Investigation of the Retinal and Optic Disc Microvascularization in Polycystic Ovary Syndrome: An Optical Coherence Tomography Angiography Study.

PURPOSE: To investigate retinal and optic disc microvascular alterations using optical coherence tomography angiography (OCTA) in women with polycystic ovary syndrome (PCOS). METHODS: Forty-six eyes of 23 patients with PCOS (PCOS group), and 50 eyes of 25 sex and age-matched healthy controls (control group) were included in this cross-sectional study. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic disc were analyzed by OCTA. RESULTS: The superficial parafoveal vessel densities were significantly lower in PCOS group compared to the control group (53.7 ± 4.0%, and 55.4 ± 2.7%, respectively, p = .02). The deep retinal vessel densities, foveal retinal thicknesses and RNFL thicknesses, whole image of optic disc radial peripapillary capillary densities, foveal avascular zone and flow areas were similar between the groups (p > .05 for all). CONCLUSION: OCTA analysis indicates that patients with PCOS tend to have lower superficial parafoveal vessel densities.

Increased Systemic Immune-Inflammation Index Levels in Patients with Dry Eye Disease.

PURPOSE: To evaluate the systemic immune-inflammation index (SII) levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with dry eye disease (DED) and to compare with control subjects. METHODS: This prospective study included 47 DED patients and 47 age- and sex-matched healthy controls. Ophthalmological examination, diagnostic DED tests, and routine complete blood cell count parameters were analyzed. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). RESULTS: The mean SII, NLR, and PLR levels were significantly higher in DED patients compared to controls (p < .001, p < .001 and p = .009, respectively). Using the receiver operating characteristics (ROC) curve analysis to predict patients with DED, the highest area under the curve (AUC) was determined SII (0.761 for SII, 0.727 for NLR, and 0.653 for PLR). CONCLUSIONS: As a novel tool superior to other inflammatory markers, SII may be a cheap and reliable indicator of inflammatory status in DED patients.

Assessment of Red Cell Distribution Width, Platelet/lymphocyte Ratio, Systemic Immune-inflammation Index, and Neutrophil/lymphocyte Ratio Values in Patients with Central Retinal Artery Occlusion.

PURPOSE: To evaluate complete blood count (CBC)-derived inflammatory indices in central retinal artery occlusion (CRAO). METHODS: A total of 42 patients with CRAO (CRAO group) and 42 age- and sex-matched subjects without CRAO (Control group) were included. CBC parameters including red cell distribution width (RDW) levels were assayed. Platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and neutrophil/ lymphocyte ratio (NLR) were calculated. RESULTS: RDW, PLR, SII and NLR values were significantly higher in CRAO group than control group [15.2 ± 1.47% vs 13.96 ± 1.13% (p < .001), 127.94 ± 48.21 vs 101.16 ± 24.84 (p = .008), 667.11 ± 357.84 vs 493.44 ± 207.07 (p = .008), 2.70 ± 1.27 vs 2.13 ± 0.83 (p = .018), respectively]. In multivariate analysis only RDW was independent predictor for CRAO (OR 2.317, p < .001). On ROC analysis, area under curve of RDW, PLR, SII, and NLR for CRAO were 0.761, 0.685, 0.622 and 0.618, respectively. CONCLUSION: RDW seems superior to other inflammatory indices to predict CRAO.

The diagnostic value of systemic immune-inflammation index in diabetic macular oedema.

CLINICAL RELEVANCE: Diabetic macular oedema (DME) is a significant cause of visual impairment and inflammation plays an important role in its pathophysiology. BACKGROUND: This study evaluates the diagnostic value of systemic immune-inflammation index (SII) in the occurrence of DME in patients with non-proliferative diabetic retinopathy. METHODS: In this prospective study, the SII was applied to 150 consecutive patients with non-proliferative diabetic retinopathy. The relationship between the SII and the occurrence of DME was examined. Patients with DME were also divided into two subgroups according to the presence of accompanying sub-retinal fluid. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). The risk factors for DME were evaluated using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve analysis of SII for predicting DME was performed. RESULTS: Patients with DME had significantly higher levels of SII than those without DME (599.7 ± 279.2 and 464. 9 ± 172.2, respectively, p < 0.001). However, The SII values were similar between sub-retinal fluid subgroups. Multivariate regression analysis indicated that SII, together with duration of diabetes, was an independent factor for DME occurrence [Odds ratio (OR) = 1.005, 95% confidence interval = 1.001-1.009, p = 0.04, and OR = 1.146, 95% CI = 1.049-1.252, p = 0.003, respectively]. ROC curve analysis revealed that the best cut-off value of SII was 399 (area under the curve: 0.633; sensitivity: 70%; specificity: 60%). CONCLUSION: An elevated SII value is strongly associated with the development of DME. The SII may be a diagnostic biomarker for identifying DME to improve the risk stratification and management of non-proliferative patients with diabetic retinopathy.

