Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels are decreased in patients with Behçet's disease.

PURPOSE: Behçet's disease (BD) is an autoimmune chronic systemic inflammatory disease characterized by a versatile clinical spectrum. Growth arrest specific protein 6 (GAS6)/soluble AXL (sAXL) signaling pathway draws attention in the resolution of inflammation, and its deficiency is associated with chronic inflammatory, autoimmune diseases, as well as clearance of apoptotic cells by phagocytes - efferocytosis. In this study, it was aimed to investigate whether GAS6/sAXL, interleukin (IL)-10, nitric oxide (NO), and BCL-2 levels were associated with inflammation and efferocytosis contributes to the pathogenesis of BD. METHODS: A total of 37 Behçet patients with ocular involvement and 30 healthy control subjects were included in this study. GAS6, sAXL, IL-10, NO, and BCL-2 levels were quantified using enzyme-linked immunosorbent assay (ELISA) method. RESULTS: Serum GAS6, sAXL, IL-10, NO, and BCL-2 levels were significantly lower in patients with BD compared to the controls (P < 0.005, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). In correlation analysis, research parameters decreased in patients with BD was significantly correlated with each other: GAS6-IL-10 (r = 0.585, P < 0.001), GAS6-BCL-2 (r = 0.541, P < 0.001), sAXL-BCL-2 (r = 0.696, P < 0.001), IL-10-NO (r = 0.717, P < 0.001), IL-10-BCL-2 (r = 0.759, P < 0.001), and NO-BCL-2 (r = 0.541, P < 0.001). CONCLUSION: In conclusion, decreased serum BCL-2 level may be an indicator of increased apoptosis in these patients and decreased levels of GAS6/sAXL, IL-10, and NO may indicate insufficient clearance of apoptotic bodies released as a result of increased apoptosis in BD patients.

The Frequency of Intraocular Pressure Elevation, Incidence of Secondary Glaucoma, and Surgical Treatment With Postoperative Complications in Pediatric and Adult Patients With Uveitis.

Purpose To determine the etiology and anatomic localization of uveitis, the frequency of intraocular pressure (IOP) elevation, and the type of secondary glaucoma and to assess the medical, surgical, and postoperative complications in adult and pediatric patients with acute or chronic uveitis. Methods A total of 307 eyes of 186 patients who were followed up in the Uvea-Behçet Unit of the Ophthalmology Department, Erciyes University, Turkey, were included in the study. Demographic, ocular, and systemic data were recorded; ophthalmological examinations were performed; and recurrences and complications of uveitis were identified. The eyes with IOP over 22 mmHg, types of secondary glaucoma, their etiologies, efficiency of medical and surgical treatments, and complications were recorded. Results The mean age was 33 ± 12 years (range: 6-65). Of the 186 patients, diagnoses were as follows: idiopathic uveitis in 84 (45.2%), Behçet disease in 65 (34.9%), ankylosing spondylitis in eight (4.3%), juvenile idiopathic arthritis in five (2.7%), herpetic keratouveitis in three (1.6%), Fuchs iridocyclitis in three (1.6%), Vogt-Koyanagi-Harada syndrome in three (1.6%), tuberculosis uveitis in three (1.6%), Crohn disease in three (1.6%), ocular toxoplasmosis in two (1.1%), multiple sclerosis in two (1.1%), Lyme disease in two (1.1%), rheumatoid arthritis in two (1.1%) and tubulointerstitial nephritis in one patient (0.5%). Secondary glaucoma was detected in 67 (21.9%) of 307 eyes, which developed in 13.7% and 26.8% of the eyes with acute and chronic uveitis, respectively. Of 67 eyes, it was open-angle glaucoma in 58 (86.5%), angle-closure glaucoma in six (9.0%), and neovascular glaucoma in three (4.5%). Control of IOP was achieved by medical therapy in 53 eyes (79.1%) and by surgery in 12 eyes (17.9%), whereas evisceration was required in two eyes (3.0%). Laser iridotomy was performed in four eyes (33.4%), trabeculectomy with mitomycin-C (MMC) in six eyes (50.0%), laser iridotomy plus trabeculectomy with MMC in one eye (8.3%), and express mini shunt implantation in one eye (8.3%). After surgery, IOP was controlled without anti-glaucomatous agents in six eyes (50%) and with anti-glaucomatous agents in the remaining six eyes (50.0%). Conclusion Secondary glaucoma is one of the most important complications of uveitis and may result in severe visual impairment. Early diagnosis and appropriate treatment can prevent these potential complications.

