Novel optical coherence tomography findings in a patient with methanol toxicity: a case report.

We report a case of acute methanol toxicity with unique optical coherence tomography findings. A 56-year-old man was referred to our ophthalmology clinic with a history of handmade vodka consumption and vision loss. On ophthalmologic examination, his vision was 20/100 in his right eye and 20/200 in his left eye. Bilateral mild optic disk hyperemia was detected on fundus examination. Because of the severity of systemic symptoms in such cases, it is very difficult to include optical coherence tomography in the ophthalmologic examination. However, we managed to perform optical coherence tomography and recorded shallow subretinal fluid and a prominent middle limiting membrane sign as acute retinal structural changes in the patient. The patient was treated with hemodialysis, intravenous ethanol, and sodium bicarbonate. On the fourth day of treatment, visual acuity improved to 20/20 in both eyes. In addition, the prominent middle limiting membrane sign and subretinal fluid disappeared. In this unusual case, retinal pigment epithelium damage and retinal ischemia may have contributed to the prominent middle limiting membrane and subretinal fluid, which are novel optical coherence tomography findings of methanol toxicity.

Choroidal structural changes in patients with early diabetic nephropathy.

PURPOSE: To determine alterations of the choroidal thickness (CT) and the choroidal vascularity index (CVI) in patients with glomerular hyperfiltration, a marker of early diabetic nephropathy (DN). METHODS: Twenty-two patients with type 2 diabetes (T2D) with glomerular hyperfiltration (early DN group) and 28 patients with T2D without DN (NDN group) were included in the study. Patients with diabetic retinopathy were excluded. Parameters including subfoveal CT, the subfoveal choroidal vascularity index (CVI), and total CVI were measured using spectral-domain enhanced depth imaging optical coherence tomography method. RESULTS: The early DN group included 22 patients and the NDN group comprised 28 patients. The groups were similar in terms of age and sex (p>0.05). The CT values were statistically significantly lower in the early DN group than in the NDN group (p < 0.001). There was no significant difference between the early DN group and the NDN group in terms of total and subfoveal CVI (p>0.05). CONCLUSION: The choroidal thickness decreased in patients with T2D with glomerular hyperfiltration, but there were no differences in CVI when they were compared with patients with T2D without DN.

HENLE FIBER LAYER THICKNESS AND AREA MEASUREMENT IN TYPE 2 DIABETES MELLITUS WITH AND WITHOUT RETINOPATHY USING A MODIFIED DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY STRATEGY.

PURPOSE: To investigate the thicknesses and areas of Henle fiber layer (HFL), outer nuclear layer, and outer plexiform layer in the eyes of patients with diabetes with no diabetic retinopathy, in eyes with nonproliferative diabetic retinopathy without diabetic macular edema, and in healthy eyes using a modified directional optical coherence tomography strategy. METHODS: In this prospective study, the no diabetic retinopathy group included 79 participants, the nonproliferative diabetic retinopathy group comprised 68 participants, and the control group had 58 participants. Thicknesses and areas of Henle fiber layer, outer nuclear layer, and outer plexiform layer were measured on a horizontal single optical coherence tomography scan centered on the fovea using directional optical coherence tomography. RESULTS: The foveal, parafoveal, and total HFL were significantly thinner in the nonproliferative diabetic retinopathy group than in the no diabetic retinopathy group and the control group (all P < 0.05). The no diabetic retinopathy group had significantly thinner foveal HFL thickness and area compared with the control group (all P < 0.05). The nonproliferative diabetic retinopathy group had significantly thicker outer nuclear layer thickness and area in all regions than the other groups (all P < 0.05). The outer plexiform layer measurements did not differ between the groups (all P > 0.05). CONCLUSION: Directional optical coherence tomography provides isolated thickness and area measurement of HFL. In patients with diabetes, the HFL is thinner, and HFL thinning begins before the presence of diabetic retinopathy.

Choroidal structural changes in airline pilots and cabin crew.

PURPOSE: To analyze the differences in terms of choroidal vascularity index (CVI) and choroidal thickness (CT) between the airline pilots-cabin crew and the normal population. METHODS: In this prospective study, 50 airline pilots-cabin crew (study group) and 50 healthy individuals (control group) were included for comparison. For each participant, one eye, the eye with the higher OCT scan score index, was enrolled. Subfoveal CT and CVI were measured using a spectral-domain optical coherence tomography system with enhanced depth imaging. RESULTS: There were no significant differences in terms of age and sex between the study and control groups. The mean CT was 368.5 ± 79.6 in the control group vs. 424.9 ± 80.7 in the study group (p = 0.001). CT was significantly thicker in the study group. The mean CVI was 64.3 ± 1.5 in the control group and 66 ± 3.1 in the study group (p = 0.5). There was no significant correlation between the study and control groups in terms of CVI. CONCLUSION: Airline pilots-cabin crew had thicker CT, but there were no differences in CVI when they were compared with healthy subjects. The effect of unique occupational exposures of airline pilots-cabin crew to the pathophysiology of choroidal structural alterations needs further investigation.