Evaluation of systemic immune-inflammation index level as a novel marker for severity of noninfectious uveitis.

PURPOSE: To evaluate the association of systemic immune-inflammation index (SII) levels, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) with severity of noninfectious uveitis. METHODS: This retrospective study included 46 patients with noninfectious uveitis (uveitis group) and 46 age- and sex-matched healthy subjects (control group). The demographic and ocular findings, localization, and activity of uveitis were recorded at the time of onset evaluation. SII, NLR, and PLR levels of patients were compared between the groups. RESULTS: SII, NLR, and PLR levels were significantly higher in uveitis group when compared to control group (p < 0.001, p = 0.005, and p = 0.001, respectively). While SII and NLR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = 0.006 and p = 0.021, respectively), only SII was significantly higher in severe posterior and panuveitis than mild ones (p = 0.038). CONCLUSION: SII, as a novel inflammation index, may be more significant tool than NLR and PLR in determining the severity of the uveitis. Furthermore, SII may be a potential useful index in clinical practice to follow-up and manage these patients by monitoring response to anti-inflammatory treatment modalities.

Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio levels are associated with keratoconus.

Purpose: The aim of this study was to assess the systemic immune-inflammation index (SII) levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with keratoconus (KC). Methods: A total of 42 patients with KC (KC group) and 42 age- and sex-matched healthy subjects (control group) were included into this cross sectional study. Complete blood count parameters were assayed. SII, NLR, red cell distribution width (RDW), and PLR values were calculated. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). Results: SII, NLR, RDW, and PLR values were significantly higher in KC group compared to control group [709 ± 236 vs. 418 ± 117 (P < 0.001), 2.5 ± 0.8 vs. 1.76 ± 0.3 (P < 0.001), 14.3 ± 1.6% vs. 12.9 ± 0.54% (P < 0.001), and 143 ± 36 vs. 106 ± 23 (P < 0.001), respectively]. Using the receiver operating characteristics (ROC) curve analysis to predict KC, the highest area under the curve (AUC) was determined SII (0.846 for SII, 0.778 for NLR, and 0.796 for PLR). Conclusion: SII, NLR, RDW, and PLR levels were significantly increased in patients with KC. This study supports the idea that several inflammatory pathways may play important role in the pathogenesis of this disorder. SII may be much better marker than NLR and PLR for predicting the inflammatory status of the disease.

Corneal endothelial cell density and microvascular changes of retina and optic disc in autosomal dominant polycystic kidney disease.

Purpose: Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD. Methods: Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography. Results: The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 µm vs. 135 ± 15 µm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all). Conclusion: Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients.

Association of childhood obesity with retinal microvasculature and corneal endothelial cell morphology.

OBJECTIVES: To investigate the optical coherence tomography angiography (OCTA) and specular microscopy (SM) findings in obese children and compare them with healthy ones. METHODS: In this prospective study, 50 eyes of 25 obese children [body mass index (BMI) ≥95th percentile], 36 eyes of 18 control age- and sex- matched healthy subjects (BMI <85th percentile) were included. Demographic features and ophthalmological examination including OCTA measurements as well as SM findings were assessed. Cellular morphology was observed by noncontact SM and results for corneal endothelial cell density (cells/mm2), coefficient of variation of cell size and percentage of hexagonal cells were obtained. The OCTA was performed with 6 × 6 mm sections for macula and 4.5 × 4.5 mm sections for optic disc in all eyes. Foveal retinal thickness (FRT), retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of retina and optic nerve head were analyzed. RESULTS: All SM parameters, RNFL thickness for average, and all quadrants and optic disc radial peripapillary capillary densities were similar between groups. However, FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities were significantly higher in obese group when compared to controls (242.4 ± 18.2 µm vs. 232.1 ± 16.5 µm, p=0.024, 2.2 ± 0.1 mm2 vs, 2.2 ± 0.0 mm2, p=0.042, 22.4 ± 6.9% vs. 15.6 ± 5.5%, p=0.001, and 38.9 ± 7.5% vs. 31.1 ± 8.6 %, p=0.001, respectively). CONCLUSIONS: Obese children seem to have higher values of FRT, flow area for choriocapillaris, superficial and deep foveal capillary densities. These results may have significant implications for understanding of how childhood obesity could affect retinal microvasculature.

The Influence of Topical Cyclopentolate Instillation on Peripapillary and Macular Microvasculature Measured by Optical Coherence Tomography Angiography in Healthy Individuals.

