Optic nerve head vascular variations in pseudoexfoliative and primary open-angle glaucoma.

PURPOSE: The purpose of this study was to assess the optic nerve head microvascular changes in pseudoexfoliative and primary open-angle glaucoma and define the relationship between vessel density and retinal nerve fiber layer thickness. METHODS: This observational cross-sectional study assessed 72 eyes with primary open-angle glaucoma, 41 eyes with pseudoexfoliative glaucoma, and 60 healthy eyes. On the basis of optic nerve head-centered, 4.5 mm × 4.5 mm scan size images, we evaluated the vessel density, as well as the peripapillary sector, inside disk, and all sectoral quadrants. RESULTS: Both glaucoma Groups had lower vessel density in all regions compared with the healthy Group (p<0.05 for all variables). Vessel densities of the nasal inferior, inferior nasal, and inferior temporal sectors in both glaucoma Groups showed similar results (p=0.157, p=0.128, p=0.143, respectively). Eyes with pseudoexfoliative glaucoma had significantly lower vessel densities than eyes with primary open-angle glaucoma in all other regions (p<0.05 for all variables). For both glaucoma Groups, the average retinal nerve fiber layer thickness positively correlated with vessel density in all peripapillary sectors (p<0.05 for all variables). CONCLUSIONS: Reduction in vessel density correlated with the thinning of retinal nerve fiber layer in both glaucoma Groups. Decreased vessel density in the optic nerve head can be used to demonstrate the microvascular pathologies and possible ischemic changes that lead to faster progression and worse prognosis in pseudoexfoliative glaucoma.

Microvascular changes in obese adults detected by Optical Coherence Tomography Angiography.

Aim: The aim of this prospective, controlled, non-randomized study was the comparison of the retinal microvascular parameters of obese and nonobese adults. Methods: 184 eyes of 92 subjects were separated to 3 groups. 68 eyes were in the normal weight group, with a body mass index between 18.5 and 24.5 kg/ m2, 60 eyes were in the overweight group, with a body mass index between 25-29.9 kg/ m2, and 56 eyes were in the obese group, with a body mass index ≥ 30 kg/ m2. All the volunteers were applied visual acuity, ocular motility testing, and slit lamp and mydriatic fundus examination. Optical Coherence Tomography Angiography (OCT-A) scanning was practiced with Optovue (Optovue, Inc; Fremont, CA) on a 6.00 x 6.00 mm macular region, in the central fovea. Results: 184 eyes of ninety-two patients were involved in this prospective study. The vessels' density (VD) in the optic nerve head (ONH) were significantly lower in the overweight and obese adult volunteers compared to the normal weight control group. However, other OCTA parameters (including macular VDs, Foveal avascular zone (FAZ), choriocapillaris plexus (CCP) area) did not demonstrate any significant difference between groups. Subfoveal choroidal thickness (SCT) was higher in the overweight and obese patients when compared to the normal weight control group. Central macular thickness (CMT) did not reveal any significant difference between groups. Conclusion: Even though clinicians are limited in pointing out any differential findings in obese patients only by fundus examination, OCT-A provides a predictable view of the microvascular changes in the retina and choroid in obese patients. Abbreviations: BMI = Body mass index, WHO = World Health Organization, AMD = Age-related macular degeneration, CT = Choroidal thickness, OCTA = Optical Coherence Tomography Angiography, (W/H) ratio = Waist-hip ratio, ETDRS = Early Treatment Diabetic Retinopathy Study, VD = Vessel density, SCP = Superficial capillary plexus, DCP = Deep capillary plexus, CCP = Flow area of the choriocapillaris, FAZ = Avascular zone, CMT = Central macular thickness, ONH = Optic nerve head.

Effect of the Presence of Silicone Oil in the Anterior Chamber After Complicated Retinal Detachment Surgery on Corneal Morphology by In Vivo Confocal Microscopy.

