Transient activation of retinopathy of prematurity secondary to erythrocyte suspension transfusion.

Retinopathy of prematurity (ROP) is a serious retinal vascular disorder that needs prompt diagnosis, and treatment to prevent undesired visual outcomes. Due to its shorter period of disease progression, it is important to be hasty in treating ROP. Erythrocyte suspension (ES) aggravates the progression of ROP. However, this progression may be transient as in the present case reports. This case report aimed to present two cases that developed type 1 ROP after erythrocyte suspension transfusion. Clinical findings of the patients were resolved within a few days without any intervention. Premature infants receiving ES treatment can be observed for 24-48 hours, and the treatment can be planned after determining the persistence of the plus sign. Abbreviations: ES = Erythrocyte suspension, ROP = Retinopathy of prematurity, NICU = neonatal intensive care unit.

Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience.

BACKGROUND: In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. METHODS: A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. RESULTS: During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). CONCLUSION: Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.

The effects of caffeic acid phenethyl ester on retina in a diabetic rat model.

PURPOSE: We aimed to investigate the effect of caffeic acid phenethyl ester (CAPE) on retinal apoptosis and oxidative stress parameters in streptozotocin (STZ) induced diabetic rat model. METHODS: This study included 3 groups; control, STZ, and STZ + CAPE. The rats in STZ, and STZ + CAPE groups were injected with STZ (35 mg/kg, i.p.) for induction of diabetes. In the STZ + CAPE group, 10 µmol/kg of CAPE were intraperitoneally injected for 4 weeks. Control and STZ groups were given only intraperitoneal vehicle (saline). Rats were anaesthetized and sacrificed on the 4th week of the experiment. Total anti-oxidant status (TAS), and total oxidant status (TOS) were measured on the dissected retinal tissues. Oxidative stress index (OSI) was also calculated. Fellow eyes were used for histopathologic evaluation with caspase-3 and matrix metalloproteinase-2 (MMP-2) and MMP-9 evaluation. RESULTS: TAS levels were similar between groups (p = 0.71). However, CAPE treatment prevented the elevation of the TOS in the STZ + CAPE group compared to the STZ group (30.93 ± 9.97 vs 61.53 ± 24.7 nmol H2O2 Eq/mg protein, p = 0.007). OSI was also significantly lower in the STZ + CAPE group than that of the STZ group (20.01 ± 5.87 vs. 37.90 ± 14.32, respectively, p = 0.007). Retinal caspase-3 staining, MMP-2 and MMP-9 scores were not different between groups (p > 0.05 for all). CONCLUSION: The present study demonstrated that CAPE treatment may decrease the oxidative stress in the retina in STZ induced diabetic rat model. However, apoptosis was not observed in the retina. The retinal apoptosis cannot be shown probably due to a shorter period of diabetes.

Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus.

PURPOSE: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). METHODS: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. RESULTS: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5-17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0-8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively (p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively (p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively (p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different (p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL (p = 0.012). Although central corneal thicknesses decreased significantly (p = 0.029), the decrease in thinnest corneal thickness was not statistically significant (p = 0.205). CONCLUSION: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

Descemet Stripping Endothelial Keratoplasty Outcomes in Patients With Rheumatoid Arthritis.

PURPOSE: To review the graft and visual outcomes in a series of patients with rheumatoid arthritis (RA) who underwent Descemet stripping endothelial keratoplasty (DSEK). METHODS: In this case series, the electronic medical records at Wills Eye Hospital were queried for cases of patients with RA who underwent DSEK between January 1, 2009 and September 1, 2018. Charts were reviewed to obtain demographic data, medical history, ocular history, surgical variables, graft survival, and visual acuity outcomes. RESULTS: During the study period, 22 transplants performed in 18 eyes of 15 patients with RA were eligible for inclusion. The mean age at the time of initial DSEK was 70.5 ± 11.1 years (range 46-87). The mean follow-up time for the included eyes was 4.89 ± 2.71 years (range 1.95-10.39). The overall estimated graft survival was 8.26 ± 0.81 years with a 5-year survival rate of 88.9%. A significant improvement from preoperative best corrected visual acuity (logarithm of the minimum angle of resolution 0.84, approximately 20/140) to the most recent follow-up (logarithm of the minimum angle of resolution 0.29, approximately 20/40) was noted (P < 0.001). CONCLUSIONS: In our case series, patients with a history of RA underwent successful DSEK with excellent graft survival rates and visual acuity outcomes. Well-controlled RA should therefore not be considered a deterrent to performing DSEK.