Automated evaluation of parapapillary choroidal microvasculature in crowded optic discs: a controlled, optical coherence tomography angiography study.

AIM: To compare superficial and deep vascular properties of optic discs between crowded discs and controls using optical coherence tomography angiography (OCT-A). METHODS: Thirty patients with crowded discs, and 47 control subjects were enrolled in the study. One eye of each individual was included and OCT-A scans of optic discs were obtained in a 4.5×4.5 mm2 rectangular area. Radial peripapillary capillary (RPC) density, peripapillary retinal nerve fiber layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical c/d ratio were obtained automatically using device software. Automated parapapillary choroidal microvasculature (PPCMv) density was calculated using MATLAB software. When the vertical c/d ratio of the optic disc was absent or small cup, it was considered as a crowded disc. RESULTS: The mean signal strength index of OCT-A images was similar between the crowded discs and control eyes (P=0.740). There was no difference in pRNFL between the two groups (P=0.102). There were no differences in RPC density in whole image (P=0.826) and peripapillary region (P=0.923), but inside disc RPC density was higher in crowded optic discs (P=0.003). The PPCMv density in the inner-hemisuperior region was also lower in crowded discs (P=0.026). The pRNFL thickness was positively correlated with peripapillary RPC density (r=0.498, P<0.001). The inside disc RPC density was negatively correlated with c/d area ratio (r=-0.341, P=0.002). CONCLUSION: The higher inside disc RPC density and lower inner-hemisuperior PPCMv density are found in eyes with crowded optic discs.

Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.

OBJECTIVE: To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review. METHODS: PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates. RESULTS: This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [-1.73 (95%CrI: -3.53 to -0.13)] and phaco+GSL+GS [-3.92 (95%CrI: -6.91 to -1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [-3.11 (95%CrI: -5.82 to -0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [-0.45 (95%CrI: -0.81 to -0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures. CONCLUSIONS: Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.

Parapapillary choroidal microvasculature in retrobulbar optic neuritis: An optical coherence tomography angiography study.

PURPOSE: To compare superficial and deep vascular characteristics of the optic disc in retrobulbar optic neuritis using optical coherence tomography angiography (OCT-A). METHODS: Nineteen patients with unilateral non-infectious retrobulbar neuritis were included in the study. The contralateral eyes of each patient were served as controls. OCT-A scans of the optic discs were performed in a 4.5 × 4.5 mm rectangular area, while macular OCT-A scans were performed in a 6 × 6 mm rectangular area. Various parameters, including radial peripapillary capillary (RPC) density, peripapillary retinal nerve fibre layer (pRNFL) thickness, cup volume, rim area, disc area, cup-to-disc (c/d) area ratio, and vertical and horizontal c/d ratios were automatically obtained using the instrument software. The density for superficial capillary plexus (SCP) and deep capillary plexus (DCP) were assessed using macular OCT-A. Parapapillary choroidal microvascular (PPCMv) density was calculated using MATLAB software. RESULTS: Parafoveal inferior, perifoveal total and inferior SCP densities were significantly decreased in eyes with optic neuritis when compared with contralateral control eyes in OCT-A measurements (respectively, p = 0.027, p = 0.041, p = 0.045). The axial lengths, (p = 0.72), vertical and horizontal cup-disc ratios, and disc area, cup-disc areas, cup volumes, and pRNFL thicknesses between the groups were similar (for each, p>0.05). CONCLUSIONS: This study demonstrated for the first time that patients with retrobulbar optic neuritis had decreased SCP densities, though it did not cause any changes in PPCMv density.

Evaluation of Agreement Between Sweep Visual Evoked Potential Testing and Subjective Visual Acuity.