PURPOSE: This study evaluated the corneal endothelium, stromal keratocytes, subbasal nerve number and density in patients with silicone oil transferred to the anterior camera after pseudophakic complicated retinal detachment surgery by in vivo laser scanning confocal microscopy (IVLSCM). METHODS: Sequential measurements were made by IVLSCM between 3-6 months after surgery in two groups of patients: a) with silicon oil migration (Group 1) and without silicone oil migration (Group 2). RESULTS: A total of 63 cases (Group 1: 32 and Group 2: 31) were examined. The mean ages of patients were 65 ± 12 and 61 ± 11 and M/F ratio was 18/14 and 17/14, respectively. Mean intraocular pressures were 16.60 ± 4.60 and 15.75 ± 5.70 mm Hg, respectively. Changes were detected by IVLSCM mostly on the superior part of the cornea. A significant decrease in endothelial cell density and the number was detected in group 1 (2072 ± 116.2 cells/mm2 vs 2752 ± 512.3 cells/mm2; p < 0.001). Significant increases in posterior keratocyte density and stromal hyperreflective deposits were observed in group 1 (887 ± 45.8 cells/mm2 vs 725 ± 65.8 cells/mm2; p < 0.001). A significant negative correlation was observed between the size of stromal deposits and endothelial cell density (r=-0.758; p < 0.001). The number and density of corneal subbasal nerves were significantly lower in group 1 (1.8 ± 0.8 and 4.8 ± 1.2 vs 420 ± 101 and 701 ± 112 µm/square; p < 0.001). CONCLUSION: IVLSCM is a useful tool for the early detection of corneal abnormalities caused by silicone oil injection. This study verified silicone oil's detrimental effect on the corneal endothelium and revealed stromal changes in the anterior chamber, which we believe can be also been associated with the presence of silicone oil.

Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery.

PURPOSE: To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate. METHODS: Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020 years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods. RESULTS: Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4 min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027). CONCLUSIONS: Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.

Optic nerve head vascular variations in pseudoexfoliative and primary open-angle glaucoma / Variações vasculares da cabeça do nervo óptico no glaucoma pseudoesfoliativo e primário de ângulo aberto

Abstract Purpose: The purpose of this study was to assess the optic nerve head microvascular changes in pseudoexfoliative and primary open-angle glaucoma and define the relationship between vessel density and retinal nerve fiber layer thickness. Methods: This observational cross-sectional study assessed 72 eyes with primary open-angle glaucoma, 41 eyes with pseudoexfoliative glaucoma, and 60 healthy eyes. On the basis of optic nerve head-centered, 4.5 mm × 4.5 mm scan size images, we evaluated the vessel density, as well as the peripapillary sector, inside disk, and all sectoral quadrants. Results: Both glaucoma Groups had lower vessel density in all regions compared with the healthy Group (p<0.05 for all variables). Vessel densities of the nasal inferior, inferior nasal, and inferior temporal sectors in both glaucoma Groups showed similar results (p=0.157, p=0.128, p=0.143, respectively). Eyes with pseudoexfoliative glaucoma had significantly lower vessel densities than eyes with primary open-angle glaucoma in all other regions (p<0.05 for all variables). For both glaucoma Groups, the average retinal nerve fiber layer thickness positively correlated with vessel density in all peripapillary sectors (p<0.05 for all variables). Conclusions: Reduction in vessel density correlated with the thinning of retinal nerve fiber layer in both glaucoma Groups. Decreased vessel density in the optic nerve head can be used to demonstrate the microvascular pathologies and possible ischemic changes that lead to faster progression and worse prognosis in pseudoexfoliative glaucoma.