PURPOSE: To investigate the influence of topical cyclopentolate 1%, as an anti-muscarinic mydriatic agent, on the peripapillary and macular microvasculature by optical coherence tomography angiography (OCT-A) in healthy adults. METHODS: A total of 41 healthy adults without any systemic or ocular disease were enrolled for this prospective consecutive study. All patients underwent OCT-A measurements (OptoVue Inc., Freemont, CA, USA) to assess optic disc status for radial peripapillary capillary network (whole image, inside disc, and peripapillary capillary densities), and superficial and deep capillary plexus whole, foveal, parafoveal and perifoveal densities, and foveal avascular zone (FAZ) densities. Foveal retinal thicknesses and all quadrant retinal fiber layer thicknesses were also assessed. The 4.5 mm × 4.5 mm peripapillary and 6 mm × 6 mm macular OCT-A images were undertaken before and 30 min after instillation of topical cyclopentolate 1% to the right eyes. RESULTS: The mean age of subjects was 38.14 ± 14.10 years. All macular, optic disc, and FAZ densities, foveal retinal thicknesses, average, and all quadrant retinal fiber layer thicknesses were statistically similar between baseline and after administration of topical cyclopentolate 1% (P > 0.05). CONCLUSION: The current study demonstrated that pupillary dilation with topical cyclopentolate 1% seems to have no statistical effect on macular and peripapillary OCT-A measurements of healthy adults.

Assessment of platelet-to-lymphocyte ratio in patients with retinal vein occlusion.

PURPOSE: To investigate platelet-to-lymphocyte ratio (PLR) in retinal vein occlusion (RVO) patients. METHODS: In this study, we retrospectively reviewed data of 32 patients with RVO (RVO group) and 32 age- and sex-matched participants without RVO (control group) between January 2017 and March 2019. The PLR was determined by dividing the platelet count by the lymphocyte count. RESULTS: Age and gender were comparable between the groups (p = 0.204 and p = 0.800, respectively). PLR was significantly elevated in the RVO group compared with the control group (137 (113-164) vs 101 (86-129), p = 0.001)). In the receiver operator characteristics curve analysis, the optimal cut-off value of PLR for predicting RVO was 123, with 69% sensitivity and 72% specificity. CONCLUSION: We report that PLR are elevated in RVO, suggesting that PLR may be a useful marker for RVO.

Schnyder Corneal Dystrophy: A Rare Case Report.

INTRODUCTION: Schnyder corneal dystrophy (SCD) is a rare, autosomal dominant, anterior stromal dystrophy described as progressive bilateral corneal opacification due to abnormal accumulation of cholesterol and phospholipids in the cornea. The clinical signs can change as the patient ages. SCD with different presentations may actually be misdiagnosed. Early diagnosis would help to rule out other potentially sight threatening or treatable conditions like infectious keratitis or drug toxicity. CASE: We present a case of a 34-year-old Syrian male patient, came to our clinic for bilateral decreased visual acuity for 5 years. His visual acuity was 0.15 in both eyes. Slitlamp examination revealed corneal arcus or disk-like lesion and polychromatic crystalline depositions in both eyes in subepithelial and the anterior 1/3 of the stroma. The mild onset of arcus lipoides was also seen. Central corneal thickness results were 507 µm in the right eye and 503 µm in the left eye. A diagnosis of Schnyder corneal dystrophy was thought based on clinical presentation and coexistence dyslipidemia of the patient. CONCLUSION: Ophthalmologists should keep in mind SCD and its associated systemic findings that need to be evaluated and managed properly.

Valsalva Maculopathy Associated with a Sudden, Forceful Shout.

Valsalva maculopathy (VM) induced by the Valsalva maneuver may cause a sudden, painless, and dramatic loss of vision in healthy individuals due to a premacular location of the hemorrhage and rupture of retinal capillaries. The prognosis is generally good. The hemorrhage usually clears spontaneously without any treatment. Presently described are clinical findings from a case evaluated as VM resulting from a sudden, forceful shout during a quarrel. A 43-year-old female was admitted to the clinic with a 1-day history of sudden, painless loss of vision in the right eye after sudden, strong shout during an argument. There was no history of trauma or any systemic disease. On examination, the visual acuity was finger count at 1 meter in her right eye, and a central subhyaloid and subinternal limiting membrane premacular hemorrhage was noted. Her intraocular pressure values were 14 mmHg in the right eye and 13 mmHg in the left eye. Her blood pressure measurement was 130/80 mmHg. At 1 month, her vision had improved to 20/25 (LogMAR 0.10) and there was resolution of the hemorrhage without treatment. Although VM is considered to be rare, the events and activities with which it is associated are relatively common in daily life. A sudden, forceful shout and Valsalva stress can lead to dangerous, sudden vision loss due to a premacular hemorrhage.

A Series of Civilian Ocular Injuries from the Civil War in Syria.