Serum IL-4, IL-12, IL-13, IL-27, and IL-33 levels in active and inactive ocular Behcet's disease.

PURPOSE: To investigate serum levels of interleukin (IL)-12 (Th1 cytokine), IL-27 (an immunomodulatory cytokine), IL-4 (suppressor of Th1-cell growth), IL-13 (a stimulatory signal for Th2 cytokines), and IL-33 (an epithelial cell-derived cytokine) and their relations with the disease activity in Behcet's Disease (BD). METHODS: Four groups, each composed of 20 participants were enrolled in the study; active ocular BD (Group-A), ocular BD in remission (Group-B), nonocular BD in remission (Group-C) and healthy controls (Group-D). IL levels were compared between the study groups and their correlation with the disease activity parameters were analyzed. RESULTS: IL-13 and IL-33 were higher in Group-A. IL-27 was lower in all BD groups. Additionally, IL-13 and IL-33 levels were positively correlated with disease activity parameters. CONCLUSION: These findings show Th2 dominance in the active phase of BD. Besides, decreased levels of IL-27, and presumably, its protective anti-inflammatory effect in all study groups may exert a new pathologic finding in BD.

Automated quantification of foveal avascular zone and vascular density in Behçet's disease.

PURPOSE: To measure the vascular density (VD) and foveal avascular zone (FAZ) area in patients with Behçet's disease (BD) obtained by optical coherence tomography angiography (OCTA). METHODS: VD and FAZ area in the deep and superficial retinal vascular networks were measured in all eyes. RESULTS: Thirty BD and 31 control subjects were included in the study. The mean overall VD measured in the entire scan was lower in BD compared with control group in both the superficial (49.52 ± 6.54 vs 53.57 ± 2.87%, respectively; p = 0.003) and deep (53.44 ± 7.44 vs 58.41 ± 3.01%, respectively; p = 0.002) areas. The FAZ in the BD group was significantly increased at the level of the superficial (0.52 ± 0.67 vs 0.28 ± 0.1 mm2, respectively; p = 0.05) and deep (0.91 ± 1.25 vs 0.39 ± 0.14 mm2, respectively; p = 0.024) areas compared with those of the control group. The deep and the superficial FAZ areas were positively correlated with disease duration and negatively with VA. CONCLUSION: In the patients with BD, OCTA showed decreased VD in both the superficial and deep retinal vascular networks. Besides, the VA was correlated with the VD and FAZ.

Optical coherence tomography angiography findings in a case with acute posterior multifocal placoid pigment epitheliopathy.

Twenty-six-year-old male patient admitted to the outpatient clinic with a complaint of decreased vision in both eyes. Visual acuity was 2/10 in the right and 7/10 in the left eye. Fundus examination revealed bilateral yellow-white subretinal lesions involving the macula. Fluorescein angiography showed hypofluorescent lesions in early and hyperflourescent lesions in the late phase. Optical coherence tomography angiography performed in the acute phase showed bilateral hypofluorescency at the choriocapillary level. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was given. After steroid treatment, visual acuity was improved to 10/10 and earlier lesions in optical coherence tomography angiography were found to be reduced. In conclusion, optical coherence tomography angiography is a noninvasive imaging technique that can be used in the diagnosis and follow-up of acute posterior multifocal placoid pigment epitheliopathy.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal vein occlusion.

BACKGROUND: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and the development of retinal vein occlusion. METHODS: One hundred and eleven patients and 88 control subjects were enrolled. Retinal vein occlusion diagnosis was clinically made with fundus examination. NLR and PLR values were compared between groups. RESULTS: Neutrophil levels were found to be comparable between the two groups (p = 0.47). Lymphocyte levels were lower in retinal vein occlusion patients (p = 0.001). NLR was significantly higher in retinal vein occlusion patients (p = 0.001). Platelet counts were found to be comparable in the two groups (p = 0.75). PLR was significantly higher in retinal vein occlusion patients (p = 0.001). According to the receiver operating characteristic curve analysis, the optimal cut-off values of NLR and PLR to predict retinal vein occlusion were > 1.63 and > 98.50, respectively. CONCLUSIONS: The present study showed that higher NLR and PLR were associated with the development of retinal vein occlusion. Also, NLR and PLR may be used as predictive tools for identifying risk for retinal vein occlusion.

