Efficacy of Intravitreal Bevacizumab in Treatment of Proliferative Type 2 Idiopathic Juxtafoveal Telangiectasia.

OBJECTIVES: To evaluate the effectiveness of intravitreal bevacizumab (IVB) in patients with subretinal neovascularization secondary to type 2 juxtafoveal telangiectasia. MATERIALS AND METHODS: Ten eyes of 10 patients were included in this retrospective study. All cases were treated with IVB (1.25 mg bevacizumab). Visual acuity and slit-lamp anterior and posterior segment examinations were performed at each visit. Central macular thickness (CMT) and intraretinal/subretinal fluid were evaluated via spectral domain optical coherence tomography (OCT). Loss of a line in visual acuity chart and presence of fluid on OCT were defined as criteria for repeated treatment. RESULTS: The mean age of patients was 66.0±7.0 years (56-75). The mean follow-up time was 54.7±16.0 month (24-72). The mean BCVA was 0.62±0.35 (0.00-1.00) logMAR at baseline and 0.54±0.35 (0.00-1.00) logMAR at final exam (p=0.03). The mean CMT was 251±25.4 µm at baseline and 239±39.3 µm at final exam (p=0.01). Patients received an average of 1.7±1.0 IVB injections during follow-up. At baseline, all cases had intraretinal/subretinal fluid. There was no fluid at final examination of all cases. CONCLUSION: IVB treatment may be effective in the treatment of subretinal neovascularization secondary to type 2 juxtafoveal telangiectasia.

SILICONE OIL BARRIER SUTURES IN APHAKIC EYES WITH IRIS DEFECTS.

PURPOSE: To evaluate the efficacy and safety of silicone oil barrier sutures in aphakic eyes with iris defects. METHODS: Sixteen aphakic and iris-defective eyes of 16 patients who underwent a pars plana vitrectomy procedure with silicone oil tamponade because of retinal detachment were included in this retrospective study. Silicone oil barrier sutures were placed as a grid pattern within the plane of the previous iris after vitrectomy and before silicone oil injection. RESULTS: The mean follow-up time after silicone oil barrier suture operations was 12.0 ± 6.8 months. Silicone oil was present in the anterior chamber in five eyes (31%) at the last visit. These eyes also had hypotony, band keratopathy, and anterior proliferative vitreoretinopathy. CONCLUSION: In this study, silicone oil barrier sutures were proven to be safe and effective in preventing silicone oil-corneal endothelium touch in aphakic eyes with iris defects, unless hypotony was present because of anterior proliferative vitreoretinopathy.

The Efficacy of Intravitreal Bevacizumab in Vitreous Hemorrhage of Diabetic Subjects.

OBJECTIVES: To evaluate the efficacy of intravitreal bevacizumab (IVB) in the resolution of vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). MATERIALS AND METHODS: Seventy eyes of 70 patients (43 male, mean age 55.6±12.2 years) diagnosed with VH secondary to PDR were evaluated retrospectively. Demographic characteristics of the patients, baseline and final clinical results, and the interventions the patients were subject to were recorded. The patients who received IVB injections (group 1, n=29) were compared to those who did not receive injections (group 2, n=41) in terms of VH clearance time and surgery rates. RESULTS: The mean follow-up time was 14.5±6.1 months in group 1 and 18.4±9.6 months in group 2 (p=0.185). The mean visual acuity was similar between the groups at baseline and at the last visit (for all p>0.05). Panretinal photocoagulation could be applied in 86% of subjects in group 1 and in 58% in group 2 2 within the first month (p=0.016). VH clearance time was not different between the groups (2.3±2.1 months in group 1 and 3.4±2.6 months in group 2, p=0.146). The number of subjects requiring surgery was 7 (24%) in group 1 and 20 (48.8%) in group 2 (p=0.048). CONCLUSION: IVB was found effective in cases with VH secondary to PDR in terms of reducing the need for surgery and increasing the rate of subjects to whom panretinal photocoagulation could be applied in the early period, although there was no impact on final visual acuity.

Immediate Intraocular Pressure Changes Following Intravitreal Dexamethasone Implant.

