Evaluation of retinal and choroidal vascular structures in obsessive-compulsive disorder.

PURPOSE: To evaluate the optical coherence tomography-angiography (OCT-A) findings and choroidal vascularity index (CVI) of patients followed with a diagnosis of obsessive-compulsive disorder (OCD) by comparing them with the healthy control group (HCG). METHODS: This prospective study included 33 patients diagnosed with OCD and 32 HCG patients who followed up for at least 3 months. OCT-A images were obtained to evaluate the microvascular circulation, and enhanced HD line images were obtained for the CVI calculation of all patients. RESULTS: Statistical analysis results revealed that the rates of superficial vascular density in the fovea region and deep vascular density in the parafovea region decreased in the OCD group compared to the HCG group (P = 0.003 and P = 0.010, respectively). Subfoveal choroidal thickness values of the OCD group were lower than those of the HCG group (P = 0.008). While total choroidal area and lumen area values were lower in the OCD group than in the HCG group (P < 0.001 and P < 0.001, respectively); CVI values were similar in both groups (P = 0.436). CONCLUSION: The use of the OCT-A device, which is a non-invasive method for detecting retinal and choroidal changes in OCD cases, may provide insight into the pathogenesis of the disease.

Comparative results of use and switching of anti-TNF-alpha agents in adult Behçet's uveitis.

PURPOSE: This study was planned to compare the clinical results and optical coherence tomography (OCT) data of patients who underwent adalimumab (ADA), infliximab (IFX) and switched protocols between these two methods in cases of Behçet's associated uveitis (BAU). METHODS: The patients with BAU who were treated with anti-TNF- α agents for at least one year were qualified for the chart review. The outcome parameters were the steroid-free remission state, the best-corrected visual acuity (BCVA), the central macular thickness (CMT), and the subfoveal choroidal thickness (SFCT) of the patients at the last visit. RESULTS: After a mean follow-up of 16.60 months, the rate of active inflammation decreased from 63.6% to 15.1%. Mean BCVA increased, mean CMT and mean SFCT decreased significantly at the last visit ( P < 0.001, P < 0.001, respectively). CONCLUSION: Anti-TNF- α treatment and switching protocols between these two agents effectively and safely control intraocular inflammation in BAU patients.

Co-assessment of OCT-A and choroidal vascularity index data in multiple sclerosis patients.

OBJECTIVE: To evaluate optical coherence tomography-angiography (OCT-A) findings and choroidal vascular index (CVI) in patients with multiple sclerosis (MS). METHODS: 113 patients, including multiple sclerosis patients with optic neuritis attack (MSON+) and no optic neuritis attack (MSON-) and healthy control group (HCG), participated in this cross-sectional study. OCT-A images of all patients were taken and CVI was calculated. RESULTS: Superior flow (SF), deep flow (DF), foveal, and parafoveal superior vascular density (sVD) were decreased in the MSON+ group compared to HCG (p < 0.05). Optic disk flow (ODF) and optic disk head density (ONHD) values decreased in the MS group (p < 0.05). CVI was decreased in the MSON+ group compared to HCG (p < 0.05). There is a correlation between CVI and foveal and parafoveal sVD. CONCLUSION: Non-invasive diagnostic tools such as OCT-A and CVI can be used for early diagnosis and follow-up of microvascular pathologies in inflammatory diseases such as MS.

Investigation of Retinal Vascular Parameters and Choroidal Vascular Index in Patients Developing Hyphema After Unilateral Blunt Trauma.

BACKGROUND: To evaluate retinal and choroidal vascular changes in cases with hyphema after blunt ocular trauma that did not cause globe rupture or any retinal pathology. METHODS: This cross-sectional study included 29 patients who developed hyphema after unilateral blunt ocular trauma (BOT). The other healthy eyes of the same patients were evaluated as the control group. Optical coherence tomography-angiography (OCT-A) was used for imaging. In addition, choroidal parameters were compared by calculating the choroidal vascular index (CVI) and using choroidal thickness measurements by two independent researchers. RESULTS: Superior and deep flow values were significantly decreased in the traumatic hyphema group compared to the control group (p<0.05). Parafoveal deep vascular density (parafoveal dVD) values were decreased in traumatized eyes compared to control eyes (p=0.000). Vascular density values were similar other than that. In addition, there was a significant decrease in optic disc blood flow (ODF) and optic nerve head density (ONHD) values compared to the control group (p<0.05). In addition, no significant difference was observed between the groups in terms of mean CVI values (p>0.05). CONCLUSION: Non-invasive diagnostic tools such as OCTA and EDI-OCT can be used to detect and monitor early changes in retinal and choroidal microvascular flow in cases of traumatic hyphema.