Outcomes of Cessation of Antiviral Therapy in Chronic Hepatitis B: A Retrospective Cohort Study.

Objective: Data on the efficacy and duration of nucleos(t)ide analogue (NUC) therapies to prevent the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B (CHB) patients are scarce and heterogeneous. This study aimed to summarize the clinical and laboratory results of the patients with CHB infection who discontinued oral antiviral therapy. Methods: A single-centered cohort study was conducted with CHB infection. NUCs were discontinued in patients who were under viral suppression for at least two years with undetectable HBV DNA levels for 18 months. Risk factors for clinical relapse (CR) were evaluated. Results: A total of 77 patients were recruited. HBeAg status showed that 9.4% of the patients underwent HBeAg seroconversion with NUCs. HBeAg reversion was noted in four (31%) of these patients. Severe hepatitis, which resolved after antiviral therapy was restored, was reported in two out of 77 patients (4%). None of the patients with CR had clinical or biological signs of hepatic decompensation or died during the study period. Conclusions: We found no benefits of the discontinuation of antiviral therapy after viral suppression in patients with initially severe fibrotic HBV infection. In patients with mild to moderate fibrosis, cessation of antiviral treatment is not associated with adverse outcomes.

Comparision effects of solifenacin, darifenacin, propiverine on ocular parameters in eyes: A prospective study.

OBJECTIVE: To evaluate the effects of solifenacin, darifenacin, and propiverine on nasal-, subfoveal-, temporal choroidal thicknesses (NCT, SFCT, TCT), intraocular pressure (IOP) and pupil diameter (PD). MATERIALS AND METHODS: Patients with overactive bladder (OAB) diagnosed according to The International Continence Society were administered with solifenacin, darifenacin or propiverine on a daily basis between November 2017 and May 2018. NCT, SFCT, TCT, IOP, and PD of these patients were measured and compared as initial, fourth and twelfth weeks. RESULTS: A total of 165 patients (330 eyes) with OAB were evaluated. Solifenacin (n=140) signifi cantly reduced IOP from 17.30±2.72 mmHg to 16.67±2.56 mmHg (p=0.006) and 16.57±2.41 mmHg (p=0.002), at the fourth and twelfth weeks, respectively. Darifenacin (n=110) signifi cantly reduced NCT from 258.70±23.96 µm to 257.51±22.66 µm (p=0.002) and 255.36±19.69 µm (p=0.038), at the fourth and twelfth weeks, respectively. Propiverine (n=80) signifi cantly increased PD from 4.04±0.48 mm to 4.08±0.44 mm (p=0.009) and 4.09±0.45 mm (p=0.001), at the fourth and twelfth weeks, respectively. CONCLUSION: These findings can help to decide appropriate anticholinergic drug choice in OAB patients. We finally suggest further well-designed randomized prospective studies with a larger population to evaluate the anticholinergic-related complications in eyes.

Development of skin aging scale by using dermoscopy.

BACKGROUND: Some features of skin aging that cannot be detected by the naked eye can be determined more easily by dermoscopy. Therefore, we aimed to measure skin aging with dermoscopy. METHODS: The study was performed in Istanbul Training and Research Hospital, a tertiary care referral center. A total of 441 participants between the ages of 20-88 (mean 48.4 ± 17.7) were separated into six groups according to their age. All participant's facial sun-exposed areas were examined by dermoscopy in terms of telangiectasia, vascular changes, pigmentation changes, seborrheic keratosis, actinic keratosis, periorbital comedones and cysts, superficial- deep- criss-cross wrinkles as the signs of photoaging and scored with the help of dermoscopic photoaging scale (DPAS). The validity of the scale was assessed with DPAS by the evaluation of both the axillar and the gluteal regions, that were not sun exposed and photoaged, with DPAS. RESULTS: The scale was found to be highly reliable as Cronbach's α coefficient was 0.756. Skin aging of patients from every decade was compared clinically with Glogou photoaging scale and Monheit-Fulton photoaging index and significant correlation was calculated as 0.773 and 0.774, respectively. An increase in photoaging scores from young people toward elders according to their ages was observed and the same linear difference between their mean values was detected. CONCLUSION: DPAS is a reliable and valid diagnostic tool that can evaluate photoaged skin quantitatively by the help of objective criteria so can be used to evaluate the effect of preventive and therapeutic applications for skin aging.