Evaluation of ganglion cell complex and retinal nerve fiber layer in children with spina bifida using optical coherence tomography.

PURPOSE: Spina bifida (SB) is a congenital disorder caused by the incomplete fusion of the embryonic neural tube during spinal cord development. In this study, we used Spectral Domain Optic Coherence Tomography (SD-OCT) for retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) analyses and compared the results of healthy children and SB patients in a similar age group. METHODS: Our study was planned prospectively and conducted between June 2017 and July 2019. One hundred eyes of 50 participants, consisting of 28 SB patients and 22 healthy children were included. In all cases, RNFL and GCC measurements were undertaken using SD-OCT. The circumpapillary RNFL analysis was conducted by examining the circular area of 3.45 mm in diameter around the centre of the optic disc. GCC parameters were determined with MM7 protocols by taking 15 vertical sections from a 7-mm macular square centred in the fovea. RESULTS: The mean GCC thickness of the participants was 91.120 ± 5.224 µm in the control group and 91.696 ± 7.410 µm in the SB group. The difference between the two groups was not statistically significant (p > 0.05). The mean RNFL thickness was 102.499 ± 11.250 µm in the control group and 99.549 ± 15.235 µm in the SB group. The mean RNFL thickness of the patients in the SB group was lower than that of the control group, but the difference was not statistically significant (p > 0.05). CONCLUSIONS: In this study, the lack of a statistically significant difference in the RNFL and GCC values between the SB and control groups can be attributed to successful clinical management.

Pharmacogenetic Aspect of Intravitreal Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Five-Year Follow-Up.

PURPOSE: This study aims to evaluate the role of complement factor H (CFH) in response to intravitreal ranibizumab (IVR) treatment, which is administered to patients with neovascular age-related macular degeneration (nAMD). METHODS: In this retrospective study, 90 nAMD patients' 90 eyes were evaluated. IVR was injected once a month for three consecutive months, and then, patients were followed up for five years by using pro re nata method. RESULTS: Average visual acuity (BCVA) values in TT group for the third, fourth and fifth years were found to be significantly higher than those in TC and CC groups, while average BCVA values in TC group were significantly higher than those in CC group (all p = .000 < .0167). CONCLUSION: Patients with CFH TT genotype responded significantly better to treatment after third year, while patients with CC genotype had a poorer response to IVR.

Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratio with visual acuity and macular thickness in age-related macular degeneration.

AIM: To investigate the place of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the diagnosis of and prognosis for neovascular age-related macular degeneration (AMD). METHODS: One hundred AMD patients and 100 healthy controls were included in the study. Blood samples were obtained from the venous blood, which is used for routine analysis, and these samples were subjected to complete blood count. NLR was defined as the neutrophil count divided by the number of lymphocytes, and PLR was defined as the platelet count divided by the number of lymphocytes. RESULTS: No statistically significant difference was observed between the two groups under consideration in terms of demographic features (P>0.05). The average NLR in the patient group was found to be significantly higher than that in the healthy control group (P<0.05). The average PLR was significantly higher in the patient group as compared to the control group (P<0.05). As best corrected visual acuity (BCVA) increased, both NLR and PLR decreased (significant negative correlations at 49.8% and 63.0%, respectively), whereas as central macular thickness (CMT) increased, both NLR and PLR increased (significant positive correlations at 59.3% and 70.0%, respectively). CONCLUSION: NLR and PLR levels are higher among neovascular AMD patients as compared to healthy control group. NLR and PLR levels were found to be inversely proportional to BCVA and directly proportional to CMT.

Dacryoadenitis and extraocular muscle inflammation associated with contact lens-related Acanthamoeba keratitis: A case report and review of the literature.

The present report discusses a new case of dacryoadenitis with extraocular muscle inflammation associated with Acanthamoeba keratitis (AK) in a contact lens wearer. A 41-year-old male, who has worn silicone hydrogel contact lenses on an extended basis for about 10 years, attended with the complaints of vision disturbance, hyperemia, and pain in his right eye. His history revealed that 1.5 month ago, he had been diagnosed with allergic conjunctivitis and had used steroid eye drops. Biomicroscopic examination revealed eyelid edema, chemosis, and ring infiltration, radial keratoneuritis and an epithelial defect in the cornea. Magnetic resonance imaging demonstrated enlarged lacrimal gland with edematous changes consistent with inflammation due to dacryoadenitis. There were also thickening and edema of the right superior oblique and lateral rectus muscle. The treatment protocol for AK was applied with no specific treatment for dacryoadenitis. After 4 months of the treatment, dacryoadenitis and keratitis regressed. Dacryoadenitis and extraocular muscle inflammation may accompany AK more frequently than expected and previously known. The evaluation of the lacrimal gland and extraocular muscles in presence of AK might be beneficial for understanding better the exact clinical picture and course of the keratitis.