Objectives: The primary objective of this study was to evaluate the agreement of visual acuity (VA) obtained with the sweep visual evoked potential (sVEP) method with the VA obtained with the Snellen chart. The secondary objective was to examine the effect of age and gender on agreement. Materials and Methods: Best corrected VAs of subjects were recorded with the Snellen chart, and sVEP testing was performed according to the recommendations of the International Society for Clinical Electrophysiology of Vision (ISCEV). Snellen VAs and sVEP measurements were analyzed using logMAR conversion for statistical analysis. Agreement was evaluated with Bland-Altman analysis. Results: The study included 49 subjects with a mean age of 53.5±17.3 years (range: 19-75 years) and mean Snellen VA of 0.31±0.32 logMAR (range: 1.3-0.0 logMAR). In the Bland-Altman analysis, the mean differences between the VA and sVEP measurements (VA-sVEP) were significantly different and outside the limits of agreement (p=0.035). A significant proportional bias (p=0.0007) was found in the regression analysis performed between VA-sVEP and the mean VA. According to the Bland-Altman analysis of sex subgroups, there was a significant difference between VA and sVEP measurements in female subjects (p=0.006). The difference between VA and sVEP measurement increased significantly with older age (R2: 0.306, p<0.001, ß: 0.05 [0.03, 0.08]). Conclusion: In conclusion, sVEP measurements and VAs did not show statistical agreement. Cranial anatomy and endocrine differences of the subjects may affect their sVEP measurements. The difference between the methods varies according to VA level. Directly using sVEP results instead of VA would not be appropriate.

Choroidal vascularity index and submacular choroidal thickness in patients with Behçet disease assessed with enhanced-depth OCT.

PURPOSE: To investigate changes in the choroid using the choroidal vascularity index (CVI) and choroidal thickness (ChT) in patients with ocular (OBD) and non-ocular Behçet disease (non-ocular BD). METHODS: Sixty-eight OBD patients, 40 non-ocular BD patients, and 40 healthy control subjects were included. ChT was measured using optical coherence tomography (OCT) in enhanced-depth imaging (EDI) mode (EDI-OCT; sub-foveal ChT at 1000 µm, nasal ChT at 1000 µm temporal ChT). The CVI value (%) was calculated by dividing the luminal area by the sub-foveal total choroidal area. RESULTS: The mean sub-foveal ChT (297 ± 68 µm), nasal ChT (261 ± 66 µm), and temporal ChT (272 ± 68 µm) in eyes with OBD and the mean sub-foveal ChT (286 ± 31 µm), nasal ChT (266 ± 29 µm), and temporal ChT (269 ± 32 µm) in eyes with non-ocular BD were significantly decreased compared with those regions in healthy control subjects (333 ± 69, 301 ± 75, and 312 ± 70 µm, respectively). Additional subgroup analysis was performed for active OBD, inactive OBD, non-ocular BD, and the control group, and in pairwise comparisons, the CVI value was significantly decreased in both active (64.3 ± 3.1) and inactive OBD groups (64.2 ± 4.5) compared with healthy control subjects (67.2 ± 3.6; p = 0.026 and p < 0.001, respectively). There was no significant difference between non-ocular BD (65.9 ± 3.4) and control subjects (67.2 ± 3.6) for CVI measurements (p > 0.05). CONCLUSIONS: Decreased CVI values in OBD suggest that uveitis affects the choroidal vasculature and that perfusion is affected by uveitis, whereas systemic inflammation in non-ocular BD does not affect them. In addition, the choroid in uveitis is affected by the chronicity of the disease rather than disease activity. ChT measurements and CVI values may be a novel and robust prognosticating biomarker to evaluate choroidal vasculature and to monitor disease progression in OBD patients because EDI-OCT is a non-invasive imaging modality. However, CVI does not seem to be a biomarker for monitoring of disease activity or treatment efficacy.

A novel terminologic "naming-meshing" system using anterior chamber sedimentation for early diagnosis and prompt treatment of ocular or systemic diseases: is it hypopyon or pseudohypopyon?

