Comparative study of laser flare photometry versus slit-lamp cell measurement in pediatric chronic non-infectious anterior uveitis.

PURPOSE: To evaluate the role of laser flare photometry (LFP) for monitoring the course of intraocular inflammation in children with chronic anterior uveitis. METHODS: Seventy-six eyes of 43 children with non-infectious chronic anterior uveitis were reviewed retrospectively. RESULTS: The median follow-up was 48.6 ± 23.1 months. Patients on immunosuppressive treatment at last follow-up, showed significantly higher flare values than patients who discontinued treatment (20.47 ± 15.49 vs. 6.33 ± 4.87 p < 0.001). The higher LFP values were correlated with the duration of immunosuppressive treatment, total duration of topical corticosteroid use and the risk for development of ocular complications at all follow-ups (all p < 0.001). No significant correlation was found between the AC cell grades and the duration of immunosuppressive treatment, topical corticosteroid use and the prevalence of complications. CONCLUSION: LFP measurements have a predictive value of monitoring the course of uveitis and the occurrence of ocular complications, and it should be considered as a primary modality to monitor intraocular inflammation in children with chronic anterior uveitis.

Comparison of Aqueous Flare Values after Micropulse Transscleral Laser Treatment and Continuous Wave Transscleral Cyclophotocoagulation.

PURPOSE: The purpose of this study was to analyse the changes in flare values after Micropulse Transscleral Laser Treatment for Glaucoma (MP-TLT) in patients with refractory glaucoma and to compare with the outcomes of patients who underwent continuous wave (CW) diode laser cyclophotocoagulation (CW-TSCPC). METHODS: In this single-centre study, we reviewed the medical records of 54 patients who underwent MP-TLT and 35 patients who underwent CW-TSCPC at Ankara University Faculty of Medicine, Department of Ophthalmology. Aqueous flare values were measured by laser flare photometry. RESULTS: The mean laser flare values in both groups (MP-TLT/CW-TSCPC) increased after surgery from 20.85 ± 8.74/22.14 ± 7.39 ph/ms at baseline to 48.52 ± 18.23/57.38 ± 20.08 ph/ms (P = .001) on day 1 and then progressively decreased to 44.13 ± 18.32/52.24 ± 20.56 in week 1, 40.5 ± 18.5/48.24 ± 19.23 week 2 and 35.28 ± 17.09/41.11 ± 16.7 month 1 (all p < .05) and returned to similar levels to baseline at month 3 and month 6 (both p > .05). Patients who achieved treatment success had significantly higher flare values than patients who failed on post-operative day 1, week 1 and week 2 in both groups. The flare values were significantly lower in the MP-TLT group than the CW-TSCPC group on post-operative day 1, week 1, week 2 and month 1 (all p < .05). There were no cases of prolonged post-operative inflammation or serious complications in both groups. CONCLUSION: Intraocular inflammation, quantified by aqueous flare, may be a contributing factor to the IOP lowering effect of transscleral diode laser cyclophotocoagulation in the early post-operative period.

Comparison of microvascular parameters and diagnostic ability of optical coherence tomography angiography between eyes with primary angle closure glaucoma and primary open angle glaucoma.

BACKGROUND: To investigate and compare the peripapillary and macular microvascular parameters between eyes with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). METHODS: Seventy-nine eyes of 43 patients with primary angle closure glaucoma (PACG), 78 eyes of 43 patients with primary open-angle glaucoma (POAG), 64 eyes of 35 patients with primary angle closure (PAC), and 73 eyes of 40 control subjects underwent imaging with OCTA. Perfusion density (PD) and vessel density (VD) for the macular area, and PD and flux index (FI) for the peripapillary area were calculated automatically. The area under receiver operator characteristic curves (AUC) were constructed to distinguish PACG and POAG eyes from healthy control eyes. RESULTS: The peripapillary FI in all quadrants and PD and VD of the macular outer circle in superior and inferior quadrants were significantly lower in PACG and POAG eyes than in control eyes. The peripapillary FI in the inferior quadrant was significantly lower in the POAG group than in the PACG group (0.348 ± 0.06 vs. 0.369 ± 0.06, p = 0.04). The remaining OCTA parameters in the peripapillary and macular area did not show a significant difference between the POAG and PACG groups. Eyes with PAC presented significantly lower PD and VD than healthy control eyes at the superior and inferior quadrant of the macular outer circle, while retinal nerve fiber layer and ganglion cell inner complex thickness were not significantly different from than control eyes. The best diagnostic parameter was peripapillary FI in both PACG (AUC: 0.922) and POAG (AUC: 0.938) eyes. CONCLUSIONS: We found significantly lower peripapillary FI in the inferior quadrant in POAG eyes compared to the PACG eyes, which may indicate the different underlying pathogenesis between POAG and PACG. The PAC eyes had lower macular PD and VD than normal eyes. This suggests that retinal vascular impairment may develop earlier than structural damage in PAC eyes.