Resumo Objetivo: Atribuir variações microvasculares à cabeça do nervo óptico no glaucoma pseudoesfoliativo e primário de ângulo aberto, e definir a relação entre a densidade dos vasos e a espessura da camada de fibras nervosas da retina. Métodos: Este estudo foi projetado como observacional e transversal. Foram incluídos 72 olhos com glaucoma primário de ângulo aberto, 41 olhos com glaucoma pseudoesfoliativo e 60 olhos saudáveis. Foram obtidas imagens do nervo óptico centralizadas na cabeça do nervo com 4,5 × 4,5 mm de tamanho de varredura. A densidade vascular foi avaliada em toda a imagem, na área peripapilar, dentro do disco óptico e em todos os quadrantes setoriais. Resultados: Em todas as regiões, a densidade vascular foi menor em ambos os grupos com glaucoma que nos olhos saudáveis (p<0,05 para todas as variáveis). Em ambos os grupos com glaucoma, a densidade vascular mostrou resultados semelhantes nos setores nasal inferior, inferior nasal e temporal inferior (respectivamente, p=0,157, p=0,128 e p=0,143). Os olhos com glaucoma pseudoesfoliativo mostraram densidade vascular acentuadamente menor que nos olhos com glaucoma primário de ângulo aberto em todas as outras regiões (p<0,05). A espessura média da camada de fibras nervosas da retina demonstrou uma correlação positiva com a densidade vascular em todos os setores peripapilares em ambos os grupos com glaucoma (p<0,05 para todas as variáveis). Conclusões: A redução da densidade vascular foi correlacionada a uma redução da espessura da camada de fibras nervosas da retina em ambos os grupos com glaucoma. A densidade vascular reduzida na cabeça do nervo óptico poderia ser usada para provar patologias microvasculares e possíveis alterações isquêmicas responsáveis por uma evolução mais rápida e um prognóstico pior no glaucoma pseudoesfoliativo.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study / O efeito da deficiência de vitamina D nos microvasos da retina: um estudo caso-controle observacional

ABSTRACT Purpose: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. Methods: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. Results: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). Conclusion: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

RESUMO Objetivo: Determinar os efeitos da deficiência de vitamina D nos microvasos da retina usando angiotomografia de coerência óptica. Métodos: Este estudo foi planejado para ser do tipo caso-controle observacional. Foram avaliados 98 olhos de pacientes com deficiência de vitamina D e 96 olhos de participantes saudáveis com nível sérico de vitamina D superior a 30 ng/mL. Foram adquiridas imagens de varredura centralizadas na mácula, com um tamanho de 6,00 × 6,00 mm. Mediram-se a densidade dos vasos nos plexos capilares superficial e profundo da retina, a área da zona avascular foveal e a área do fluxo coriocapilar. Resultados: Os grupos mostraram-se semelhantes em relação à melhor acuidade visual corrigida, ao gênero, ao comprimento axial, ao erro refrativo, à idade e à pressão intraocular ajustada. O nível médio de vitamina D foi significativamente menor no grupo de estudo (p=0,021). As densidades total, parafoveal e perifoveal do plexo capilar profundo foram significativamente maiores no grupo de estudo que no grupo controle (respectivamente, p=0,012, p=0,014 e p=0,023). As áreas da zona avascular foveal e do fluxo coriocapilar foram semelhantes nos dois grupos (respectivamente, p=0,37 e p=0,27). Além disso, houve uma forte correlação negativa do nível sérico de vitamina D com as densidades vasculares medidas em toda a imagem e nas regiões parafoveais e perifoveais do plexo capilar profundo no grupo de estudo (respectivamente, ρ de Spearman = −0,71, p=0,043; ρ de Spearman = −0,79, p=0,011; e ρ de Spearman = −0,74, p=0,032). Conclusão: Pode ocorrer um aumento na densidade vascular da retina devido a alterações estruturais dos vasos causadas pela deficiência de vitamina D. O aumento da densidade vascular, especialmente no plexo capilar profundo, pode ser usado para o diagnóstico precoce da vasculopatia associada à deficiência de vitamina D.

Evaluation of the choroidal vascularity index after subthreshold yellow laser treatment in the patients with chronic central serous chorioretinopathy.