PURPOSE: To evaluate the immediate intraocular pressure (IOP) changes following intravitreal dexamethasone implantation. METHODS: Thirty-four eyes of 34 consecutive patients (16 females and 18 males; mean age, 59.9 ± 9.0 years) with diagnosis of macular edema secondary to diabetic retinopathy (20 eyes) or retinal vein occlusion (14 eyes) scheduled for intravitreal dexamethasone implantation (Ozurdex) were included in the study. IOP at baseline, minute 1, minute 10, hour 1, and day 1 was measured using Tono-Pen XL. As a subgroup, the eyes with visible reflux after the implantation were analyzed separately for IOP change. RESULTS: Overall, the only significant change in relation to baseline was observed immediately after the implantation (16.5 ± 3.4 mmHg at baseline vs. 13.5 ± 5.7 mmHg at minute 1, P = 0.004). In eyes with reflux (N = 9), the mean IOP was 15.4 ± 2.4, 6.3 ± 4.2, 10.1 ± 4.4, 15.8 ± 2.9, and 15.6 ± 2.2 mmHg at baseline, minute 1, minute 10, hour 1, and day 1, respectively. The mean IOP was significantly lower at minute 1 (P = 0.008) and minute 10 (P = 0.013). In eyes without reflux (N = 25), the mean IOP was not significantly altered at any time point (for all P > 0.05). The rate of hypotony (IOP <6 mmHg) at minute 1, minute 10, hour 1, and day 1 was 8.8%, 2.9%, 0%, and 0%, respectively. Wound leakage and choroidal detachment were not observed in any of the eyes. CONCLUSIONS: The injection procedure of the Ozurdex implant itself does not affect IOP, except in the case of observable reflux, in which case the IOP temporarily decreases.

Comparison of three methods of tonometry in normal subjects: Goldmann applanation tonometer, non-contact airpuff tonometer, and Tono-Pen XL.

OBJECTIVE: WE AIMED TO COMPARE INTRAOCULAR PRESSURE (IOP) MEASUREMENTS VIA THREE DIFFERENT TONOMETERS: the Goldmann applanation tonometer (GAT), the Tono-Pen(®) XL (TPXL), and a non-contact airpuff tonometer (NCT). METHODS: This was a cross-sectional study of 200 eyes from 200 patients. Right eyes of all patients were included in this study. IOP was measured via GAT, NCT, and TPXL by three physicians. Each physician used one of the tonometers. Measurements via the three devices were compared. RESULTS: The mean IOP was 15.5±2.2 mmHg (range 10-22) with the GAT, 16.1±3.0 (range 9-25) with the TPXL, and 16.1±2.8 (range 10-26) with the NCT. Bland-Altman analysis showed that the mean difference between measurements from the NCT and the GAT was 0.6±2.3 mmHg. The mean difference between the TPXL and GAT measurements was 0.7±2.5 mmHg. The mean difference between the NCT and TPXL measurements was -0.02±3.0 mmHg. There was no significant difference between the groups according to a one-way analysis of variance (ANOVA) test. P-values were 0.998 for NCT-TPXL, 0.067 for NCT-GAT, and 0.059 for TPXL-GAT. CONCLUSION: The NCT and TPXL provide IOP measurements comparable to those of the gold standard GAT in normotensive eyes.

Comparison of intravitreal bevacizumab treatment between phakic and pseudophakic neovascular age-related macular degeneration.