Evaluation of the Use of Brinzolamide-Brimonidine Fixed Combination in Maximum Medical Therapy.

Objectives: To investigate the intraocular pressure (IOP)-lowering efficacy, safety, and treatment tolerability of brinzolamide/brimonidine fixed combination (BBFC) in maximum medical therapy. Materials and Methods: The medical records of 92 patients with glaucoma or ocular hypertension who had previously been treated with a different antiglaucomatous regimen and were switched to a treatment regimen that included BBFC were retrospectively analyzed. Patients were divided into 4 groups including 22, 20, 27, and 23 patients based on previous glaucoma treatment. All patients received maximum medical treatment regimen by adding a combination of beta blocker-prostaglandin analogue therapy along with BBFC. IOP values at baseline and month 1, month 3 and month 6 after starting BBFC and ocular adverse effects at follow-up visits were evaluated. Results: The mean age of all patients was 62.7±16.6 years (range: 18-90). Fifty-two patients (56.5%) were women and 40 (43.5%) were men. Forty-eight (52.2%) patients had primary open-angle glaucoma, 35 (38.0%) had pseudoexfoliation glaucoma, and 9 (9.8%) had ocular hypertension. The IOP of the all eyes was 21.1±4.8 mmHg (range: 17-25) before and 17.6±3.7 mmHg, 17.3±3.4, and 17.0±3.5 mmHg at month 1, 3, and 6 after the introduction of BBFC, respectively (p<0.001 for all time points compared to baseline). In all 4 groups, a significant decrease in IOP was observed at month 1, 3, and 6 follow-ups compared to baseline after the introduction of BBFC. The mean number of antiglaucoma drops was significantly reduced from 2.5±0.6 at baseline to 2 after BBFC (p<0.001). The most frequent ocular adverse event was ocular allergic reactions reported in 8 patients (8.7%), conjunctival hyperemia in 5 patients (5.4%), and ocular discomfort in 2 patients (2.5%). Conclusion: Maximum medical therapy with BBFC provides significant IOP reduction and antiglaucoma therapy simplification with a favorable safety profile in patients with glaucoma.

Clinical Follow-up of Patients with Behçet Uveitis after Discontinuation of Infliximab Therapy.

PURPOSE: To evaluate the clinical course of patients with Behçet uveitis after discontinuation of infliximab (IFX) therapy. METHODS: Medical records of eight patients who discontinued treatment between 2010 and 2018 were retrospectively analyzed. The main outcome measures were frequency of uveitis attacks per year, best-corrected visual acuity (BCVA), aqueous flare, foveal thickness and fluorescein angiography (FA) scores before initiation, during treatment and after 6, 12, and 24 months of cessation of the IFX therapy. RESULTS: The mean follow-up after withdrawal of infusions was 38.6 ± 20.4 (12-90) months. Frequency of uveitis attacks, BCVA, aqueous flare, foveal thickness and FA scores were improved significantly after treatment (p < .05). In terms of these parameters, there was no significant difference between the periods of during treatment and after 6, 12, and 24 months of cessation of the IFX therapy. CONCLUSION: IFX therapy might be discontinued safely with an effective inflammation control in patients with Behçet uveitis.

Comparative efficacy and safety of micropulse transscleral laser cyclophotocoagulation using different duration protocols in eyes with good visual acuity.

