta negativamente os achados pupilomé­tricos, mas com a retinopatia diabética proliferative, alterações significativas foram observadas. Estes resultados sugerem que o uso da pupilometria quantitativa automatizada pode ser útil na verificação gravidade da retinopatia diabética.

Closure of Recalcitrant Macular Hole after Choroidal Neovascularization.

PURPOSE: To report the closure of a recalcitrant macular hole (MH) following the development of choroidal neovascularization. METHODS: A 67-year-old female patient in this case report was diagnosed with a MH and operated twice, but anatomical closure of MH could not be achieved. The patient was followed up without further treatment, as she rejected any additional procedure. RESULTS: Six months later, a lesion consistent with choroidal neovascularization appeared in the central macula, and the recalcitrant MH closed spontaneously. The MH defect remained closed in the following years. CONCLUSION: Besides being a new example of the presence of choroidal neovascularization after MH surgery, the most important aspect of this case report is to report the closure of a recalcitrant MH following the development of choroidal neovascularization.