COMPARISON OF THE CHOROIDAL VASCULARITY INDEX MEASUREMENTS OF IMAGES ACQUIRED WITH DIFFERENT OPTICAL COHERENCE TOMOGRAPHY SCAN SCALE TYPES.

PURPOSE: To evaluate the differences in choroidal vascularity index (CVI) measurements between images acquired at the 1:1 pixel scale and at the 1:1 µ m scale of the Heidelberg optical coherence tomography device. METHODS: Forty-five healthy eyes of 45 healthy subjects were included for this study. Fovea-centered scans were obtained with an enhanced-depth imaging mode with a high-speed protocol scan. Each scan was exported in 3 different types: 1) 1:1 pixel scale type; 2) 1:1 µ m scale type (MST); and 3) 4×-magnified MST (4×MST; 400%-magnified 1:1 µ m images exported via screenshot). A comparison between CVI measurements based on the different scale types of optical coherence tomography images was conducted using the Bland-Altman analysis and intraclass correlation coefficient. RESULTS: The image with the worst clarity was acquired via the MST, and the CVI was found to be higher in MST images (69.05 ± 3.21) compared with the other groups. The intraclass correlation coefficient between the CVI values of the 4×MST and pixel scale type images was 0.92, between those of the 4×MST and MST images was 0.33, and between those of the pixel scale type and MST images was 0.44. CONCLUSION: The optical coherence tomography scale and export method type significantly influence the image resolution, CVI, and choroidal area measurements.

Quantitative analysis of deep learning-based denoising model efficacy on optical coherence tomography images with different noise levels.

BACKGROUND: To quantitatively evaluate the effectiveness of the Noise2Noise (N2N) model, a deep learning (DL)-based noise reduction algorithm, on enhanced depth imaging-optical coherence tomography (EDI-OCT) images with different noise levels. METHODS: The study included 30 subfoveal EDI-OCT images averaged with 100 frames from 30 healthy participants. Artificial Gaussian noise at 25.00, 50.00, and 75.00 standard deviations were added to the averaged (original) images, and the images were grouped as 25N, 50N, and 75N. Afterward, noise-added images were denoised with the N2N model and grouped as 25dN, 50dN, and 75dN, according to previous noise levels. The choroidal vascularity index (CVI) and deep choroidal contrast-to-noise ratio (CNR) were calculated for all images, and noise-added and denoised images were compared with the original images. The structural similarity of the noise-added and denoised images to the original images was assessed by the Multi-Scale Structural Similarity Index (MS-SSI). RESULTS: The CVI and CNR parameters of the original images (68.08 ± 2.47 %, and 9.71 ± 2.80) did not differ from the only 25dN images (67.97 ± 2.34 % and 8.50 ± 2.43) (p:1.000, and p:0.062, respectively). Noise reduction improved the MS-SSI at each noise level (p < 0.001). However, the highest MS-SSI was achieved in 25dN images. CONCLUSIONS: The DL-based N2N denoising model can be used effectively for images with low noise levels, but at increasing noise levels, this model may be insufficient to provide both the original structural features of the choroid and structural similarity to the original image.

The Inflammatory and Cytological Effect of Repeated Povidone-Iodine Application in Patients Receiving Intravitreal Injections.

OBJECTIVE: To investigate the effect of repeated povidone-iodine (PVI) application on the ocular surface parameters of patients who received intravitreal injections. MATERIALS AND METHODS: In this prospective study, 52 eyes of 52 patients with age-related macular degeneration who underwent unilateral intravitreal injection at least three times in the last 1 year (intravitreal injection [IVI] group), 52 fellow eyes with no previous intravitreal injection (NIVI group), and 51 eyes of 51 healthy subjects (control) were included. Tear break-up time (TBUT), the Schirmer test, the Oxford staining score, the Ocular Surface Disease Index questionnaire, conjunctival impression cytology, and tear inflammatory cytokine levels (interleukin [IL]-1ß and IL-6) were analyzed in all participants. RESULTS: The IVI group had lower TBUT and higher Oxford staining score than the NIVI and control groups ( P <0.05). No significant difference was found between the groups in the Schirmer test ( P =0.161). Conjunctival impression cytology analysis revealed that the IVI group had a significantly lower goblet cell count and significantly higher Nelson staging result than the NIVI and control groups ( P <0.05). As a result of tear cytokine analysis, although IVI and NIVI groups had higher IL-1ß and IL-6 levels than the control group ( P <0.05), there was no difference between NIVI and IVI groups ( P ≥0.05). CONCLUSIONS: Repeated PVI application caused cytotoxic injury to the ocular surface, resulting in goblet cell loss and squamous metaplasia of epithelial cells. As a result, the stability of the tear film layer was found to be impaired and ocular surface-related symptoms developed in patients.