INTRODUCTION: Before the era of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment, only prevention for visual loss might have been achieved in a limited number of neovascular age-related macular generation (nAMD) patients with different treatment options. OBJECTIVE: To compare the efficacy of intravitreal bevacizumab (IVB) for the treatment of nAMD between phakic and pseudophakic eyes. MATERIALS AND METHODS: The newly diagnosed nAMD patients were included in this retrospective study. The patients were divided into the phakic and pseudophakic groups. Initially, the patients received three consecutive, monthly, IVB injections, and then the treatment was continued on an as-needed regimen. The patients were examined monthly, and the data at the baseline, at 3, 6, 9, and 12 months and at the last follow-up were evaluated. The changes in the visual acuity (VA), central retinal thickness (CRT) and the number of injections were compared between the two groups. RESULTS: The study included 62 eyes of 62 patients (39 phakic, and 23 pseudophakic patients). The mean follow-up time was 19.7 and 17.2 months in the phakic and pseudophakic groups, respectively (p=0.06). The mean Log MAR VA at the baseline, 12 months and the last follow-up was 0.82, 0.72 and 0.75 in the phakic group and 0.77, 0.67, and 0.68 in the pseudophakic group, respectively. The change in the mean BCVA from the baseline to 12 months and at the last follow-up was not statistically different between the two groups (p=0.9 and p=0.7, respectively). The mean injection number at 12 months was 4.5 and 4.9 in the phakic and pseudophakic group, respectively (p=0.2). CONCLUSION: The beneficial effect of IVB is equal in both the phakic and pseudophakic group of nAMD patients. The functional and anatomical outcomes of the treatment and the number of injections were similar in the two groups.

Laser in situ keratomileusis in adult patients with anisometropic amblyopia.

AIM: To evaluate the increase in corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) in adults with anisometropic amblyopia. METHODS: The medical records of consecutive patients diagnosed with anisometropic amblyopia at the time of refractive evaluation who underwent LASIK were retrospectively reviewed. Patients with at least a two-line difference of visual acuity (VA) between the eyes with a spherical refractive error difference of at least 3.00 diopters (D) or an astigmatic difference of at least 2.00D were included. Patients with any other possible reason for amblyopia other than anisometropia or those who had undergone previous amblyopia treatment were excluded. Amblyopic eyes with myopia or myopic astigmatism were considered as group 1, hypermetropia or hypermetropic astigmatism constituted group 2, and mixed astigmatism patients comprised group 3. Uncorrected distance visual acuity (UDVA), subjective manifest refraction, and CDVA were analyzed at 1 week and 1 month, 3, and 6 months. RESULTS: The study included 57 eyes of 57 patients. There were 33 eyes in group 1, 12 eyes in group 2, and 12 eyes in group 3. The preoperative mean values for spherical equivalent of subjective manifest refraction (SE) in groups 1, 2, and 3 were (-4.66±1.97)D, (4.40±1.00)D, and (0.15±1.05)D, respectively. Mean CDVA improved 0.1 log units (1 line LogMAR) at 6 months (P<0.05). Sixteen eyes (28%) exhibited an improvement in CDVA in week 1. Fourteen eyes (25%) experienced two or more lines of CDVA improvement at month 6. There were no statistically significant differences among the groups in terms of CDVA (P>0.05). Moreover, age, the amount of preoperative refractive error, and the levels of preoperative corrected and UDVA had no effect on postoperative CDVA improvement (P>0.05). CONCLUSION: Correction of refractive errors with LASIK produced significant CDVA improvement in adult patients with anisometropic amblyopia and no previous amblyopia treatment.

Photorefractive keratectomy in the correction of astigmatism using Schwind Amaris 750s laser.

AIM: To evaluate the results of three photorefractive keratectomy (PRK) procedures in the treatment of astigmatism. METHODS: In this retrospective comparative case series, 89 eyes of 50 patients who underwent PRK treatment for astigmatism were enrolled. The patients were divided into 3 groups based on the PRK procedure: Group 1: PRK without mitomycin-C (MMC) application, Group 2: PRK with MMC application, and Group 3: Trans-Photorefractive Keratectomy (T-PRK). The efficacy, safety, predictability, and complications of treatment were assessed at 1, 3 and 6 months after the treatment. RESULTS: At postoperative 6 months, the percentage of postoperative uncorrected visual acuity (UCVA) of 20/20 or better was 55.6% (20 eyes) in group 1, 75% (15 eyes) in group 2, and 75.8% (25 eyes) in group 3 (P=0.144). The percentage of postoperative best corrected visual acuity (BCVA) of unchanged or gained ≥1 lines was 80.6% (29 eyes) in group 1, 70% (14 eyes) in group 2, and 90.9% (30 eyes) in group 3 (P=0.151). The percentage of postoperative BCVA of lost ≥2 lines was 11.1% (4 eyes) in group 1, 20% (4 eyes) in group 2, and 6.1% (2 eyes) in group 3. The mean manifest refractive spherical equivalent (MRSE) and mean cylindrical refraction were not significantly different among the each groups (P>0.05). At postoperative 6 months, the percentage of MRSE of within ±0.50 D was 100% (36 eyes) in Group 1, 100% (20 eyes) in Group 2, and 93.9% (31 eyes) in Group 3. At the each follow-up period, there was no significant difference in number of eyes with haze and mean haze score(P>0.05). CONCLUSION: The study showed that PRK without MMC, PRK with MMC and T-PRK appears to have similar effectiveness, safety and predictability in the treatment of astigmatism. The incidence of haze was also similar between the three groups.