PURPOSE: To compare the success rates and safety of micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) for the treatment of refractory glaucoma using the 240-s and 160-s duration protocols in eyes with good visual acuity. METHODS: A retrospective analysis of patients with refractory glaucoma who underwent MP-TSCPC from December 2017 to September 2019 with baseline best-corrected visual acuity (BCVA) of ≥ 20/60. Laser treatments for the moderate and short duration protocols were defined as 240 s and 160 s with settings of 2000 mW/Cm2 and a duty cycle of 31.3%. Follow-up examinations were performed regularly until 12 months after the procedure. RESULTS: Seventy-six eyes of 76 patients were included with BCVA ranging from 20/60 to 20/20. Forty-four eyes were treated with 240 s and 32 eyes were treated with 160-s duration protocols. There was no significant reduction in mean logMAR BCVA and visual field parameters from baseline at any follow-up point in both groups. Visual acuity remained unchanged or improved in 39 of 44 patients (88.6%) in 240-s group and in 28 of 32 patients (87.5%) in 160-s group. Seven of 44 eyes (15.9%) in 240-s group and 12 of 32 eyes (37.5%) in 160-s group required re-treatment for adequate IOP control. After the re-treatments, both protocols showed similar success rates of 79.5% in 240-s group and 75% in 160-s group at 12 months, respectively (p > 0.05). CONCLUSIONS: MP-TSCPC can be offered as a primary surgical treatment for the management of refractory glaucoma in patients with good visual acuity. Considering the high re-treatment rates in 160-s group, the 240-s duration protocol appears to be more effective than 160-s protocol for adequate IOP control.

Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma.

PURPOSE: The aim of this study is to compare the outcomes of micropulse transscleral cyclophotocoagulation between primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. METHODS: Outcomes of 96 consecutive patients with refractory, end-stage glaucoma treated with micropulse transscleral cyclophotocoagulation were retrospectively reviewed. Follow-up examinations were performed on a regular basis until 12 months postoperatively. Surgical successes were defined as maintaining intraocular pressure ⩽18 mmHg and ⩾20% reduction in intraocular pressure (criteria A), ⩽15 mmHg intraocular pressure and ⩾25% reduction in intraocular pressure (criteria B), and ⩽12 mmHg intraocular pressure and ⩾30% reduction in intraocular pressure from baseline (criteria C). RESULTS: Ninety-six eyes of 96 patients (50 (52%) females, 46 (48%) males) were included. Among all eyes, 32 were primary open-angle glaucoma, 30 were pseudoexfoliation glaucoma, and 34 were other types of secondary glaucoma. The mean age was 59.37 ± 11.45 (range: 20-91) years. The mean follow-up period was 14.2 ± 3.9 (range: 12-16) months. At 12 months, the success rates of primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma group were 68.75%, 66.6%, and 64.7% (p = 0.185) for criteria A; 56.25%, 53.3%, and 50% (p = 0.153) for criteria B; and 43.75%, 43.3%, and 38.2% (p = 0.146) for criteria C. Four patients (12.5%) in primary open-angle glaucoma group, 5 patients (16.6%) in pseudoexfoliation glaucoma group, and 14 (41.2%) patients in other secondary glaucoma group required reoperation during the follow-up (p < 0.05). CONCLUSION: Micropulse transscleral cyclophotocoagulation is an equally effective method of lowering intraocular pressure in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. The rate of reoperation was higher in refractory secondary glaucoma patients.

Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes.

AIM: To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), ocular hypertension (OHT) and normal eyes using optical coherence tomography angiography (OCTA). METHODS: A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups (aged 68.17±6.30y, 61.11±10.26y, 58.1±8.9y, and 56.9±4.6y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density (VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness (RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic (ROC) curves. RESULTS: The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors (44.35%±6.78% vs 50.47%±1.83%, P<0.001), the superficial (44.08%±5.46% vs 51.28%±2.85%, P<0.001) and the deep (45.13%±8.55% vs 54.20%±5.44%, P<0.001) vascular plexus. There was a significant difference in peripapillary VD between glaucomatous and OHT eyes (44.35%±6.78% vs 49.86%±2.45%, P<0.001). The OHT group featured a lower superficial (48.06%±4.32% vs 51.28%±2.85%, P=0.027) and deep plexus (48.70%±5.99% vs 54.20%±5.44%, P=0.013) whole image vessel density (wiVD) than did the control group. The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG (42.22%±5.36% vs 46.54%±5.56%, P=0.046). CONCLUSION: OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT, and these results are correlated to functional and structural glaucomatous alterations. Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG. Furthermore, the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