Retinal Nerve Fiber Layer Thickness Changes in Age-Related Macular Degeneration Treated with Multiple Intravitreal Ranibizumab.

PURPOSE: The objective of this study was to investigate the effect of multiple intravitreal ranibizumab (IVR) injections on the retinal nerve fiber layer (RNFL) in neovascular age-related macular degeneration (nAMD). METHODS: One hundred sixty-eight eyes of 168 patients with nAMD who received an IVR at least 3 times were included in this prospective interventional case series. The RNFL thickness data on 80 healthy eyes, used as the control group, were obtained. The patients were grouped as follows: 3-10 injections (group 1, 62 eyes, 37%), 10-20 injections (group 2, 62 eyes, 37%), and ≥20 injections (group 3, 44 eyes, 26%). The RNFL thickness was measured by spectral domain optical coherence tomography. RESULTS: The mean baseline measurement of the RNFL thickness was 97.4 ± 6.4 µm in the control group, 96.4 ± 5.6 µm in group 1, 93.8 ± 4.6 µm in group 2, and 93.2 ± 5.3 µm in group 3. At the last follow-up, it was 95.1 ± 2.4 µm in the control group, 93.4 ± 7.3 µm in group 1, 90.5 ± 3.6 µm in group 2, and 89.2 ± 4.9 µm in group 3 (all P values >0.050). A statistically significant difference was not found between the mean total RNFL thickness of the eyes that received injections and that of the eyes in the healthy control group (P value >0.050). A statistically significant difference was not found in all the treatment groups between the intraocular pressure level taken 1 day after the administration of the injections and that recorded preintervention (all P values >0.050). CONCLUSION: Repeated IVR did not lead to a significant change in RNFL thickness in patients with nAMD.

Amniotic membrane in the management of strabismus reoperations.

PURPOSE: To reduce postoperative scar formation and to improve duction using amniotic membrane (AM) in strabismus reoperations. METHODS: A prospective study of interventional case series comprised of 14 patients with restrictive strabismus. Objective clinical findings (visual acuity, angle of deviations and degree of duction deficits) were recorded in both the pre- and post-operative periods. Strabismus surgery included the excision of adhesions and scar tissue, repositioning of extraocular muscles (according to the degree of deviations) and placement of two sheets, one between muscle and tenon and the other between muscle and sclera. Conjunctival recession with covering of the bare sclera using AM was also performed. RESULTS: The mean preoperative deviation of the patients was 34.3 prism diopters (PD) and mean post-operative deviation was 4.6 PD. The mean pre-operative duction deficit of the patients was 1.7; mean post-operative duction deficit was 0.2. Postoperatively all patients improved in relation to deviation and duction. Less than 8 PD deviations with no duction deficits were achieved in 12 (86 %) of the patients. CONCLUSIONS: Amniotic membrane placement around the extraocular muscle improves the duction and decreases the residual angle of deviations by inhibiting postoperative scar formation.

Combination treatment with intravitreal injection of ranibizumab and reduced fluence photodynamic therapy for choroidal neovascularization secondary to angioid streaks: preliminary clinical results of 12-month follow-up.

BACKGROUND: To evaluate combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks. METHODS: This is an interventional case series of 10 previously untreated eyes of 10 patients with choroidal neovascularization secondary to angioid streaks. All eyes were treated with reduced fluence photodynamic therapy using 25 J/cm, immediately followed by intravitreal ranibizumab injection at baseline, and subsequent injections were performed on an as-needed basis thereafter. Treatment efficacy was assessed based on best-corrected visual acuity and optical coherence tomography findings. RESULTS: After 12 months of follow-up, the best-corrected visual acuity improved by >2 lines in 6 eyes (60%), remained within 2 lines of baseline in 3 eyes (30%), and decreased by ≥ 3 lines in only 1 eye (10%). The mean central foveal thickness decreased significantly from 332.2 µm at baseline to 235.7 µm at the last follow-up (P < 0.001), as measured by optical coherence tomography. CONCLUSION: The preliminary results of this prospective study indicate that combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks seems to be effective in reducing or eliminating retinal edema, regression of neovascularization, and improving or stabilizing visual acuity without any complications. Large controlled studies are needed to evaluate the long-term effects of this combination regimen.