Assessment of the anterior chamber angle in patients with nanophthalmos: an anterior segment optical coherence tomography study.

PURPOSE: To quantitatively assess the parameters of anterior chamber and angle dimensions by anterior segment optical coherence tomography (AS-OCT) in nanophthalmos. METHODS: In this prospective, cross-sectional and comparative study, 34 eyes of 34 healthy individuals (control group) and 37 eyes of 37 patients with nanophthalmos (study group) were enrolled. A single experienced ophthalmologist imaged and measured the right eye with the Visante AS-OCT. The anterior chamber angle (ACA), angle opening distance (AOD) at 500 and 750 µm from the scleral spur, and trabecular-iris space area (TISA) at 500 and 750 µm at the nasal and temporal angles were measured. RESULTS: Mean nasal/temporal ACA was 44.90 ± 9.09/47.07 ± 8.69° in the control group and 32.15 ± 10.30/29.77 ± 10.57° in the study group (p < 0.001). Mean nasal/temporal AOD500 and AOD750 was 0.52 ± 0.18/0.53 ± 0.15 mm and 0.71 ± 0.26/0.71 ± 0.23 mm in the control group. The mean nasal/temporal AOD500 and AOD750 were 0.33 ± 0.12/0.31 ± 0.15 mm and 0.48 ± 0.16/0.47 ± 0.22 mm in the study group. Mean nasal/temporal TISA500 and TISA750 were 0.16 ± 0.06/0.17 ± 0.05 mm(2) and 0.31 ± 0.11/0.33 ± 0.09 mm(2) in the control group. Mean nasal/temporal TISA500 and TISA750 were 0.11 ± 0.04/0.09 ± 0.05 mm(2) and 0.20 ± 0.07/0.20 ± 0.10 mm(2) in the study group. All values were significantly lower in the study group compared with the control group. CONCLUSION: Determination of angle parameters using AS-OCT is a rapid noncontact method that is useful in patients with nanophthalmos. The findings demonstrated that nanophthalmic eyes had lower ACA parameters including ACA, AOD500, AOD750, TISA500 and TISA750 at the nasal and temporal angles.

Biomechanical evaluation of cornea in topographically normal relatives of patients with keratoconus.

PURPOSE: To compare the biomechanical properties of the cornea between topographically normal relatives of patients with keratoconus and age-matched controls. METHODS: Thirty healthy individuals (control group) and 30 topographically normal relatives of patients with keratoconus (study group) were enrolled in this prospective, cross-sectional comparative study. Topographical measurements including pachymetric values, keratometry values, irregularity, and inferior-superior dioptric asymmetry difference values in the right eye of each participant were obtained using Orbscan II (Bausch & Lomb Laboratories, Inc, Rochester, NY). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure, and Goldmann-related intraocular pressure were also measured using the Reichert Ocular Response Analyzer (ORA). RESULTS: Topographic parameters were not significantly different between both groups (P > 0.05). Mean CH was 9.9 ± 1.6 mm Hg in the study group and 11.3 ± 1.0 mm Hg in the control group (P = 0.001); mean CRF was 9.8 ± 1.6 mm Hg and 11.2 ± 2.1 mm Hg in the study and control groups, respectively (P = 0.013). Mean Goldmann-related intraocular pressure was 15.0 ± 4.3 mm Hg in the study group and 15.8 ± 6.7 mm Hg in the control group (P = 0.603); mean corneal compensated intraocular pressure was 16.2 ± 4.7 mm Hg in the study group and 15.4 ± 5.8 mm Hg in the control group (P = 0.595). CONCLUSIONS: The CH and CRF values were significantly lower in the relatives of patients with keratoconus than in the controls. Future studies including monitoring of these participants with topographical and biomechanical measurements may indicate the role of this study in detection of early corneal changes in relatives of patients with keratoconus.