Iris Cysts: Clinical Features, Imaging Findings, and Treatment Results

Objectives: To report the clinical and demographic characteristics, imaging findings, treatment results, and follow-up data of patients with iris cysts. Materials and Methods: The medical records of 37 patients with iris cysts were retrospectively analyzed. Ultrasound biomicroscopy (UBM), swept-source optical coherence tomography (SS-OCT), and SS-OCT angiography (SS-OCTA) were performed to examine the iris cysts. Results: The mean age of the patients was 34.4 years, ranging from 5 to 85 years. Twenty-four patients (65%) were female and 13 (35%) were male. Mean follow-up period was 21.3 months, ranging from 4 months to 8 years. Thirty-five (94.5%) of the cysts were classified as primary and 2 (4.5%) were classified as secondary. Thirty-one (83.7%) of the primary cysts were pigment epithelial and 4 were stromal. Primary iris pigment epithelial (IPE) cysts were classified as peripheral in 26 patients (72.2%), midzonal in 4 (11.1%), and dislodged in 1 (2.7%). Stromal cysts were classified as acquired in 3 patients (8.1%) and congenital in 1 patient (2.7%). Secondary iris cysts were caused by perforating eye injury. UBM could visualize both the anterior and posterior surfaces of the cysts (26 patients). Anterior segment SS-OCT could visualize the anterior but not the posterior surface of the cysts (4 patients). Iris cysts did not display intrinsic vascularity on SS-OCTA (4 patients). All pigment epithelial cysts were managed by observation. Of the 4 primary stromal cysts, 3 were managed by surgical excision and 1 by observation. Two secondary cysts required surgical removal. Conclusion: Pigment epithelial cysts generally remain stable without need for treatment. However, iris stromal cysts frequently require surgical intervention. UBM and SS-OCT were valuable in the diagnosis of iris cysts. On UBM, iris cysts appear with a thin, hyperechoic wall with hypoechoic internal content. Iris cysts did not have intrinsic vascularity on anterior segment SS-OCTA.

Comparison of the Treatment Results for Behçet Uveitis in Patients Treated with Infliximab and Interferon.

Purpose: To compare the efficacy and safety of infliximab and interferon in patients with refractory Behçet uveitis.Methods: Medical records of 20 patients treated with infliximab (IFX) and 33 patients treated with interferon (IFN) were retrospectively analyzed by evaluating the number of uveitis attacks, visual acuity and ocular inflammation at 6 and 12 months after initiation of treatment.Results: Mean duration of treatment was 22 ± 18 months in IFX group and 30.3 ± 22.5 months in IFN group. Sixteen patients of IFX group (80%) and 28 patients of IFN group (85%) achieved remission. In both groups, the mean best-corrected visual acuity and all inflammatory parameters improved. In terms of these parameters, there was no significant difference between the two groups.Conclusion: Infliximab and interferon improve control of ocular inflammation and efficiently decrease the relapse rate. Our results determined no significant difference between two agents in controlling intraocular inflammation.

A Rare Complication of Oropharyngeal Tularemia: Dacryocystitis

Tularemia is a zoonotic disease caused by Francisella tularensis, a highly virulent gram-negative coccobacillus. Oropharyngeal tularemia, one of the clinical subtypes, is the most common clinical form of the disease in Eastern Europe, including Turkey. This clinical form affects mostly the head and neck region and the most common complaints of patients are mass in the neck, sore throat, and fever. This form of tularemia may be confused with tonsillitis, pharyngitis, or cervical lymphadenitis caused by other microbial agents due to the nonspecific clinical and laboratory features. In this study, we present a patient with nasolacrimal duct obstruction and dacryocystitis caused by oropharyngeal tularemia.