Choroidal Vascularity Index as a Potential Inflammatory Biomarker for Obsessive Compulsive Disorder.

BACKGROUND: To evaluate choroidal vascularity index (CVI) and to investigate the association of CVI with neutrophil-to-lymphocyte ratio (NLR) as an indicator of inflammation in obsessive-compulsive disorder (OCD). MATERIAL AND METHODS: This prospective study included newly diagnosed OCD patients and healthy controls. All patients underwent EDI-OCT imaging to assess the subfoveal choroidal thickness (sCT) and peripapillary CT (pCT). CVI was defined as the ratio of luminal area to stromal area after binarization on EDI-OCT images. RESULTS: A total of 39 patients with OCD and 25 controls were included. The sCT, pCT, and CVI values were significantly higher in the OCD vs. control group (p˂0.05 for all). The NLR values were significantly higher in the OCD vs. control group (p = .007). A significant positive correlation was noted between CVI and NLR (p = .039). CONCLUSION: Our findings suggest that systemic inflammation may play a role in the pathogenesis of OCD.

The pupillary dynamics of patients with physiological anisocoria.

BACKGROUND: To evaluate static pupillometric measurements and making inter-ocular comparative analysis in healthy subjects for demonstrating the prevalance of physiological anisocoria in various lighting conditions and to compare the variations of the dynamic pupillometric measurements of the patients with physiological anisocoria. METHODS: Automatic quantitative pupillometry system was used to measure pupillary diameters in low mesopic (0.1 cd/m2), high mesopic (1 cd/m2), low photopic (10 cd/m2) and high photopic (100 cd/m2) conditions. After inter-ocular comparison of these data, the prevalance of physiological anisocoria was detected in four different lighting conditions. The inter-ocular dynamic pupillometric parameters (amplitude, latency, duration and velocity of pupil contraction; latency, duration and velocity of pupil dilation) of these patients were further analysed. RESULTS: After inter-ocular comparison of pupillary diameters of 195 participants [96 females (49.2%) and 99 males (50.8%)] with a mean age of 38.4 ± 18.9 years (range 7-78 years), six (3.1%) participants under high photopic; 11 (5.6%) participants under low photopic; 25 (12.8%) participants under high mesopic, and 34 (17.4%) participants under low mesopic illumination levels exhibited physiological anisocoria. The mean relative amplitude of anisocoric small pupils' contraction was lower than the mean relative amplitudes of pupil contraction of both isocoric and anisocoric large pupils (p = 0.021, p = 0.035, respectively). The mean velocity of anisocoric small pupils' contraction was lower than the mean velocity of anisocoric large pupils' contraction (p = 0.013). CONCLUSIONS: The mean contraction amplitude and contraction velocity of smaller pupils was lower when compared to fellow larger pupils of anisocoric patients.

The relationship between retinal microcirculation and right heart catheterization and echocardiography findings in patients with idiopathic pulmonary arterial hypertension.

OBJECTIVE: To determine the possible alterations of retinal microcirculation associated with right-sided intracardiac pressures in patients with IPAH. METHODS: Twenty patients with IPAH and 20 age- and sex-matched healthy controls were included in the study. Hemodynamic data were obtained from the most recent right heart catheterization. Echocardiographic examination was performed within 24 h of ophthalmological examination. For the right eyes of all participants, high-resolution scans of chorioretinal microvascular networks at different depths of the retina were captured via OCT angiography. RESULTS: The perfusion of the superficial and deep capillary plexus (SCP and DCP), and choriocapillaris (CCP) flow area were significantly lower than those in healthy control subjects (p < .05 for all). In IPAH group, PVR and mPAP were correlated significantly with the perfusion measurements at SCP and DCP (r = .461, r = .626 and r = .625, r =0.730, respectively, p < .05). sPAP and TRV were positively correlated with the perfusion measurements at SCP and DCP (r = .600, r = .662 and r = .670, r = .655 p < .05). CONCLUSIONS: The positive correlation of retinal perfusion at SCP and DCP with right-sided echocardiographic and hemodynamic measurements unveiled that retinal microcirculation is affected by the pressure alterations in the pulmonary circulation of IPAH patients.

Treatment of neovascular age related macular degeneration during COVID-19 pandemic: The short term consequences of unintended lapses.