OBJECTIVES: This study aimed to evaluate the demographic and clinical features of eye injury cases in the Syrian Civil War. METHODS: A total of 224 eyes of 212 Syrian patients who were referred urgently to Hatay Mustafa Kemal University Faculty of Medicine Department of Ophthalmology between January 2011 and December 2018 were evaluated retrospectively. Types of trauma and clinical findings were analyzed. RESULTS: Patients were predominantly male (n=194, 91.5%). The mean age was 29.50±10.76 (range 1-74) years. A total of 30 (14.15%) patients were <18 years old. Most eye traumas (n=177, 79.0%) were open globe injuries, and the remaining 21.0% (n=47) were closed globe injuries. Intraocular foreign body was detected in 106 (47.32%) eyes. Primary repair was performed in 74.10% (n=166) of the cases, and evisceration was performed in 4.46% (n=10). CONCLUSION: Our study indicated that war conditions can cause serious eye injuries in civilians. These conditions often cause vision and eye loss in adults and children. In addition, all units carrying and treating patient should be strongly coordinated to minimize vision, time, and economic losses.

Plasminogen activator inhibitor-1 4G/5G polymorphism and dyslipidemia with branch retinal artery occlusion in a young lady.

Branch retinal artery occlusion (BRAO) leads obstruction of blood flow in the distribution of the affected vessel giving rise to ischemia and reorganization of the retinal layers. It is a very rare diagnosis and the etiological risk factors of BRAO are not clean in the young population. Various hypercoagulable states leading to thrombosis appeared to be more responsible. Here, the authors present an interesting case of a 25-year-old female patient with BRAO accompanying with plasminogen activator inhibitor-1(PAI-1) 4G/5G gene polymorphism and dyslipidemia together, for the first time. There was a history of sudden painless blurred vision in her right eye 3 months ago. Her visual acuity was 20/20 in both eyes at the admittion. Fundus photo, red-free photo, optical coherence tomography images of 3 months ago revealed BRAO in the right eye. Fundus exam and images taken at the 3th month confirmed the recovery of retinal edema. Attenuation of inferotemporal retinal artery still mildly appeared. Applied confrontation fields showed a visual field defect corresponding with affected area. Ophthalmologists are advised to be aware of the importance of PAI-1 4G / 5G gene polymorphism and dyslipidemia conditions besides the other genetic mutations and thrombophilic markers regarding BRAO in young patients.

Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects.

During surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 µg/kg) plus atropine (15 µg/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group.

Changes in the cornea related to sickle cell disease: a pilot investigation.

PURPOSE: To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). METHODS: This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. RESULTS: The mean CCT value was 509.6 ± 20.7 µm in the study group and 520.8 ± 23.6 µm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm², 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm², 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. CONCLUSIONS: The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion.

OBJECTIVE: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex(®)) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema. MATERIALS AND METHODS: Patients (n = 31) received 1-3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality. RESULTS: Mean follow-up period was 9.7 ± 3.3 months. Mean number of injections was 1.5 ± 0.8. Mean IOP values were 15.6 ± 2.6 mm Hg at baseline, 17.7 ± 3.6 mm Hg at one month, 16.4 ± 4.1 mm Hg at three months, and 16.0 ± 2.7 mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p = 0.008). There were no significant differences in mean ECD (p = 0.375), CV (p = 0.661), percentage of hexagonality (p = 0.287), and CCT (p = 0.331). CONCLUSION: Although intravitreal injection of 0.7 mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.

Scheimpflug imaging in dermatochalasis patients before and after upper eyelid blepharoplasty.

PURPOSE: The aim of this study was to evaluate corneal parameters obtained by Scheimpflug imaging of dermatochalasis patients both preoperatively and after blepharoplasty. MATERIALS AND METHODS: Sixty eyes of 30 patients (22 female, 8 male), which were operated upon for the upper eyelid, were included in the study. Patients were divided into two groups according to preoperative upper margin reflex distance (MRD): MRD < 2.5 mm (Group 1) and MRD ≥ 2.5 mm (Group 2). Preoperative and postoperative (third-month) central corneal thickness, anterior chamber depth, steepest keratometric reading, and astigmatic power vectors were the main outcomes. RESULTS: Postoperatively, the keratometric value of the steepest meridian increased significantly in Group 1 (p = 0.018). Preoperatively and postoperatively, J0 and J45 astigmatic power vectors were similar in each group (in Group 1, for J0 p = 0.20 and for J45 p = 0.67; in Group 2, for J0 p = 0.90 and for J45 p = 0.75). The groups were similar regarding the changes in Ksteep, in astigmatic power vector J0 naJ45 (p = 0.11, p = 0.24, p = 0.55, respectively). CONCLUSIONS: The repositioning of the upper eyelid does not lead to significant changes in visual acuity, steepest keratometric reading, anterior chamber depth, central corneal thickness, or astigmatic power vector of J0 and J45. The only parameter that was significantly different from the preoperative value was the steepest keratometry reading in Group 1 patients. According to our results, blepharoplasty seems not to cause significant changes in the main corneal indices.