Corneal biomechanical properties and intraocular pressure measurement in patients with nanophthalmos.

AIMS: To compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with nanophthalmos and age-matched controls. METHODS: In this prospective, cross-sectional and comparative study, 27 eyes of 27 healthy individuals (control group) and 27 eyes of 27 patients with nanophthalmos (study group) were enrolled. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc) and Goldmann correlated intraocular pressure (IOPg) were recorded for the right eye of each participant using Reichert Ocular Response Analyser measurements. Also, all participants in this study underwent a standardised ocular examination including IOP measurement with Goldmann applanation tonometry (IOP(GAT)), central corneal thickness and axial length (AL) assessments. RESULTS: Mean CH in the nanophthalmic eyes and in the control eyes were 13.3 ± 2.4 mm Hg and 11.6 ± 1.7 mm Hg, respectively (p=0.003); mean CRF values in the nanophthalmic and the control eyes were 13.2 ± 1.8 mm Hg and 11.4 ± 1.9 mm Hg, respectively (p=0.001). Mean IOP(GAT) was 15.2 ± 3.3 mm Hg in the nanophthalmic eyes and 13.4 ± 2.7 mm Hg in the control group (p=0.031); mean IOPg values for the nanophthalmic and the control groups were 17.1 ± 5.3 mm Hg and 14.7 ± 3.5 mm Hg, respectively (p=0.042). Mean IOPcc values in the nanophthalmic and the control group were 13.6 ± 6.1 mm Hg and 14.8 ± 3.2 mm Hg, respectively (p=0.365). CONCLUSION: The CH, CRF, IOPg and IOP(GAT) were significantly higher in the nanophthalmic eyes, whereas no significant differences in IOPcc were observed. These findings may be taken into account when measuring IOP values in patients with nanophthalmos.

Corneal biomechanical properties and intraocular pressure measurement in Marfan patients.

PURPOSE: To compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with Marfan syndrome and age-matched controls. SETTING: Departments of Ophthalmology and Genetics, Bakirkoy Maternity and Children Diseases Hospital, and Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. DESIGN: Cross-sectional study. METHODS: This study comprised patients with Marfan syndrome (study group) and healthy individuals (control group). The study group was subdivided into patients with ectopia lentis and patients without ectopia lentis. In the right eye of each patient, the corneal hysteresis (CH), corneal resistance factor (CRF), Goldman-correlated IOP, and corneal-compensated IOP were recorded. RESULTS: Overall, the mean CH, CRF, Goldman-correlated IOP, and corneal-compensated IOP were not significantly different between the study group and the control group. The mean CH was 9.9 mm Hg ± 1.2 (SD) in study eyes with ectopia lentis and 11.2 ± 1.5 mm Hg in study eyes without ectopia lentis (P=.016); the mean CRF was 8.2 ± 1.8 mm Hg and 11.3 ± 1.9 mm Hg, respectively (P<.001). The mean Goldman-correlated IOP was 11.7 ± 2.7 mm Hg in study eyes with ectopia lentis and 16.2 ± 4.3 in study eyes without ectopia lentis (P=.003); the mean corneal-compensated IOP was 13.5 ± 4.1 mm Hg and 15.6 ± 3.8 mm Hg, respectively (P=.07). CONCLUSION: The CH, CRF, and Goldman-correlated IOP were significantly lower in the Marfan syndrome eyes with ectopia lentis than in the Marfan syndrome eyes without ectopia lentis.