PURPOSE: To assess the choroidal vascularity index (CVI) after subthreshold laser treatment in patients with central serous chorioretinopathy (CSC). METHOD: A total of 32 eyes with CSC were included in this study. In group 1, 14 eyes with persistent CSC were treated with the PASCAL (Endpoint Management Software) at 577-nm wavelength and in group 2, 18 eyes without treatment. The luminal area (LA), stromal area (SA), total area of choroid (TA), and CVI were measured by binarization (ImageJ) of optical coherence tomography images. Changes of choroidal structure parameters were evaluated over 3 months. RESULT: A significant decrease was observed in LA, TA, and CVI at the third month after the laser treatment (p = 0.018, p = 0.024, p = 0.046). The best-corrected visual acuity (BCVA) and choriocapillaris plexus (CCP) flow area values were increased after treatment in group 1 (p < 0.001, p = 0.002). The final subfoveal fluid height, and CVI were lower in group 1 (p = 0.003, p = 0.011). The visual acuity and CCP flow area were higher in group 1 at the third month (p < 0.001, p = 0.003). A positive correlation between the final BCVA and CVI was observed (r = 0.539, p = 0.01). DISCUSSION: Decreased CVI was observed in CSC eyes after subthreshold yellow laser treatment. The CVI may be a useful index to evaluate the response to treatment.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study.

PURPOSE: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. METHODS: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. RESULTS: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). CONCLUSION: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

Sensitivity and Specificity of the Optical Coherence Tomography Angiography for Detection of Neovascularization and Evaluation of Peripheral Ischemia in Diabetic Retinopathy.

Objectives: The purpose of this study was to identify the sensitivity and specificity of optical coherence tomography angiography (OCTA) parameters for the presence of neovascularization elsewhere (NVE) and to investigate the relationship between ischemic areas. Methods: This study included 59 eyes with non-proliferative diabetic retinopathy (NPDR) and 36 eyes with proliferative diabetic retinopathy (PDR). The foveal avascular zone (FAZ), vessel density (VD) for the superficial and the deep capillary plexus (DCP), choriocapillaris flow area (CCP), and non-perfusion area (unit²) were recorded. The area under the curve (AUC) under the receiver operating characteristic curves, sensitivity and specificity were calculated for statistically significant outcomes. Later, based on visual acuity, PDR group was subdivided into group 2A: PDR eyes with VA ≤0.2 logMAR and group 2B: PDR eyes with VA>0.2 logMAR. Non-perfusion area and OCTA features were compared between the subgroups. Results: The VD in DCP was significantly lower, FAZ and non-perfusion area were larger in PDR group (p=0.001, p<0.001, and p<0.001). The AUC for presence of NVE, for the VD, was 0.710 (p=0.012) with sensitivity and specificity of 64% and 65%, for the FAZ was 0.746 (p<0.001) with sensitivity and specificity of 72% and 72.7%. There was a significant positive correlation between the FAZ and non-perfusion area (For NPDR, p=0.025, for PDR p<0.001). There was a significant negative correlation between the VD in DCP and ischemic area in PDR group. (p<0.001) In group 2B, non-perfusion area and FAZ were larger than group 2A. The VD and CCP flow area were also lower in group 2B (All, p<0.05). Conclusion: In cases with decreased VD in DCP and increased FAZ, the probability of PDR increases. Despite the sensitivity and specificity of the OCTA indices for the prediction of NVE being moderate, the OCTA is very useful in evaluating the microvascular structure in DR.

Microvascular differences in amblyopic subgroups: An observational case-control study.