A novel, algorithmic "naming-meshing" system was introduced for the distinction of hypopyon from pseudohypopyon to make an early diagnosis and prompt treatment of anterior chamber collection standardized to encompass all sediment characteristics. For this reason, a literature review of "hypopyon" and "pseudohypopyon" was conducted in MEDLINE/PubMed, Scopus, and Web of Science from 1966 to May 15, 2023. Two issues were clarified: 1) which strategies should the ophthalmologist follow when asked to evaluate an eye with anterior chamber sedimentation to distinguish hypopyon from pseudohypopyon, and 2) in which systemic disorders should a non-ophthalmologist order a prompt ophthalmic consultation to distinguish pseudohypopyon from hypopyon. Pathognomonic characteristics of the sediment were examined; scleral show (warm/cold), location (corneal/anterior chamber/capsular/posterior), visibility (macro/micro/occult-angle), orientation (horizontal/vertical/oblique), number (single/double), shape (convex/triangular/pyramidal/ring/lumpy/inverse), and color (white/yellow/pink/brown/black). Associated findings were then assessed; acute/chronic, spontaneous/provoked, unilateral/bilateral, inflammatory/non-inflammatory, suppurative (non-sterile)/non-suppurative (sterile), granulomatous/non-granulomatous, recurrent/non-recurrent, shifting/non-shifting, and transient/persistent. The type of precipitation was named (naming) and matched (meshing) to a potential list of etiologies (inflammatory, infective, therapeutic, masquerades). Given that (pseudo)hypopyon predominantly afflicts younger patients in their most productive years, clinicians supervising such patients should be aware of all sediment characteristics. The ophthalmologist should never ask non-ophthalmologists to run the full battery of tests in a patient with (pseudo)hypopyon, and rather indicate which type of collection is present, what its pathognomonic feature is, and what the most likely diagnoses to be excluded are.

Transparent intrastromal corneal lenticule obtained from SMILE surgery as a free graft for the treatment of primary pterygium: A pilot study.

Purpose: To report our initial experience in patients with primary pterygium surgery who had a transparent intrastromal corneal lenticule as a free graft obtained during small incision lenticule extraction (SMILE) surgery. Observations: This study enrolled five eyes of 5 patients with pterygium who were surgically treated with single or double free lenticule that was sutured to the defective area of the nasal corneosclera immediately following pterygium excision. All cases with pterygium were primary, and topical mitomycin C was not used at the time of surgery. The mean age of the patients was 51.0 years and 2 of the 5 eyes belonged to male subjects. The patients were followed up for an average of six months. During the follow-up period, the lenticule grafts demonstrated no sign of rejection and were intact in all cases. All patients recovered well with no complications or recurrences at six months postoperatively. Conclusions and Importance: This report suggests that transparent corneal lenticules obtained during SMILE laser surgery may be used as an alternative novel graft source for the surgical treatment of patients with primary pterygium. It appears to be a safe, easy, cost- and time-effective reliable method.

Adalimumab rapidly controls both anterior and posterior inflammation in patients with ocular Behçet syndrome and non-infectious uveitis refractory to conventional therapy: a prospective, 6-month follow-up investigation.

PURPOSE: To evaluate the efficacy and safety of adalimumab (ADA, Humira®) for treatment of non-infectious uveitis (NIU) refractory to conventional medications. METHODS: Anti-tumor necrosis factor-α naive patients with NIU unresponsive to conventional immunosuppressive treatment were treated with ADA. Most cases with NIU were related to ocular Behçet syndrome. Adult cases used 80 mg ADA subcutaneously on day 0, 40 mg in the first week, and then 40 mg every 2-week, while this was 20 mg in children. Evaluations were performed pre-treatment and at weeks 2, 8, and 24. The study endpoints were best-corrected visual acuity (BCVA, LogMAR) improvement, anterior chamber (AC) cell grade, vitreous cell and haze grades, decrease in macular thickness and edema, prednisolone dose, immunosuppressive dose, and adverse reactions. RESULTS: Thirty-eight eyes (19 right, 19 left) of 24 patients (14 female, 10 male) with (ocular Behçet syndrome) OBS (n = 27 eyes/18 patients) and NIU (n = 11 eyes/6 patients) were included. Mean age was 29.0 ± 14.1 years (range, 5-49) and follow-up time was 24 weeks. After ADA, BCVA increased (p < 0.001), and improvements in AC cell grade (p < 0.001), vitreous cell grade (p < 0.001), and vitreal haze grade (p < 0.001) were achieved at the final visit. Mean macular thickness decreased from 243.5 to 235.5 µm (p < 0.001). Such a rapid control of both anterior and posterior uveitis was observed in all eyes as early as the second week without relapses during follow-up. No ocular or systemic complications emerged during treatment. CONCLUSIONS: ADA is effective and well-tolerated in pediatric and adolescent patients with NIU including OBS refractory to traditional medications and demonstrated corticosteroid- and immunosuppressive-sparing effects with no major side effects.

Retinal dysfunction in Parkinson's disease-results of the extended protocol for photopic negative response (PHNR) full-field electroretinogram (ERG).