Characteristics of myopic and hyperopic eyes in patients with antimetropia.

CLINICAL RELEVANCE: Antimetropia is a rare type of anisometropia in which one eye is myopic and the fellow is hyperopic, This optical condition condition permits the evaluation of both sides of the emmetropisation process failure in the same individual by minimising genetic and environmental factors. BACKGROUND: This study aimed to evaluate the ocular biometric, retinal, and choroidal characteristics of myopic and hyperopic eyes of antimetropic subjects older than six years. METHODS: In this retrospective study, myopic and hyperopic eyes of 29 antimetropic patients with a spherical equivalent (SE) difference of at least 2.00D between the eyes were included. Axial length (AL), mean corneal keratometry, anterior chamber depth, the proportion of anterior chamber depth in AL, crystalline lens power, central macular thicknesses, disc-to-fovea distance, fovea-disc angle, peripapillary retinal nerve fibre layer (RNFL) thicknesses, and subfoveal choroidal features were compared between the eyes. The prevalence of amblyopia was determined. Refractive parameters and total astigmatic profile were evaluated in eyes with and without amblyopia. RESULTS: The median absolute SE and AL differences between the eyes were 3.50D (interquartile range:1.75) and 1.18 mm (interquartile range:0.76), respectively (p < 0.001). Myopic eyes had lower crystalline lens power and proportion of anterior chamber depth in AL, and longer disc-to-fovea distance. Macular thicknesses, global RNFL, and temporal RNFL were thicker in myopic eyes, and there was no difference in other RNFL quadrants. Despite the increase in the choroidal vascularity index, other choroidal parameters were decreased in myopic eyes. Amblyopia was found in three of the myopic eyes and seven of the hyperopic eyes (p = 0.343). The highest interocular SE and AL difference and the highest frequency of anisoastigmatism were observed in patients with amblyopia in the myopic eye. CONCLUSION: Each ocular structure may respond differently to, or may be affected differently by, ametropic conditions.

Detection and Classification of Diabetic Macular Edema with a Desktop-Based Code-Free Machine Learning Tool.

Objectives: To evaluate the effectiveness of the Lobe application, a machine learning (ML) tool that can be used on a personal computer without requiring coding expertise, in the recognition and classification of diabetic macular edema (DME) in spectral-domain optical coherence tomography (SD-OCT) scans. Materials and Methods: A total of 695 cross-sectional SD-OCT images from 336 patients with DME and 200 OCT images of 200 healthy controls were included. Images with DME were classified into three main types: diffuse retinal edema (DRE), cystoid macular edema (CME), and cystoid macular degeneration (CMD). To develop the ML model, we used the desktop-based code-free Lobe application, which includes a pre-trained ResNet-50 V2 convolutional neural network and is available free of charge. The performance of the trained model in recognizing and classifying DME was evaluated with 41 DRE, 28 CMD, 70 CME, and 40 normal SD-OCT images that were not used in the training. Results: The developed model showed 99.28% sensitivity and 100% specificity for class-independent detection of DME. Sensitivity and specificity by labels were 87.80% and 98.57% for DRE, 96.43% and 99.29% for CME, and 95.71% and 95.41% for CMD, respectively. Conclusion: To our knowledge, this is the first evaluation of the effectiveness of Lobe with ophthalmological images, and the results indicate that it can be used with high efficiency in the recognition and classification of DME from SD-OCT images by ophthalmologists without coding expertise.

Evaluation of dry eye and meibomian gland function in pregnancy.