PURPOSE: To determine retinal microvascular differences among amblyopic subgroups and compare them with control eyes. STUDY DESIGN: This study was designed as an observational case-control study. METHODS: Twenty-three strabismic, 23 anisometropic, 22 meridional, 22 ametropic amblyopic eyes, and 24 healthy control eyes were included. The mean vessel densities in the deep and superficial capillary plexus, the foveal avascular zone area, the choriocapillaris flow area, and the foveal thickness were compared. RESULTS: Vessel density was markedly lower in all sectors of the amblyopic subgroups in the deep capillary plexus than in control eyes. Density was significantly lower in the superficial capillary plexus only in ametropic and meridional amblyopic eyes. Among these groups, the meridional amblyopic eyes had the largest choriocapillaris flow area (p = 0.013) and the lowest vessel density in all sectors (p < 0.001). The foveal avascular zone area was similar in all groups (p = 0.561). The fovea was significantly thicker only in the anisometropic and meridional subgroups than control eyes (p = 0.011, p = 0.001, respectively). The foveal avascular zone area was inversely related to the foveal thickness in all groups. CONCLUSION: Retinal structural and microvascular differences were found among amblyopic subgroups. Optical coherence tomography angiography can noninvasively detect these variations, which may be related to the etiologic factors.

Microvascular retinal alterations in rhegmatogenous retinal detachment after pneumatic retinopexy.

PURPOSE: To evaluate the macular microvascularity with optical coherence tomography angiography (OCTA) in rhegmatogenous retinal detachment (RRD) which were successfully treated with pneumatic retinopexy (PR). METHODS: Thirty eyes of thirty patients who were treated with PR (12 eyes with macula-off RRD and 18 eyes with macula-on RRD) were included in this prospective study. OCTA was used to evaluate the macular perfusion changes postoperatively at 1 and 3 months. The fellow eyes (30 eyes) were used as control for comparison. Parafoveal retinal thickness (RT) and best-corrected visual acuity (BCVA) were evaluated. RESULTS: Vessel density (VD) in SCP, DCP and choriocapillaris plexus (CCP) flow area was significantly lower in the macula-off group one month after the PR (p < 0.001). In the macula-off group, VD in SCP, DCP and CCP flow area significantly increased at months 3 (p < 0.001, p < 0.001, p = 0.009). The inner RT, RT and FAZ decreased three months after PR (p < 0.001, p = 0.001, <0.001). The FAZ was significantly larger in the macula-off group at third months after PR (p < 0.001). The inner RT was higher in the macula-off group at third month (p = 0.012). There was no significant difference between the groups in means of final VD, CCP flow area and RT. There was also a negative correlation between the final BCVA (logMAR) and FAZ at month 3 (r = 0.776, p = 0.003). CONCLUSION: Optical coherence tomography angiography evaluation of macular capillary plexuses may be useful for predicting vascular structural changes in patients undergoing PR.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments.

PURPOSE: To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). METHODS: The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. SURGICAL TECHNIQUE: After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. RESULTS: The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. CONCLUSION: Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.

Preclinical ocular features in patients with Behçet's disease detected by optical coherence tomography angiography.

OBJECTIVE: The aim of this study was to evaluate the perifoveal and peripapillary microvascular structure in patients with Behçet's disease (BD) without clinically ocular involvement. METHODS: Fifty-six eyes of 28 patients with Behçet's disease without clinically ocular involvement and 50 age-matched healthy eyes were included in this prospective study. Vessel densities (VD) of macula and optic nerve head, foveal avascular zone (FAZ), choroid capillary plexus (CCP) flow area, perifoveal capillary nonperfusion, capillary dilatation and/or telangiectasia and perifoveal capillary arcade disruption were analyzed with optical coherence tomography angiography (OCTA). The relationship between duration of disease and vessel densities was also evaluated. RESULTS: The FAZ was significantly higher in the BD group (p < 0.001). VD of the foveal and parafoveal region in deep capillary plexus (DCP) were significantly lower in the BD group than in the control group (p < 0.001, p < 0.001). Total disc, peripapillary and inside-disc VD were significantly lower in BD group (p = 0.001, p = 0.002, p = 0.004). Perifoveal morphological changes in DCP were significantly higher in nonocular BD (p < 0.001, p < 0.001, p < 0.001). There was a mild negative correlation between disease duration and whole VD in DCP, total disc VD, peripapillary VD was determined (For whole VD in DCP, r = -0.400, p = 0.035; for total disc VD r = -0.396, p = 0.037; for peripapillary VD r = -0.442, p = 0.018). DISCUSSION: Perifoveal and peripapillary microvascular changes that can be detected by OCTA may occur in Behçet's patients without clinically ocular involvement.