Bimatoprost 0.03% versus brimonidine 0.2% in the prevention of intraocular pressure spike following neodymium:yttrium­aluminum­garnet laser posterior capsulotomy.

PURPOSE: The aim of this study was to compare the efficacy of bimatoprost 0.03% with brimonidine 0.2% in preventing intraocular pressure (IOP) elevations after neodymium:yttrium­aluminum­garnet (Nd:YAG) laser posterior capsulotomy. METHODS: In this prospective, randomized, double-masked study, 195 eyes of 195 consecutive patients who had YAG laser capsulotomy for posterior capsule opacification were recruited. Eyes received either 1 drop of bimatoprost 0.03% (98 patients) or brimonidine 0.2% (97 patients) at 1h before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1h, 3h, 24h, and 7 days. Inflammation was evaluated after surgery. Formation of cystoid macular edema was assessed by measuring the macular thickness before and after laser surgery. RESULTS: The average peak of postoperative IOP elevation was 2.2±3.9mm Hg in the bimatoprost 0.03% and 3.6±3.1mm Hg in the brimonidine 0.2% group. The difference was statistically significant (P<0.001). Postoperative IOP elevations of 10mm Hg or more occurred in 1 eye (1.56%) in the bimatoprost 0.03% group and 5 eyes (7.35%) in the brimonidine 0.2%. This difference was statistically significant (P<0.001). Macular edema and anterior chamber reaction were not observed related to bimatoprost. No clinically significant side effects were noted in either group. CONCLUSIONS: Our results indicate that prophylactic use of bimatoprost 0.03% is more effective than brimonidine 0.2% in preventing IOP elevation immediately after YAG laser capsulotomy. Bimatoprost 0.03% as a prostamide analog may provide new option for preventing IOP elevation after YAG laser capsulotomy.

Posterior reversible encephalopathy syndrome after intravitreal bevacizumab injection in patient with choroidal neovascular membrane secondary to age-related maculopathy.

The posterior reversible encephalopathy syndrome (PRES), a complex of cerebral disorders including headache, seizures, visual disturbances, is associated with a variety of conditions in which blood pressure rises acutely. Arterial hypertension can occur in systemic administration of bevacizumab. A few cases of systemic injection of bevazicumab-induced PRES have been reported. In this article, we first report on a patient who developed PRES following intravitreal bevazicumab.

Vitreous levels of VEGF, IL-8, and TNF-alpha in retinal detachment.

PURPOSE: To determine intravitreal levels of interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha), and vascular endothelial growth factor (VEGF) in patients with rhegmatogenous retinal detachment (RD). METHODS: Vitreous samples were collected from 22 eyes of 22 patients during vitrectomy procedures for RD. For controls, vitreous samples were obtained from 12 eyes of 12 patients without RDs during pars plana vitrectomies. Control group patients included four with macular holes and eight with epiretinal membranes; none had any associated vitreoretinopathy. All vitreous samples were immediately frozen at -80 degrees C until assayed. RESULTS: VEGF concentrations were significantly elevated in samples from patients with RDs compared to samples from control patients (p < 0.001). Vitreous concentrations of IL-8 were also significantly elevated in patients with macular edema when compared to control patients (p < 0.05). However, no significant difference was observed in vitreous concentrations of TNF-alpha in subjects with RDs compared to control subjects (p > 0.05). CONCLUSIONS: Increases in IL-8 (an inflammatory angiogenic mediator) and VEGF (a regulatory mediator of cellular proliferation and permeability) may be related to development of proliferative vitreoretinopathy.

Intravitreal bevacizumab in treatment of idiopathic persistent central serous chorioretinopathy: a prospective, controlled clinical study.