BACKGROUND: We investigated whether the photopic negative response (PhNR) in the electroretinogram (ERG) was affected in Parkinson's disease (PD) patients and whether it was associated with retinal changes on optical coherence tomography (OCT). METHODS: Thirty-two patients with PD and 31 age and sex-matched healthy controls from a single tertiary centre were included in the study. Hoehn and Yahr scale scores and the presence of REM sleep behaviour were recorded. PhNR, a-wave and b-wave responses in photopic ERG (red on blue background) and retinal layer thicknesses in OCT were obtained. RESULTS: The mean age was 61 ± 10.4 in the PD group (female/male: 18/14) and 60.9 ± 7 in the control group (female/male: 18/13). The amplitudes of the PhNR, a- and b-waves in the ERG were significantly decreased in the PD group, but the implicit times were not significantly different. BCVA was significantly correlated with Hoehn and Yahr scores (p < 0.001, r = - 0.596). There was a significant correlation between BCVA and a-wave amplitude (p = 0.047, r = - 0.251). On OCT analysis, the thickness of the nasal INL was increased, and the temporal and inferior OPL and temporal peripapillary RNFL were decreased in the PD group compared to healthy controls (p = 0.032, p = 0.002, p = 0.016 and p = 0.012, respectively). CONCLUSION: This study demonstrated reduced a-wave, b-wave and PhNR-wave amplitudes on ERG measurements in PD patients. These findings suggest that the whole ERG response, not just the PhNR, is attenuated in patient with PD, suggesting a possible involvement of the visual system in the disease.

Comparison of the Rate of Posterior Capsule Opacification Following Combined Treatment With Topical Dexamethasone 0.1% Plus Ketorolac 0.5% Eye Drops Versus Dexamethasone 0.1% Alone: A Two-Year, Randomized Clinical Investigation.

Background and aim The use of non-steroidal anti-inflammatory drugs in animals decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. We evaluated the rate of PCO in patients with cataract surgery and foldable "in the bag" posterior chamber intraocular lens (PC-IOL) implantation treated with combined dexamethasone 0.1% plus ketorolac tromethamine 0.5% versus dexamethasone 0.1% alone. Materials and methods A total of 114 eyes of 101 patients underwent uneventful corneal small-incision phacoemulsification with primary implantation of a foldable acrylic PC-IOL (AcrySof®, Alcon, Fort Worth, USA). Postoperatively for four weeks, group 1 eyes were treated with dexamethasone 0.1% plus ketorolac tromethamine 0.5% ophthalmic solutions four times daily for each whereas group 2 eyes were treated with dexamethasone 0.1% alone. Other regiments were the same for each group. Patients were evaluated between one- and four-year following surgery. The frequency and timing of severe PCO following surgery that needed Nd:YAG laser posterior capsulotomy were recorded and evaluated. Results The mean (SEM) age of group 1 (n = 54) and group 2 (n = 60) at operation was similar (62.8 ± 2.2 vs. 60.6 ± 1.7 years, respectively). Eighty-eight patients had unilateral cataract and 13 cases had bilateral disease. Overall, the mean follow-up duration was 24.7 months postoperatively (range, 15-48). Clinically significant PCO that finally needed Nd:YAG laser application developed in two eyes (3.7%) in group 1 and in four eyes (6.6%) in group 2, and the difference was not statistically significant (p>0.05). The mean month at capsulotomy was 26.5 in group 1 and 24.3 months in group 2 eyes (p>0.05). Conclusions Topical instillation of ketorolac ophthalmic solution in the immediate period after phacoemulsification and PC-IOL implantation did not seem to influence the incidence of PCO formation two years after cataract surgery.

Modified external revision-DCR in previous failed endonasal, transcanalicular or external-DCR: technical strategy and teaching Pearls for success.