PURPOSE: To evaluate the signs and symptoms of dry eye in healthy pregnant women and investigate the effect of pregnancy on meibomian gland loss using non-contact meibography. METHODS: Healthy pregnant women and age-matched healthy non-pregnant women were included in the study. Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI). The first and average non-invasive break-up times (first-NIBUT and avg-NIBUT, respectively) were determined, and the Schirmer test was applied. Non-contact meibography was performed. RESULTS: The study included a total of 62 women, 30 pregnant (study group) and 32 non-pregnant (control group). There was no significant difference between the groups in terms of OSDI score and the Schirmer test (p > 0.05). The mean first-NIBUT and avg-NIBUT values of the study group (13.1 ± 5.3 and 13.7 ± 4.5 s) were significantly lower than the control group (16.0 ± 2.4 and 16.4 ± 1.5 s) (p: 0.015 and p: 0.040, respectively). The mean meibomian gland losses in the upper and lower eyelids were significantly higher in the study group (16.9 ± 8.2% and 11.6 ± 10.2%) compared to the control group (9.7 ± 6.2% and 5.6 ± 4.7%) (p < 0.001 and p: 0.011, respectively). CONCLUSIONS: It is considered that loss of the meibomian glands may occur during pregnancy, and this may predispose pregnant women to evaporative dry eye. Although dry eye does not cause significant ocular surface symptoms in pregnancy, NIBUT and non-contact meibography can be considered as effective diagnostic methods for the detection of dry eye in pregnant women.

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.

Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis / Avaliação de pacientes pediátricos apresentando blefaroptose transitória unilateral de início agudo

ABSTRACT Purpose: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

RESUMO Objetivo: Avaliar as características clínicas de pacientes pediátricos com blefaroptose adquirida unilateral, transitória e de início agudo. Métodos: Neste estudo retrospectivo, foram revisados prontuários clínicos entre abril de 2015 e junho de 2020. Os pacientes foram avaliados em termos de características demográficas, manifestações neurológicas e oftalmológicas associadas, duração dos sintomas, etiologia e achados de imagem. Foram excluídos pacientes com blefaroptose congênita e com blefaroptose adquirida de etiologia crônica. Resultados: Foram incluídos neste estudo 16 pacientes pediátricos (10 masculinos e 6 femininos) com blefaroptose adquirida transitória unilateral de início agudo. A média de idade dos pacientes foi de 6,93 ± 3,16 anos. As causas etiológicas mais comumente identificadas foram trauma em 7 pacientes (43,75%) e infecção (casos parainfecciosos) em 5 pacientes (31,25%). Além disso, a síndrome de Miller-Fisher, a síndrome de Horner secundária a neuroblastoma, a síndrome de Brown adquirida e pseudotumor cerebral foram determinados como causas etiológicas em um paciente cada uma. Achados oculares adicionais estavam associados à blefaroptose em 7 pacientes (58,33%). Foi observada a resolução espontânea da blefaroptose, sem tratamento, em todos os pacientes, exceto nos pacientes com síndrome de Miller-Fisher, neuroblastoma e pseudotumor cerebral. Nenhum paciente precisou de tratamento cirúrgico. Morbidades oculares, como ambliopia, não foram encontradas em nenhum paciente. Conclusão: Este estudo demonstrou que a blefaroptose transitória unilateral de início agudo, rara na infância, pode regredir sem a necessidade de tratamento cirúrgico na população pediátrica. No entanto, também não deve ser esquecido que patologias graves que requerem tratamento podem se apresentar com blefaroptose.

Effect of foveal herniation on surgical outcomes in patients with idiopathic epiretinal membrane.

PURPOSE: This study aimed to compare the anatomical and visual outcomes of idiopathic epiretinal membrane peeling surgery, with and without foveal herniation. METHODS: This retrospective, comparative, two-center study included age- and sex-matched patients exhibiting an idiopathic epiretinal membrane with and without foveal herniation (epiretinal membrane + foveal herniation group and epiretinal-membrane-only group, respectively). The baseline best-corrected visual acuity and central foveal thickness were compared within the groups through months 1, 3, 6, and 12 of follow-up postoperatively. Then, changes in these two parameters at all follow-up points were compared between the groups. RESULTS: We enrolled 16 patients per study group. The baseline best-corrected visual acuity and central foveal thickness were not significantly different between the two groups (p>0.05). Compared with the baseline, both the best-corrected visual acuity and central foveal thickness improved significantly in both groups in all follow-ups (p<0.05), except for the best-corrected visual acuity of the epiretinal-membrane-only group after month 1 (p<0.05). The mean best-corrected visual acuity improvement after month 1 and the mean central foveal thickness reduction after months 1, 3, and 6 were significantly better in the foveal herniation + epiretinal membrane group than in the epiretinal-membrane-only group (p<0.05). However, the best-corrected visual acuity and central foveal thickness changes were not significantly different between the groups at the final visit (p>0.05). CONCLUSIONS: Although epiretinal membrane + foveal herniation demonstrated prompt anatomical and functional improvement, foveal herniation occurrence did not affect the final surgical outcomes in patients with idiopathic epiretinal membrane.