Macular microvasculature differences in patients with macular hole after vitrectomy with internal limiting membrane removal or single-layered temporal inverted flap technique.

PURPOSE: To compare the macular microvasculature differences in cases with idiopathic macular hole (MH) after vitrectomy when using internal limiting membrane (ILM) removal or temporal inverted ILM flap technique (IFT). METHOD: A total of 34 patients were included, of whom 20 were treated vitrectomy with ILM removal (group 1), and 14 were treated with IFT (group 2). The OCTA (RTVue; Optovue, Fremont, CA) parameters, including foveal avascular zone (FAZ), vessel density (VD) ratios in superficial capillary plexus (SCP), and deep capillary plexus (DCP) were evaluated at baseline and 6 months follow-up. The VD measurements in DCP and inner retinal thickness (IRT) in temporal and nasal sectors were compared in subanalyses. RESULTS: There was no significant difference in means of post-operative BCVA and FAZ between the two groups (p = 0.943, p = 0.760). The mean VDs of the DCP was significantly decreased at 6 months postoperatively in both groups (p < 0.001, p < 0.001). The mean post-operative temporal VDs of DCP were similar in the two groups, but the mean post-operative nasal VDs of the DCP was lower in group 1 than in group 2 (p = 0.005 and p = 0.03 for parafovea and perifovea, respectively). The mean temporal IRTs were similar in the two groups, but paranasal and perinasal IRTs were significantly thinner in group 1 than in group 2 (p < 0.001, p < 0.001). The mean post-operative VDs of parafoveal and perifoveal temporal and nasal quadrants in DCP significantly and positively correlated with the IRTs. CONCLUSION: Single-layered temporal IFT causes fewer VD changes when compared to complete ILM removal, especially in the DCP.

Optic nerve head microvascular changes after phacoemulsification surgery.

BACKGROUND: To determine optic nerve head (ONH) microvascular changes detected by optical coherence tomography angiography (OCTA) and intraocular pressure changes (IOPs) after uncomplicated phacoemulsification surgery. METHODS: The study was designed as a prospective observational study. Twenty-four eyes were included. Eyes with retinal vascular pathology, any type of age-related macular degeneration, IOP more than 21 mmHg, axial length less than 20 mm and more than 24 mm, corneal edema and cataracts that can disrupt images, and history of ocular surgery were excluded. Patients underwent OCTA imaging and IOP measurement preoperatively (baseline) and postoperatively (weeks 1 and 4). Vessel density % (VD) in the total disc, peripapillary, and inside disc were measured. IOP was measured with the applanation tonometer. Comparison of VD and IOP and correlation between VD and IOP change were determined. RESULTS: VD was significantly increased in all quadrants in week 4 compared to those in week 1. In terms of VD and IOP, although there was no significant difference between week 1 and baseline, week 4 results were significantly different from baseline (p < 0.05 and p < 0.001, respectively). The IOP was significantly lower in week 4 (14.8 mmHg) than in week 1 (16.0 mmHg) (p < 0.001). There was a significant negative correlation between the inside disc and total VD and IOP at weeks 1 and 4. CONCLUSION: Phacoemulsification surgery can result in a decrease in IOP and an increase in VD of the ONH.

Choroidal thickness in macular holes.