Objective: To report perioperative findings of patients with multiple failed-dacryocystorhinostomy (DCR) and to determine the success rate of revision external (rEx-DCR) performed by a modified technique. Methods: Thirty-one eyes of 31 patients (19 women, 12 men) with recurrent dacryocystitis or epiphora following at least one previous failed-DCR were assessed regarding the time from initial surgery to recurrence and revision surgery, type of primary surgery (endoscopic, transcanalicular, Ex-DCR), recurrence number, stent usage and the success rate. Relief of epiphora and positive dye test were established as functional and anatomical successes, respectively. Results: The mean age was 43.0 years (8-78), with a mean follow-up period of 21.4 months (6-46). The mean reoperation number was 1.4 (1-5). The mean time from initial surgery to recurrence was 15.2 months (1-55) and to rEx-DCR, 19.8 months (4-65). Untouched medial canthal ligament was observed in 28 (90.3%), improper rhinostomy location in 26 (83.8%), inadequate osteotomy size in 25 (80.6%), single-anterior-flap-only in 5 (16.1%), membranous ostial scar formation in four (12.5%) and no flap in three (9.6%) patients. The success rate was 93.5%, which was lower than our primary modified Ex-DCR (99.1%). Conclusions: The most common reasons for recurrence were small and unsuitable osteotomy locations with intact medial canthal ligaments. "Double-mucosal flap" approach with an anterior sacco-mucosal complex suspension increases the functional success rate, and stent implantation is not obligatory if canalicular problems or small/ atrophic sacs do not exist. The knowledge of technical strategy and teaching pearls improves the success rates of primary and revision surgeries. Abbreviations: DCR = dacryocystorhinostomy, Ex-DCR = external DCR, EE-DCR = endoscopic endonasal DCR, TC-LA-DCR = transcanalicular laser-assisted DCR.

One-step repair of a large congenital upper eyelid coloboma using a bilamellar graft in an infant: a case report and literature review.

Large congenital lid colobomas are traditionally repaired using 1- or 2-step vascularized flap-graft combinations. However, visual axis occlusion for weeks is a severe problem in small children and recent reports suggest that the flap pedicle does not contribute to blood perfusion. A "one-step" substitute for large lid defects has recently been reported in animals and humans, demonstrating the viability of a bilamellar autograft alone. We present an alternative "one-step" reconstructive approach in a 6-month-old infant who had a centrally-located large upper eyelid defect resulting from a congenital coloboma. The free full-thickness bilamellar autograft was harvested from the contralateral upper eyelid. The follow-up time was 48 months. Cosmetic and functional results were good, the bilamellar graft survived, and there was no graft ischemia, necrosis, or rejection. The boy developed madarosis, lid notching, and mild contour irregularity but needed no reoperation since the parent was satisfied with the surgical result. A free bilamellar eyelid autograft seems to be an outstanding alternative to both "conventional 2-step" and "modern 1-step" options for the reconstruction of large colobomatous eyelid openings, especially in young infants who cannot tolerate visual axis blockage. It is an easy, practical, fast, and effective technique that also saves cost in health care.

Comparison of optic disc head vascular density status between crowded and normal discs: An optical coherence tomography angiography study.

BACKGROUND: To compare the optic disc capillary vascular status between crowded and normal optic discs using optical coherence tomography angiography (OCT-A). METHODS: A total of 101 eyes were included in this cross-sectional, comparative study. Fifty-one eyes with crowded optic discs (Group 1) were compared with 50 eyes with normal discs (Group 2). Peripapillary and optic disc head capillary vascular density measurements were obtained quantitatively with OCT-A. RESULTS: Mean ages were 46.2 ± 6.2 years in Group1 and 45.9 ± 6.0 years in Group2 (p=0.796).Vertical disc diameters were 1.52±0.2 mm in Group 1 and 1.61±0.16 mm in Group 2 (p=0.022) whereas horizontal disc diameters were 1.53±0.17 mm in Group 1 and 1.61±0.13 mm in Group 2(p˂0.014). OCT-A findings were as follows: radial peripapillary capillary, vascular density whole image measurements (%); 49.6 ± 2.3 in Group 1 and 49.1 ± 2.3 in Group 2 (p=0.292), peripapillary capillary density; 53.3 ± 2.8 in Group 1 and 52.6 ± 2.6 in Group 2 (p=0.176), inside disc measurements 52.4 (48.7-54.7) in Group 1 and 46.5 (42.6-49.6) in Group 2 (p˂0.001). RNFL was 118.2 ± 12.2 µm in Group 1 and 110.8 ± 11.4 µm in Group 2(p=0.002). CONCLUSION: The vascular density of the disc circumference in individuals with healthy crowded optic discs is not different from those with normal discs. However, inside disc measurements differ between crowded and normal size discs. This finding suggests that when the disc size is reduced, the amount of vessels in it does not decrease in a way that correlates with the size. Therefore, the vascular structures are suitable for compression in the narrow optic nerve head.