Effect of foveal herniation on surgical outcomes in patients with idiopathic epiretinal membrane / O Efeito da herniação foveal nos resultados cirúrgicos em pacientes com membrana epirretiniana idiopática

ABSTRACT Purpose: This study aimed to compare the anatomical and visual outcomes of idiopathic epiretinal membrane peeling surgery, with and without foveal herniation. Methods: This retrospective, comparative, two-center study included age- and sex-matched patients exhibiting an idiopathic epiretinal membrane with and without foveal herniation (epiretinal membrane + foveal herniation group and epiretinal-membrane-only group, respectively). The baseline best-corrected visual acuity and central foveal thickness were compared within the groups through months 1, 3, 6, and 12 of follow-up postoperatively. Then, changes in these two parameters at all follow-up points were compared between the groups. Results: We enrolled 16 patients per study group. The baseline best-corrected visual acuity and central foveal thickness were not significantly different between the two groups (p>0.05). Compared with the baseline, both the best-corrected visual acuity and central foveal thickness improved significantly in both groups in all follow-ups (p<0.05), except for the best-corrected visual acuity of the epiretinal-membrane-only group after month 1 (p<0.05). The mean best-corrected visual acuity improvement after month 1 and the mean central foveal thickness reduction after months 1, 3, and 6 were significantly better in the foveal herniation + epiretinal membrane group than in the epiretinal-membrane-only group (p<0.05). However, the best-corrected visual acuity and central foveal thickness changes were not significantly different between the groups at the final visit (p>0.05). Conclusions: Although epiretinal membrane + foveal herniation demonstrated prompt anatomical and functional improvement, foveal herniation occurrence did not affect the final surgical outcomes in patients with idiopathic epiretinal membrane.

RESUMO Objetivo: Comparar os resultados anatômicos e visuais da cirurgia com peeling da membrana epirretiniana idio pática na presença e ausência de herniação foveal. Métodos: Estudo retrospectivo, comparativo, de dois centros. Pacientes com membrana epirretiniana idiopática pareados por idade e sexo com herniação foveal (grupo membrana epirretiniana + herniação foveal) e sem herniação foveal (grupo apenas com membrana epirretiniana) foram incluídos. Mudanças na acuidade visual melhor corrigida e espessura foveal central em todos os pontos de acompanhamento foram comparadas entre os grupos. A linha de base da melhor acuidade visual corrigida e a espessura foveal central foram comparadas dentro dos grupos no 1º, 3º, 6º e 12º meses de acompanhamento após a cirurgia Resultados: Dezesseis pacientes com membrana epirretiniana + olhos com herniação foveal e 16 pacientes com olhos apenas com membrana epirretiniana foram incluídos no estudo. Não houve diferença significativa entre os grupos na linha de base com melhor acuidade visual corrigida e espessura foveal central (p>0,05), exceto para a melhor acuidade visual corrigida do grupo da membrana epirretiniana após o 1º mês (p> 0,05), a melhor acuidade visual corrigida e a espessura foveal central melhoraram significativamente em ambos os grupos em todos os acompanhamentos em comparação com a linha de base (p<0,05). A média da melhor acuidade visual corrigida melhorou após o 1º mês e a redução média da espessura foveal central após o 1º, 3º e 6º meses foram significativamente melhores no grupo de herniação foveal + membrana epirretiniana do que no grupo com apenas membrana epirretiniana (p<0,05). Não houve diferença significativa na melhor acuidade visual corrigida e nas alterações da espessura foveal central entre os grupos na visita final (p>0,05). Conclusões: Embora uma melhora anatômica e funcional bem mais precoce tenha sido mostrada no grupo membrana epirretiniana + herniação foveal, a presença de her niação foveal não afetou os resultados cirúrgicos finais em pacientes com membrana epirretiniana idiopática.

Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis.

PURPOSE: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. METHODS: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. RESULTS: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. CONCLUSION: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

The relation of optical coherence tomography findings with oxidative stress parameters in patients with bipolar disorder and unaffected first-degree relatives.