PURPOSE: To evaluate and determine the effect of intravitreal bevacizumab in treatment of persistent central serous chorioretinopathy. METHODS: This prospective, comparative clinical study included 30 eyes of 30 patients with persistent, symptomatic central serous chorioretinopathy of 3 months' duration or more. Fifteen eyes of 15 patients were treated with intravitreal injections of 2.5 mg (0.1 ml) bevacizumab (treatment group). Fifteen eyes of 15 patients with the same characteristics who declined treatment were an acceptable control group. The visual and anatomic responses were observed with best-corrected visual acuity and central foveal thickness measured by optic coherence tomography at baseline,1, 3, and 6 months after treatment. RESULTS: Twelve (80%) eyes in the treatment group compared with 8 (53.3%) eyes in the control group showed morphologic restitution at 6 months (P < 0.01). All 15 (100%) treated eyes had stable or improved vision, compared with 10 (66.6%) eyes in the control group (P < 0.01). At 6 months, the mean +/- SD central foveal thickness for the treatment group remained significantly lower compared to the control group, with 174 +/- 68 microm and 297 +/- 172 microm, respectively (P < 0.001). Injection-related complications were not encountered. CONCLUSIONS: Our results indicate that intravitreal bevacizumab injection may be a new, promising treatment option for select patients with idiopathic persistent central serous chorioretinopathy. Continued studies with intravitreal bevacizumab in this population will help to establish its long-term efficacy.

Intravitreal ranibizumab in the treatment of cystoid macular edema associated with retinitis pigmentosa.

PURPOSE: To report and evaluate the anatomic, clinical, and visual acuity response after intravitreal ranibizumab (IVR) injection in patients with cystoid macular edema (CME) due to retinitis pigmentosa (RP). METHODS: This study included 30 eyes of 30 patients with RP who had persistent CME at least 6 months despite medication with acetazolamide. Fifteen eyes of 15 eligible patients were treated with 0.5 mg IVR injection (treatment group). Fifteen eyes of 15 patients with the same characteristics who refused treatment were accepted as control group. The primary outcome of the study (morphologic restitution) was the complete or significant resolution of cystoid space on optic coherence tomography (OCT) without relapse or complication at 6 months. The serial changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured. RESULTS: Thirteen eyes (86.6%) in the treatment group had significant resolution of CME at 6 months after single IVR injection. The difference between the 2 groups in BCVA was not statistically significant (P > 0.05). The baseline mean +/- SD CFT for the treatment and control groups were 478 +/- 88 microm and 469 +/- 75 microm, respectively (P > 0.05). At 6 months after treatment, the mean +/- SD CFT of the treatment group improved to 272 +/- 65 microm whereas that in the control group was 480 +/- 92 microm (P < 0.001). CONCLUSIONS: This investigation indicated that IVR may provide a new therapeutic approach for the treatment of CME secondary to RP. No adverse event was found to be associated with the treatment. Continued experience with IVR in this population will help establish its longer-term efficacy.

Phacoemulsification in patients with nanophthalmos.

OBJECTIVE: To evaluate phacoemulsification surgery and its possible risks in patients with nanophthalmos. DESIGN: The surgical procedure, corneal diameter, keratometry, axial length, visual acuity, and intraoperative and postoperative complications were reviewed. Scleral thickness was determined by echography. PARTICIPANTS: 5 patients, 8 eyes. METHODS: The results of cataract surgery in nanophthalmic eyes were reviewed. Inclusion criteria was based on a clinical diagnosis of nanophthalmos and ocular surgery for cataract. Nanophthalmos was diagnosed according to a shorter than average axial length (usually less than 20.0 mm), typically a shallow anterior chamber, hyperopia, and scleral thickening greater than 1.5 mm. The procedure was planned as phacoemulsification, and foldable acrylic PCIOL implantation via a clear corneal tunnel. RESULTS: The procedure was planned as phacoemulsification. Six eyes had cataract extraction with posterior chamber intraocular lens implantation by phacoemulsification. It was necessary to change the procedure to extracapsular cataract surgery in 2 cases because of uncontrolled shallowing of the anterior chamber. Postoperative trabeculectomy was needed in 1 eye, and Nd:YAG laser capsulotomy was performed on 4 eyes. No postoperative uveal effusion or infections were seen in any of the eyes. Complications included iritis with posterior synechia (n = 1), transient choroidal hemorrhage (n = 1), vitreous loss (n = 1), posterior capsule opacity (n = 4), and glaucoma (n = 1). In 1 case retinal detachment developed 3 weeks postoperatively. Prophylactic laser iridoplasty or iridotomy was not performed for surgery. CONCLUSIONS: Although phacoemulsification seems to be relatively safe in nanophthalmic patients without performing any prophylactic surgical procedure, surgeons need to be attentive of the challenges of working through them when performing phacoemulsification in these high-risk eyes. However, with careful preoperative evaluation and planning, complications can be avoided.

Simultaneous intravitreal and intracameral injection of bevacizumab (Avastin) in neovascular glaucoma.