Evaluation of Optic Disc Perfusion with Optical Coherence Tomography Angiography in Acute Non-arteritic Anterior Ischemic Optic Neuropathy

Objectives: This study aimed to evaluate superficial peripapillary vascularization qualitatively and quantitatively in patients with acute non-arteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCT-A). Materials and Methods: Eleven patients with acute NAION and 14 controls were evaluated retrospectively. Complete ophthalmologic examination with best corrected visual acuity, peripheral visual field test, and disc angiography with OCT-A were performed. Quantitative optic disc perfusion indexes were evaluated by the device with automatically segmentation and qualitative comparison of choroidal, retinal, and en-face peripapillary perfusion angiogram images. Results: In the NAION and control groups, mean age was 57.55±12.34 years and 50.79±4.67 years (p=0.110), the proportion of women was 7/11 (63.6%) and 9/14 (60%), and best corrected visual acuity was 0.95±0.63 and 0.00±0.0 LogMAR (p=0.001), respectively. Visual field defect was present in 10/11 (91%) eyes in the NAION group. In 6 patients, visual field defects were correlated with areas of peripapillary and optic nerve head hypoperfusion. In the patient group, optic nerve head capillary density was significantly decreased (p=0.008) and radial peripapillary capillary density was significantly decreased in all sectors except the inferonasal sector. Conclusion: In our study, we observed that visual field evaluations were partially correlated with optic nerve head and peripapillary capillary perfusion assessed by OCT-A. Being practical and non-invasive, OCT-A is a useful and up-to-date method for evaluating perfusion in NAION.

Studies on the Effectiveness of Ozone Therapy on the Treatment of Experimentally Induced Keratitis with Candida albicans in Rabbits.

PURPOSE: In the present study, antifungal activity of ozonated olive oil (OZO) and ozonated distilled water (ODW) in the treatment of experimentally induced keratitis with C. albicans in rabbits were investigated. METHODS: The Groups were composed of as 1, 2, 3, 4, 5, 7 (n = 5 rabbits, 10 eyes/in each group) and Group 6 (n = 10 rabbits, 20 eyes/in the group). Fourty-eight hours after C. albicans inoculation; Group 1 received fluconazle (FLU)+OZO drops, Group 2 received FLU drop, Group 3 received OZO drop, Group 4 received FLU+ODW drops, Group 5 received ODW drop, Group 6 (infected control group) and Group 7 received PBS drop (negative control group). Treatment continued in all groups for 22 days for every 8 hours. RESULTS: Cornea cultures made 24 days post inoculation revealed statistically significant differences (p < 0,05) with concern to C. albicans amounts between Group 6 and Group 1-5. Statistical comparison of corneal opacity and corneal ulcer and conjunctivitis values among the Group 6 and Group 1-5 were also different significantly (p < 0,05) on days 20 and 24 post inoculation. CONCLUSION: OZO and ODW were found to be effective in treating C. albicans keratitis in the present study. It has also been proven by this study that ODW contain 26 µg/ml was the most effective in the treatment of C. albicans keratitis.

Systemic oxidative stress in non-arteritic anterior ischemic optic neuropathy.

PURPOSE: To investigate whether the serum total oxidant status (TOS), total antioxidant status (TAS), advanced oxidation protein products (AOPP), and thiol parameters could play a role in the pathogenesis of non-arteritic anterior ischemic optic neuropathy (NA-AION). METHODS: In this study, 18 newly diagnosed NA-AION patients and 17 healthy subjects (control group) were included. Serum plasma TOS and TAS, AOPP, and thiol parameters were measured by spectrophotometric method and the results were compared. RESULTS: Mean age of the patients and the controls were 60.8 ± 8.4 and 61.9 ± 9.4 years, respectively (p = 0.729). There were no significant differences between the patients and the control group with regard to the values of TAS, TOS, AOPP, and thiol (p = 0.869, p = 0.863, p = 0.040, p = 0.314; respectively). There was a positive correlation between TOS and thiol (p = 0.002, r = 0.681). CONCLUSION: We found no significant relationship between systemic oxidative parameters and NA-AION. However, this study should be accepted as a pilot investigation and needs to be validated.