BACKGROUND: We aimed to evaluate the optical coherence tomography(OCT) findings and oxidative stress parameters in patients with bipolar disorder(BD) and their unaffected first-degree relatives(FDRs) and to explore OCT findings and oxidative stress parameters as potential endophenotype candidates. METHODS: Fifty patients with BD, 40 FDRs of BD, and 50 healthy controls(HCs) were included. OCT was performed to measure peripapillary retinal nerve fiber layer(RNFL), ganglion cell layer(GCL), inner plexiform layer(IPL), central macular, and minimum foveal thicknesses(CMT and MFT), choroidal thickness(ChT). 4-hydroxy-2-nonenal(HNE), total thiol(TT), native thiol(NT), total oxidant status(TOS), total antioxidant status(TAS), disulfide(DIS) and oxidative stress index(OSI) were measured from serum samples. RESULTS: TOS was higher patients with BD and FDRs than HCs (p < .001 and p = .012, respectively). OSI, DIS, HNE levels were higher patients with BD and FDRs than HCs (p < .001). TAS, TT, NT levels were lower patients and FDRs than HCs (p < .001). MFT of patients was thinner than HCs (p = .001). CMT of patients was thinner than HCs (p = .006); the same trend was observed in FDRs but did not reach the statistical significance level (p = .07). The groups did not differ on RNFL and choroidal thickness or GCL and IPL volume. LIMITATIONS: Evaluation of only a few retinal layers. CONCLUSIONS: TOS, TAS, OSI, TT, NT, DIS, HNE can be useful endophenotype biomarkers in BD. Among the OCT findings, CMT was determined as the closest parameter to being an endophenotype biomarker. Our study corroborates that oxidative stress parameters are more effective than OCT findings in endophenotype studies.

Regional analysis of segmented-macular structure in patients with myopic anisometropia.

PURPOSE: To compare intraretinal layers between the eyes in patients with myopic anisometropia, and evaluate the relationship between the layers with spherical equivalent (SE) and axial length (AL). METHODS: In this retrospective study, the more myopic (MM) and fellow (F) eyes of 41 patients with myopic anisometropia, and 38 emmetropic (± 0.50 diopter) control (C) eyes were inclueded. Intraretinal layer segmentation was performed by optical coherence tomography. Global volumes of retinal layers and their thicknesses in nine macular regions were compared. Correlation analysis was used to determine the relationship with SE and AL in each layer. RESULTS: Total retinal, ganglion cell (GCL), inner nuclear (INL), and outer plexiform (OPL) layer volumes in MM eyes were less than in C eyes, while INL and OPL were less than in F eyes. There was no difference in the fovea, except for the retinal pigment epithelium. In MM eyes, only INL and OPL were thin in at least one perifoveal and parafoveal quadrant compared to F eyes. Only INL and OPL thicknesses were significantly correlated with both SE and AL in all perifoveal quadrants. In contrast to the thinning found in MM eyes, the only layer in which thickening was detected to compare to C eye was nerve fiber layer (NFL), which correlated positively with SE and negatively with AL. CONCLUSION: While the fovea is less affected by myopia, thinning becomes remarkable in the perifoveal quadrants. Despite thinning in many layers, especially INL and OPL, NFL thickening may be seen due to myopia.

Effects of 1,25 Dihydroxyvitamin D3 on Human Retinal Pigment Epithelial Cell Lines.

PURPOSE: To assess the effects of 1,25 dihydroxyvitamin D3 (vitamin D3) either alone or under oxidative damage on human retinal pigment epithelium cell lines. METHODS: The human retinal pigment epithelial cell lines were pretreated with hydrogen peroxide with different concentrations (100-1000 µM) and durations (4, 12 and 24 h) to determine the appropriate dose. A group of cells were treated with vitamin D3 alone, and another group of cells were co-treated with different concentrations of (10-100 nM) vitamin D3 and hydrogen peroxide. Anti-cytotoxic, anti-apoptotic and anti-genotoxic effects of vitamin D3 on the hydrogen peroxide treated cell line were evaluated. In addition, mitochondrial membrane potentials of treated cell lines were measured. RESULTS: Vitamin D3 showed statistically significant anti-cytotoxic effects and increased cell viability in all concentrations (p < 0.001). It has also significantly decreased the intracellular ROS generation at concentrations between 10-60 nM and increased intracellular reactive oxygen species in high doses over 90 nM (p < 0.01). When apoptosis was evaluated, vitamin D3 caused statistically significant decrease in a dose-dependent manner (p < 0.001). In terms of DNA damage which was caused by oxidative stress, it was observed that vitamin D3 significantly reduced the damage in a dose-dependent manner (p < 0.001). At the doses of 10-50 nM, vitamin D3 significantly decreased the mitochondrial membrane potential (p < 0.01). CONCLUSION: Our study suggests that 1,25 (OH)2 D3 is capable for alleviating the oxidative damage in ARPE cell lines. With these results, vitamin D is thought to be a therapeutic alternative for the prevention of age-related macular degeneration. This warrants further investigations.