AIM: To investigate the short-term effects of COVID-19 pandemic related unintended treatment lapses on neovascular age related macular degeneration (nAMD) patients. METHODS: In this prospective cross-sectional study, 140 patients who had at least one anti-vascular endothelial growth factor (VEGF) injection for nAMD within 12 months before COVID-19 pandemic and who had at least 3 months of unintended lapse for control visits during pandemic were recruited and underwent a detailed opthalmological examination and optical coherence tomography imaging. RESULTS: Of these 140 eyes, 113 (80.7%) were active with presence of either intraretinal and/or subretinal fluid and necessitated intravitreal anti-VEGF injections; and 20 (14.3%) of them complicated with subretinal hemorrhage. The mean interval of clinical visits and intravitreal antiVEGF injections were found to be prolonged during COVID-19 pandemics, which demonstrates a statistically significant lapse for both (p = 0.001 and p = 0.003 consecutively). The decreased visual acuity due to lapse was positively correlated with number of intravitreal anti-VEGF injections at last 6 months before COVID-19 pandemic (r = 0.217, p = 0.010) and central subfoveal thickness at first post-COVID-19 visit (r = 0.175, p = 0.038); and negatively correlated with follow-up duration (r = -0.231, p = 0.006) and number of control visits (r = -0.243, p = 0.004). Fifteen (16.9%) of the 89 patients who had drusen in the fellow eye before COVID-19 pandemic evolved to nAMD with an accompanying subretinal and/or intraretinal fluid. CONCLUSION: Unintended lapses during COVID-19 pandemic resulted with poor functional and structural outcomes for nAMD patients, especially for those at the beginning of the treatment period and who still have an unstable clinical course.

Choroidal vascular changes in acne patients under isotretinoin treatment.

PURPOSE: The aim of this study was to evaluate the potential changes in choroidal vasculature in nodulocystic acne patients under isotretinoin treatment by using choroidal thickness (CT), choroidal vascularity index (CVI), and choriocapillaris (CC) flow area. MATERIALS AND METHODS: This prospective study included nodulocystic acne patients under isotretinoin treatment and healthy controls. All patients underwent enhanced depth imaging-optical coherence tomography (EDI-OCT) imaging to assess the subfoveal CT and submacular CVI, and optical coherence tomography angiography (OCTA) imaging to evaluate the CC flow area. RESULTS: A total of 25 patients with acne and 23 controls were included. The mean duration of the treatment was 7.20 ± 0.79 months and the mean daily isotretinoin dose was 38.7 ± 2.8 mg in the acne group. The mean CT and CVI values were significantly higher in the acne group compared to the control group (p = 0.005 and p = 0.027, respectively). The cumulative isotretinoin dose was positively correlated with subfoveal CT and submacular CVI (r = 0.434, p = 0.015 and r = 0.385, p = 0.033, respectively). Regarding the CC flow area, the values for area with a radius of 1 mm, 2 mm and 3 mm were lower in the acne group than in the control group; however, the difference was not significant (p > 0.05, all values). CONCLUSION: After a mean 7-month course of isotretinoin treatment, subfoveal CT and submacular CVI values were significantly higher in the nodulocyctic acne patients. Whether the choroidal changes are permanent or not should be investigated in future studies.

Evaluation of the optic nerve head vessel density in patients with limited scleroderma.

OBJECTIVES: To investigate the optical coherence tomography angiography (OCTA) parameters of the optic nerve head and peripapillary retina and to assess macular and peripapillary retinal nerve fiber layer (RNFL) thickness by using spectral-domain optical coherence tomography (SD-OCT) in patients with limited scleroderma and to compare these results with those of healthy control subjects. MATERIALS AND METHODS: 42 patients with a confirmed diagnosis of limited scleroderma and 32 age- and sex-matched healthy control subjects were included in the study. OCTA was performed for the radial peripapillary capillary plexus (RPCP) whole image, inside disc, and peripapillary vessel densities in all participants with XR Avanti AngioVue OCTA (Optovue, Fremont, California, USA). OCT images were obtained with Spectralis OCT with eye-tracking dual-beam technology (Heidelberg Engineering GmbH, Heidelberg, Germany), and peripapillary RNFL thickness was evaluated with circle program. The data from the right eyes of all participants were used for statistical analysis. RESULTS: No significant difference was found between the radial RPCP whole image, inside disc, and peripapillary vessel density values or the RNFL parameters of the scleroderma patients when compared with the controls (p > 0.05 for all). CONCLUSION: Decreased peripapillary vessel density on OCTA, which can be an early sign of glaucoma, could not be observed in scleroderma patients in this study. However, further long-term studies are still needed to identify glaucoma tendency in patients with scleroderma before clinically detectable glaucoma.