YouTube as a source of information in retinopathy of prematurity.

AIM: We aimed to evaluate the quality of information available on YouTube regarding the basic information, examination, diagnosis, and the treatment of retinopathy of prematurity (ROP). METHODS: A YouTube search was performed on https://www.youtube.com / for videos pertaining to "retinopathy of prematurity" and "ROP." The first 100 relevant videos were included in the study. Two ophthalmologist reviewers independently evaluated and classified the videos as useful or misleading. The videos were accepted as "useful," if they provide scientifically correct information about any aspect of ROP: cause, pathogenesis, symptoms, findings, treatments, procedure details of the treatment, epidemiology, and prognosis. The videos contain scientifically unproven information are defined as "misleading." Videos were also classified according to the source: surgeon/practitioner, independent user, hospital/free clinic, social media/TV, medical site, university, and advertisement. RESULTS: The mean duration, the mean days on YouTube, the mean comments per videos, and the mean dislikes per video were similar in useful and misleading videos. However, the mean likes per day, mean view per video, and mean view per day were significantly higher in useful videos than those of misleading videos (p = 0.004, p = 0.022, and p = 0.011, respectively). Most of the useful videos were uploaded by healthcare professionals including source from university, hospital/free clinic, and surgeon/practitioner (48/64). The videos uploaded by healthcare professionals were more useful compared to those of non-healthcare professionals (p = 0.029). CONCLUSION: YouTube could be used as an important tool for patient information in ROP. However, one third of the YouTube videos regarding ROP are misleading and may present a risk of harmful consequences. In this aspect, authoritative videos by healthcare professionals should be uploaded for dissemination of reliable information on ROP.

Peripapillary retinal nerve fiber layer and macular ganglion cell complex thickness in patients with chronic phase of nonarteritic anterior ischemic optic neuropathy.

Objective: We aimed to investigate the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (mGCC) thickness in patients with chronic phase of nonarteritic anterior ischemic optic neuropathy (crNAION) analyzed by spectral domain optical coherence tomography (SD-OCT). Methods: Patients with crNAION, and healthy control subjects were enrolled in the study. All participants underwent SD-OCT for measurement of pRNFL, mGCC, and central macular thickness (CMT). The measurements of the eyes of the patients with crNAION were compared with those of the control subjects and unaffected fellow eyes. Results: A total of 25 patients with crNAION were eligible for the study. The control group consisted of 50 healthy subjects. The pRNFL and mGCC thickness in eyes with crNAION were found to be significantly thinner in all quadrants when compared to those of healthy control subjects and unaffected fellow eyes. The CMT of the eyes with crNAION was similar to that of the healthy control subjects. Conclusions: We demonstrated that mGCC and pRNFL thickness measurement by SD-OCT are capable of detecting axonal damage in eyes with crNAION. Furthermore, this study used SD-OCT and found that mGCC and pRNFL had the ability to detect GC loss in the eyes of the patients with crNAION.

Early detection of macular and peripapillary changes with spectralis optical coherence tomography in patients with prediabetes.

PURPOSE: To compare the retina ganglion cell complex (GCC) layer and peripapillary nerve fibre layer thickness (pRNFL) in patients with prediabetes and healthy subjects analysed by spectral domain optical coherence tomography (SD-OCT). METHODS: This cross-sectional and comparative study included prediabetic patients and healthy subjects. All participants underwent SD-OCT measurement of pRNFL thickness, and GCC thickness. RESULTS: A total of 30 eyes of the 30 patients with prediabetes and 30 eyes of 30 controls were included. The overall calculated pRNFL thicknesses were similar between the prediabetic and control subjects. The GCC thickness was significantly lower in all quadrants of the inner macula, and outer nasal quadrant in the prediabetes group when compared to the control group. CONCLUSION: Our study demonstrated that inner macular GCC thickness was significantly thinner in prediabetic subjects. As a result neurodegeneration may play role in the thinning of GCC.