A new perspective in the treatment follow-up of toxoplasma retinochoroiditis: Infiltrate thickness measurement.

BACKGROUND: This study aimed to describe the spectral domain optical coherence tomography (SD-OCT) findings of active lesions in toxoplasma retinochoroiditis cases and to examine the changes in retinochoroidal infiltrate thickness after treatment. METHODS: A total of 21 newly diagnosed patients with ocular toxoplasmosis were included in this prospective study. A complete ophthalmologic examination and SD-OCT were performed at the first visit. The patients were followed up weekly, and the SD-OCT images were taken over the lesion at each visit for 6 weeks. The characteristics of the active retinochoroiditis focus at the first visit were determined, and the infiltrate thicknesses at all visits were analyzed. RESULTS: A statistically significant BCVA difference was observed at the first visit and at the last visit 6 weeks later (p < 0.01). The first week after treatment showed a significant decrease in infiltrate thickness (113.904 ± 86.001 µm). In the following weeks, this decrease continued more softly. The thickness change at 6 weeks was significantly reduced (16.095 ± 14.784 µm) compared with the previous ones. Weekly infitrate thickness changes were compared among themselves; a statistically significant difference was found between the 1st and 2nd weeks and the 5th and 6th weeks (p = 0.035 and p = 0.007, respectively). Detached posterior vitreous in 71% (15/21) and increased posterior vitreous thickness in 76% (16/21) of active lesion were detected. All patients had 100% (21/21) increased retinal reflectivity and disorganized retinal layers, and choroidal hypo-reflectivity was observed in 86% (18/21). CONCLUSION: SD-OCT is a useful imaging modality in the diagnosis and follow-up of ocular toxoplasmosis cases. Serial thickness measurements of toxoplasma retinochoroiditis lesions may help confirm our diagnosis and determine the need for treatment.

Comparison of both eyes anterior segment structures of patients with unilateral blunt trauma.

BACKGROUND: To evaluate anterior segment optical coherence tomography (AS-OCT) data in patients with unilateral blunt ocular trauma (BOT), to determine the relationship of results with hyphema development. METHODS: 21 patients who received unilateral BOT were included in the study. Healthy eyes of patients were included in the control group. Iris stromal thickness (IST), schlemm canal area (SCA) and pupil diameter were measured by AS-OCT of the participants. In addition, eyes with ocular trauma were divided into those with and without hyphema and compared in terms of these parameters. RESULTS: The mean nasal and temporal (n-t) IST was measured as 373± 40 µm and 369 ± 35 µm in BOT in comparison with 344 ± 35 µm and 335 ± 36 µm in control eyes, respectively (p = 0.000 and p = 0.001, respectively). The mean nasal and temporal (n-t) SCA was measured as 12,571 ± 880 µm2 and 12,162 ± 1181 µm2 in developed hyphema in comparison with 10,455 ± 1506 µm2 and 10,188 ± 939 µm2 in did not develop hyphema, respectively (p = 0.016 and p = 0.002 respectively). CONCLUSION: The ISTs of the traumatized eyes in the nasal and temporal quadrants were statistically thicker than the other healthy eyes. SCA in both nasal and temporal quadrants of eyes with hyphema was statistically significantly larger than the group without hyphema.

A novel spot mutation leading to sialidosis type 1-myoclonus syndrome and optical coherence tomography findings.

This report presents the optical coherence tomography findings and a new NEU1 mutation in bilateral macular cherry-red spot syndrome associated with sialidosis type 1. A 19-year-old patient with a macular cherry-red spot underwent metabolic and genetic analyses supported by spectral-domain optical coherence tomography. Fundus examination revealed bilateral macular cherry-red spot. Spectral-domain optical coherence tomography revealed increased hyperreflectivity in the retinal inner layers and the photoreceptor layer in the foveal region. The genetic analysis detected a new NEU1 mutation, which caused type I sialidosis. In cases with a macular cherry-red spot, sialidosis should be included in the differential diagnosis, and NEU1 mutation should be screened. Spectral-domain optical coherence tomography alone is not sufficient in the differential diagnosis because childhood metabolic diseases may exhibit similar signs.

Comparison of the efficacy of accelerated corneal cross-linking therapy in different pediatric age groups having progressive keratoconus.