The effect of ocular dominance on macular function: A pattern electroretinogram study.

PURPOSE: To investigate the effect of ocular dominance on pattern electroretinogram (PERG) recordings in the participants who have no ophthalmic diseases. METHODS: One hundred and twelve eyes of 56 participants (mean age 32.96 ± 10.82 years) were included in this prospective, cross-sectional study. After detailed ophthalmological examination and determination of the ocular dominance with hole-in-a-card test, the PERG was performed to determine implicit time and amplitudes of P50 and N95. RESULTS: There were no significant interocular differences in visual acuity, refractive error, or intraocular pressure (p > 0.05 for all). Thirty-six (64.3%) of the participants had ocular dominance in the right eye. The dominant eyes had significantly higher P50 amplitude than in the fellow nondominant eyes (6.90 µV in dominant vs 5.87 µV in nondominant; p = 0.015; 95% confidence interval). There was no significant difference in N95 amplitude, N95/P50 ratio, and implicit times of P50 and N95 between the dominant and nondominant eyes of the participants (p = 0.090, p = 0.124 p = 0.817, p = 0.668; respectively). CONCLUSION: The analysis revealed a significantly increased P50 amplitude of the PERG, which is known to be highly associated with macular function, in dominant eyes of the patients when compared to fellow nondominant eyes.

Is there a relationship between hypoparathyroidism and retinal microcirculation?

PURPOSE: To investigate the retinal microvasculature in patients with surgically induced hypoparathyroidism who have no clinical evidence of retinopathy and to compare these data with those of healthy control subjects. METHODS: Forty patients with a confirmed diagnosis of permanent hypoparathyroidism and no clinical evidence of retinopathy and 37 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; radial peripapillary capillary plexus (RPCP) vessel density; superficial, middle and deep capillary plexus vessel densities (SCP, MCP and DCP). The data from the right eyes of all participants were used for statistical analysis. RESULTS: The SCP and MCP vessel densities were significantly lower, and the RPCP whole image and peripapillary vessel densities were significantly higher than those in healthy control subjects (p < 0.05 for all). The DCP vessel densities of patients with surgically induced hypoparathyroidism were not significantly different from those of healthy control subjects (p > 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 measurements between patients and controls (p > 0.05 for all). CONCLUSIONS: Reduced retinal vessel density in patients with surgically induced hypoparathyroidism supports the hypothesis that parathyroid hormone is associated with regulation of vascular homeostasis, including macular microcirculation. Increased perfusion in the peripapillary area may suggest an early subclinic effect of hypoparathyroidism.

Analysis of retinal and choroidal microvasculature in systemic sclerosis: an optical coherence tomography angiography study.

BACKGROUND: To investigate the retinal and choroidal microvasculature in patients with systemic sclerosis (SSc) who have no clinical evidence of retinopathy and to compare these structures with those of healthy control subjects. METHODS: Forty-five patients with a confirmed diagnosis of SSc and no clinical evidence of retinopathy and 45 age- and sex-matched healthy control subjects were included in the study. After complete ophthalmological examination, all patients underwent optical coherence tomography angiography (OCTA) measurement (Optovue Inc., Fremont, California, USA) to assess the foveal avascular zone (FAZ) area; FAZ perimeter; acircularity index of FAZ; foveal density-300; superficial and deep capillary plexus vessel densities; and choriocapillaris flow area at 1, 2, and 3 mm radius. The data from the right eyes of all participants were used for statistical analysis. RESULTS: The superficial capillary plexus vessel density of the whole image, fovea, parafovea and perifovea, and the deep capillary plexus vessel density of the fovea were significantly lower than those in healthy control subjects (p < 0.05 for all). No significant difference was found in the FAZ area, FAZ perimeter, acircularity index of FAZ, foveal density-300 and choriocapillaris flow area measurements between patients and controls (p > 0.05 for all). CONCLUSIONS: We demonstrated the ability of OCTA to reveal early retinal microvascular alterations in patients with SSc without any clinical evidence of retinopathy. Reduced vessel density in SSc patients supports the hypothesis of widespread vascular injury, including ocular microcirculation.