Refractive precision in uncomplicated eyes with pseudoexfoliation: three-piece versus one-piece intraocular lens implantation.

PURPOSE: To evaluate the refractive precision of three-piece versus one-piece intraocular lenses (IOLs) in eyes with pseudoexfoliation (PXF) and changes in anterior chamber depth (ACD) following cataract surgery. METHODS: This prospective, nonrandomized, interventional, comparative case series included PXF eyes, which were implanted with one-piece acrylic IOL or three-piece acrylic IOLs (Group A; n = 31, Group B; n = 30). Non-PXF control eyes were implanted with one-piece acrylic IOL (Group C; n = 30). Postoperative refractive error (RE) and absolute RE, as well as pre- to postoperative ACD changes, were statistically analysed. A p value < 0.05 was considered statistically significant. RESULTS: Changes in ACD (mean ± standard deviation) in Groups A, B and C were 0.9 ± 0.4, 1.0 ± 0.3 and 0.7 ± 0.4 mm, respectively. Significant differences were found between Groups A and C (p = 0.043) and between Groups B and C (p = 0.008). In Groups A, B and C, the median and interquartile (Q1 to Q3) values were 0.3 (-0.8 to 1.0), -0.5 (-0.8 to -0.3) and 0.1 (-0.4 to 0.3) for RE and 1.0 (0.4 to 1.3), 0.5 (0.3 to 0.8) and 0.3 (0.3 to 0.5) for absolute RE, respectively. The RE differences between Group A and B (p = 0.009) and Group B and C (p < 0.001) were statistically significant. For absolute RE, the differences were significant for all comparisons (p < 0.05). CONCLUSION: Refractive precision in PXF eyes may be better with three-piece than with one-piece IOL implantation, but worse than with one-piece IOL implantation in non-PXF eyes. Significant changes in ACD in PXF eyes may be related to RE.

Regression of Serous Macular Detachment After Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema.

Purpose: To assess the effect of intravitreal dexamethasone (Ozurdex®) implant in eyes with serous macular detachment (SMD) secondary to diabetic retinopathy (DRP) with diabetic macular edema (DME). Methods: Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP were included in this study. Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP, which was documented by optical coherence tomography, were included in this study. Intravitreal dexamethasone implantation was performed for treatment to all eyes. Main outcome measures included changes in best corrected visual acuity (BCVA), central neuroretinal thickness (CRT), and height of SMD. After intravitreal dexamethasone implantation, functional and anatomic responses were observed. Results: From the data at 3 months follow-up, we found that the Ozurdex implant was effective in treating SMD with DME, no eyes had lost vision from baseline, 22 eyes (92%) had improved visual acuity, and 22 eyes (92%) had presented SMD regression. Only two eyes had needed dexamethasone implant retreatment. Data at 6-months follow-up, no eyes had lost vision from baseline, 20 eyes (83%) had improved visual acuity, and all eyes had presented SMD regression. Also, after injections and at the end of the follow-up, mean CRT and BCVA were statistically different from the baseline. Conclusions: Intravitreal Ozurdex implantation increases BCVA and reduces SMD and CRT, in patients with SMD. In this context, intravitreal dexamethasone implantation is an effective treatment for SMD in patients with DME.

Comparison of two laser capsulotomy techniques: cruciate versus circular.

PURPOSE: To compare the safety and efficacy of two Nd: YAG laser capsulotomy techniques. METHODS: In this prospective comparative interventional case series, 60 eyes of 57 patients with posterior capsular opacification were enrolled. Thirty eyes were selected to undergo a cruciate capsulotomy (Cross group) and the other 30 eyes were selected to undergo a circular capsulotomy (Circular group). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), amount of energy used, mean macular thickness (MMT), and floater symptoms. RESULTS: The amount of energy used was significantly higher in the Circular group than in the Cross group (p < 0.001). BCVA and IOP were not significantly different between the two groups at baseline or follow-up. MMT was significantly higher in the Circular group than in the Cross group at one day after the laser procedure (p = 0.032). MMT was not significantly different between groups at one week, one month, and three months (p > 0.05). The number of patients with floater symptoms was significantly higher in the Circular group than in the Cross group at one week and one month (p < 0.05). CONCLUSION: Both the cross-like and circular Nd:YAG laser capsulotomy techniques induce similar visual and IOP changes. The circular technique is associated with a higher amount of energy used, more floater symptoms, and has a greater effect on macular thickness at one day after laser capsulotomy.