PURPOSE: To report a comparison analysis of accelerated corneal cross-linking (A-CXL) treatment for progressive keratoconus patients in different pediatric age groups. STUDY DESIGN: Retrospective, cross-sectional. METHODS: Patients with progressive keratoconus aged ≤ 18 were retrospectively reviewed. Forty-one eyes of 41 patients were included in the study. Patients were divided into two groups according to their age (≤ 14 years and 15-18 years). All patients underwent epithelium-off A-CXL protocol. Acquired data were compared between the two groups. RESULTS: The mean age was 14.3 ± 1.8 (10-18) years. Twenty-five (61%) of the participants were male, and 16 (39%) were female. Twenty (49%) patients were separated into group 1 (≤ 14 years of age), and 21 (51%) were in group 2 (15-18 years). Age at presentation was found to be the only factor in anticipating the progression of keratoconus at the second postoperative year visit (p < 0.001). Progression in keratometric values was detected in seven (35%) of the 20 eyes in group 1, and one (4%) of the 21 patients in group 2 (Z = - 2.44, p = 0.014). CONCLUSION: Even if proper treatment is applied, the progression of keratoconus is likely in patients younger than 14 years of age. Instead of evaluating pediatric patients as a whole, closer follow-up and early treatment may be useful in younger age groups (≤ 14 years).

Evaluation of the Initial Optical Coherence Tomography Parameters in Anticipating the Final Visual Outcome of Central Retinal Vein Occlusion.

PURPOSE: To evaluate the predictive and associated factors in determining the visual outcome in patients having central retinal vein occlusion (CRVO)-related macular edema (ME). METHODS: The charts of the patients who were treated due to CRVO-related visual disturbance were reviewed. The optical coherence tomography (OCT) images of eyes were analyzed, and disorganization of retinal inner layers (DRILs), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption length, hyper-reflectivity of retinal inner layer (HRIL) existence, baseline and final visual acuity (VA), subfoveal thickness (SFT), subretinal fluid (SRF), and injection numbers were noted. The regression and correlation analyses were applied. RESULTS: Thirty eyes of thirty patients were included in the study. The mean follow-up time was 17.5 ± 11 (8-47) months. The mean baseline VA was 1.4 ± 0.7 (0.2-3.1) logMAR. A total of 87 intravitreal injections were applied for the treatment of ME during the follow-up. The initial mean central subfield thickness was 795 ± 264 (1470-398) µm. HRIL and SRF were observed in 16 and 23 eyes at the initial visit, respectively. The final mean VA was 1.2 ± 0.9 (0.1-3.1) logMAR. At the final visit, additional OCT parameters were evaluated. The mean DRIL length was 463 ± 324 µm. The mean disruption length of EZ and ELM was 367 ± 247 µm and 414 ± 327 µm, respectively. The final mean SFT was 290 ± 91 µm. SRF presence at the initial visit was found to be associated with elongated EZ and ELM disruption length at the final visit (P = 0.03 and P = 0.04, respectively). On linear regression analyses, none of the baseline features (SRF, SFT, and HRIL) except baseline poor best corrected visual acuity were found to be predictive in anticipating the final visual outcome (P = 0.04). On linear bivariate analysis, the final poor visual outcome was found to be affected by EZ disruption length of ≥500 µm at the last visit (P = 0.02). CONCLUSION: Baseline VA was the only predictive factor in anticipating the final visual outcome. At the final visit, extensive disruption length of EZ in the subfoveal area was associated with a poor visual outcome.

Long-Term Results of Accelerated Corneal Cross-Linking in Adolescent Patients With Keratoconus.

PURPOSE: To report long-term results of accelerated corneal collagen cross-linking treatment in patients with progressive keratoconus in the pubertal period. METHODS: Patients with progressive keratoconus aged 14 and younger were retrospectively reviewed. Thirty-five eyes of 23 patients, who were followed for at least 4 years postoperatively, were included in the study. Demographic characteristics, uncorrected visual acuity, best-corrected visual acuity, and corneal topography data were recorded. All patients underwent an epi-off accelerated corneal collagen cross-linking protocol. RESULTS: The mean age of the participants was 13 ± 0.5 (11-14) years. Male to female ratio was 3/2. The mean pupillary center to cone apex distance was 1.6 ± 0.5 mm. At presentation, 11 eyes (31%) were classified as stage 1 keratoconus; 14 eyes (40%) were classified as stage 2 keratoconus, 8 eyes (23%) were classified as stage 3 keratoconus, and 2 eyes (6%) were classified as stage 4 keratoconus. The mean follow-up period was 56 ± 8 months. At the first year of the follow-up, central corneal thickness (CCT) and thickness of thinnest point of the cornea (TTPC) were found to be decreased significantly in comparison to preoperative values (P = 0.02 and P = 0.003, respectively). At the second year of follow-up, only TTPC was found to be decreased in comparison to preoperative value (P = 0.01). At the last follow-up visit, CCT was found to be increased significantly in comparison to preoperative CCT (P = 0.04). CONCLUSIONS: After an average follow-up of 56 months, progression was determined in 20% of the eyes despite appropriate treatment. In the last visit, progression was found to be associated with K1, K2, CCT, TTPC, and age.