PURPOSE: To report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization. PATIENTS AND METHODS: The study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle. RESULTS: After treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations. CONCLUSIONS: Simultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.

Intravitreal bevacizumab (Avastin) injection in retinitis pigmentosa.

PURPOSE: To evaluate and report the effectiveness, visual, anatomical, and clinical outcome of intravitreal bevacizumab (Avastin) injection in patients with retinitis pigmentosa (RP). METHODS: Our prospective study included 13 eyes of 7 patients (4 women and 3 men) in the age range of 25-69 years (mean 44.14 years) with cystoid macular edema (CME) secondary to RP. Intravitreal bevacizumab at a dose of 1.25 mg/0.05 ml was injected via a 28-gauge needle. The response rate to treatment was monitored functionally by visual acuity assessment and anatomically using the optical coherence tomography. RESULTS: The baseline mean central macular thickness was 370.15 microm (range 245-603 microm. The central macular thickness decreased to 142.53 microm (range 124-168 microm) after bevacizumab injections. The pre- and post-treatment visual acuity ranges were 5/400-20/100 and 20/200-20/63, respectively. CONCLUSIONS: Our data reveal that intravitreal bevacizumab administration is effective for the treatment of CME in RP. Further studies with a larger population and longer follow-up period are warranted to assess the efficacy of the treatment.

The results of cataract nigra cases operated with the mini-nuc technique.

The purpose of this study was to evaluate the efficacy and safety of the mini-nuc technique for the removal of brunescent and black cataracts. A prospective study was carried out in 33 eyes of 33 patients with cataract nigra operated with the mini-nuc technique between April 2002 and June 2003. Slit-lamp examinations, intraocular pressure (IOP) measurements, and best-corrected visual acuity (BCVA) were assessed pre- and postoperatively. Accompanying systemic diseases were noted. Intraoperative and postoperative complications were evaluated. Unilateral eyes of 33 patients (18 male [54.5%], 15 female [45.5%]) aged between 65 and 90 years (mean 72 years) were operated with the mini-nuc technique. Preoperative BCVA values varied between light perception and 0.2 in the Snellen chart. Intraocular lenses (IOL) were implanted into all of the patients (27 in-the-bag [81.8%], four to sulcus [12.1%], and two with scleral fixation [6.1%]). During the surgery, five patients (15.15%) had zonular dialysis and two (6.1%) had posterior capsule rupture and vitreous loss. Postoperatively, three (9.1%) rises in IOP, two (6.1%) hyphema, and one (3%) IOL subluxation were observed. At the first day visit, the mean of the uncorrected visual acuities (UCVA) was 0.5 in the Snellen chart. At the third month visit, the mean BCVA was observed to be 0.8. The residual mean astigmatism was 0.75 D against the rule. The mini-nuc technique was effective in removing brunescent and black cataracts with a low rate of serious complications. The mini-nuc technique, which is also performed with a small incision and without sutures, might be an alternative to phacoemulsification in cases of cataract nigra.

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma.

PURPOSE: To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. DESIGN: Interventional case report. METHODS: The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. RESULTS: The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. CONCLUSIONS: Our study shows that intravitreal 1.25 mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture.

Acute retinal arterial occlusion after intravenous administration of bevacizumab.

Retinal artery occlusions are usually the result of emboli, although non-embolic causes such as vasculitides, coagulopathies, and vasospasms resulting from migraines and inflammatory conditions do occur. Bevacizumab, a humanised monoclonal antibody, is designed to bind to and inhibit vascular endothelial growth factor (VEGF). VEGF is a protein that plays a critical role in tumour angiogenesis, the formation of new blood vessels to the tumour. The use of bevacizumab has spread worldwide, but the drug related adverse events associated with its use have been reported in a few retrospective reviews. We report on a previously unpublished case of retinal artery occlusion following the use of systemic bevacizumab.

Fixed, dilated pupil after phakic intraocular lens implantation.

A 26-year-old man with degenerative high myopia had bilateral anterior chamber phakic intraocular lens (IOL) implantation under general anesthesia. The preoperative slitlamp examination was normal. No mydriatic drops were used before, during, or after the procedure. Postoperatively, the intraocular pressure (IOP) in the right globe increased to 60 mm Hg. After the IOP was controlled, the pupil became fixed and dilated. Iris fluorescein angiography was obtained and delayed filling of the iris capillary plexus with large areas of no perfusion was observed in the right eye. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. To our knowledge, this is the first report of Urrets-Zavalia syndrome after phakic IOL implantation.