PURPOSE: To determine the association between choroidal thickness (CT) and anatomic success in closed and open macular holes (MHs) following surgery. METHODS: One hundred and thirty-six eyes of 136 patients who underwent surgery due to primary MH were included in this study. Choroidal thickness was measured from various points (subfoveal, temporal, nasal, superior and inferior 1500 µm from the center of the fovea) in both eyes with MH and fellow eyes. We determined associations among the duration of symptoms, MH dimensions and CTs from various points with anatomic success and correlations between CT and MH dimensions and duration of symptoms. RESULTS: Choroidal thickness was significantly lower in eyes with MH than fellow eyes in both open and closed MHs. Base diameter [p = 0.025, odds ratio (OR) = 0.428], minimum hole diameter (p = 0.030, OR = 0.211) and duration of symptoms [p = 0.034, OR = 0.443] were significantly associated with anatomic success. However, CTs from various points were not associated with anatomic success despite a significant preoperative subfoveal CT difference between open and closed MHs (198 ± 21 µm in open MHs and 230 ± 30 µm in closed MHs; p < 0.001). Preoperative subfoveal CT was moderately correlated with base diameter (r = - 0.505, p < 0.001), minimum hole diameter (r = - 0.518, p < 0.001) and duration of symptoms (r = - 0.510, p < 0.001). CONCLUSIONS: Failed MHs were associated with larger hole dimensions (base diameter and minimum hole diameter) and longer duration of symptoms. Preoperative subfoveal CT was thinner in open MHs, but there was no association with anatomic success. Choroidal thinning may be linked to larger and chronic MHs.

Microvascular changes in amblyopic eyes detected by optical coherence tomography angiography.

PURPOSE: To investigate retinal microvascular findings detected by optical coherence tomography angiography (OCT-A) in amblyopic eyes compared with normal eyes. METHODS: A total of 23 amblyopic (strabismic, ametropic, anisometropic, and meridional amblyopia) and 22 normal eyes were included in this prospective observational, comparative study. All patients underwent complete ophthalmological examination and OCT-A imaging. Vessel density (VD) percentage in the superficial and deep retinal vessel plexus, foveal avascular zone (FAZ) area, flow area in the outer retina and choriocapillaris, and retinal thickness in µm in a 6.00 × 6.00 mm scan size were measured and compared between groups. RESULTS: There were no statistically significant differences between groups in terms of age (P = 0.584) and sex (P = 0.661). Mean FAZ area was smaller in the amblyopic group; however, the difference was not statistically significant (P = 0.145). The outer retina flow area was significantly wider in the amblyopic group (P = 0.03). The fovea was thicker in the amblyopic group (P = 0.02). In addition, VD in both the superficial and deep retinal plexus was significantly lower in amblyopic eyes in all quadrants except the fovea. In amblyopic subgroups, VD of anisometropic amblyopic eyes was significantly higher than other subgroups in both superficial and deep retinal plexuses at all regions except the fovea. Other measures were similar in between groups. CONCLUSIONS: Microvascular retinal structural anomalies detectable on OCT-A could shed further light on the causes of amblyopia.

First-Year Outcomes of Cataract Surgery Combined with Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration

Objectives: To compare the first-year results of patients with active neovascular age-related macular degeneration (nAMD) under intravitreal ranibizumab (IVR) treatment who did and did not undergo cataract surgery. Materials and Methods: The records of 72 patients with active nAMD were reviewed retrospectively. Group 1 consisted of 23 patients who underwent uncomplicated cataract surgery and continued with IVR treatment and group 2 consisted of 49 patients without cataract who received only IVR treatment. The groups were compared according to pretreatment and first year best spectacle-corrected visual acuity (BCVA), central foveal thickness (CFT), number of injections, and nAMD activity (presence of subretinal or intraretinal fluid). Logarithm of minimum angle of resolution (LogMAR) was used for the determination of visual acuity. Activity findings were evaluated with optical coherence tomography. Results: Pretreatment BCVA was 0.94±0.21 in group 1 and 0.77±0.36 in group 2 (p=0.041). At the end of the first year, BCVA was 0.48±0.35 in group 1 and 0.49±0.33 in group 2 (p=0.902). BCVA change was 0.46±0.29 in group 1 and 0.28±0.31 in group 2 (p=0.026). Pretreatment CFT was 305±146 µm in group 1 and 340±120 µm in group 2 (p=0.292). At the end of the first year, CFT was 246±110 µm and 245±82 µm in group 2 (p=0.977). CFT change was 59±45 µm in group 1 and 92±97 µm in group 2 (p=0.135). Mean number of injections over 1 year was 6.2±1.9 in group 1 and 5.7±1.8 in group 2 (p=0.271). At the end of the first year, subretinal fluid was observed in 3 patients in group 1 (13%) and 5 patients in group 2 (10.2%) (p=0.721) and intraretinal fluid was present in 3 patients in group 1 (13%) and 4 patients in group 2 (8.2%) (p=0.515). Conclusion: Cataract surgery combined with IVR treatment yielded significant visual gain in patients with active nAMD. Anatomic results suggest that cataract surgery does not worsen nAMD.

A Novel Surgical Method to Treat Chronic Ocular Hypotony.

BACKGROUND AND OBJECTIVES: To assess the effect of a novel surgical method for the treatment of chronic ocular hypotony (COH). The surgical method involves partially blocking the iridocorneal angle and decreasing aqueous humor outflow. A capsular tension ring (CTR) is placed in the iridocorneal angle. PATIENTS AND METHODS: Thirteen eyes of 13 patients were included in this retrospective, interventional case series. All of the eyes had severe ocular hypotony with a diagnosis of hypotony after vitreoretinal surgery or glaucoma filtration surgery. A CTR was placed in the iridocorneal angle via a corneal incision. The follow-up period was at least 1 year. Main outcome measurement was intraocular pressure (IOP). RESULTS: IOP increased in all of the eyes. The increase in IOP persisted during the follow-up period. Visual acuity increased or stabilized in all of the eyes. No ocular complications were noted due to the procedure. CONCLUSIONS: The authors have described a novel and simple technique for the setting of IOP in COH. Mechanical obstruction of aqueous humor outflow with a CTR can increase IOP and stabilize or improve vision in eyes with COH for a follow-up time longer than 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e56-e60.].

Argon laser-assisted hypotony model in the rabbit.

To investigate whether ocular hypotony formation with 360 degrees endocyclophotocoagulation is possible. Twelve male New Zealand White rabbits were used. Entire ciliary body epithelium was destructed with green laser photocoagulation after pars plana lensectomy and anterior vitrectomy in six rabbits. Endocyclophotocoagulation was not performed to the remaining six rabbits (control group). Intraocular pressure (IOP) was measured preoperatively and followed up everyday in the first week and weekly until the end of month one. All of the rabbits were sacrificed and ciliary bodies were left for gross and light microscopic examination. Mean baseline IOPs were similar in laser and non-laser group (14.8 ± 1.4 (range 12.2-17.3) vs 14.4 ± 1.4 (range 12.2-15.9), p = 0.650). Mean IOP was 6.6 ± 0.45 mmHg (range 5.9-7.1) in the laser group and 11.5 ± 1.2 mmHg (range 10.2-13.4) in the non-laser group in postoperative day 1. IOP was below 4 mmHg in all eyes on the second day and after in laser group. In the macroscopic evaluation, the entire ciliary body had a white (loss of pigmentation) and atrophic appearance in all of the eyes in the laser-treated group compared to non-laser group. In the laser group, light microscopic examination demonstrated a severe 360 degrees disruption of ciliary processes. Ciliary processes were covered with fibrin exudation consisting of fibroblasts. There was a mild inflammation with disruption or atrophy of ciliary body epithelium with cystic vacuolar degeneration. Three hundred sixty degrees endocyclophotocoagulation yielded severe ciliary epithelium damage. IOP reduction started very early and continued in hypotonic levels during follow up period.