Switch to aflibercept in the treatment of neovascular age-related macular degeneration: 30-month results / Mudança de tratamento para o aflibercepte no tratamento da Degeneração Macular neovascular Relacionada à Idade: resultados de 30 meses

ABSTRACT Purpose: This study was conducted to evaluate visual function and changes in the central macular thickness of patients with unresponsive neovascular age-related macular degeneration who were switched from ranibizumab (Lucentis®) to aflibercept (Eylea®) treatment at 30 months. Methods: This retrospective study examined patients with neovascular age-related macular degeneration who were switched to aflibercept after ≥6 previous intravitreal ranibizumab injections at 4- to 8-week intervals. All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3 consecutive injections followed by a prore nata dosing regimen and after 30 months of treatment. Best corrected visual acuity, biomicroscopic examination, intraocular pressure, fundus examination, and central macular thickness were recorded at the start of treatment, before the transition to intravitreal aflibercept treatment, and at 6, 12, 18, 24, and 30 months of intravitreal aflibercept treatment. Results: A total of 33 eyes met the inclusion criteria. The median age of the patients was 73.57 ± 7.98 years, and 21 (61.8%) patients were males and 12 (35.3%) were females. Before the transition, the patients received a mean of 16.8 ± 8.8 ranibizumab injections (range 6-38).After the transition to intravitreal aflibercept treatment, the mean number of aflibercept injections was 9.09 ± 3.94. No significant differences were observed in best corrected visual acuity after the aflibercept switch in any of the months. The central macular thickness was significantly decreased at 6, 12, 18, and 30 months (p=0.01, p=0.03, p=0.05, p=0.05, p<0.001, respectively). Conclusion: Patients with neovascular age-related macular degeneration who were switched to intravitreal aflibercept treatment due to unresponsiveness to intravitreal ranibizumab exhibited a significant anatomic improvement in the retina, and although this state persisted, there was no significant functional gain.(AU)

RESUMO Objetivo: Avaliar, depois de 30 meses, a função visual e as alterações na espessura macular central de pacientes com degeneração macular relacionada à idade sem resposta terapêutica ao ranibizumabe (Lucentis®) que mudaram seu tratamento para o aflibercepte (Eylea®). Métodos: Realizou-se um estudo retrospectivo de pacientes com degeneração macular neovascular relacionada à idade que mudaram o tratamento para o aflibercepte após 6 ou mais injeções intravítreas de ranibizumabe a intervalos de 4-8 semanas. Todos os pacientes mudaram para o aflibercepte intravítreo (2,0 mg) e depois de 3 injeções consecutivas, seguidas de um regime de dosagem pro re nata, foram avaliados após 30 meses de tratamento. A melhor acuidade visual corrigida, o exame biomicroscópico, a pressão intraocular, a fundoscopia e a espessura macular central foram registrados no início do tratamento, antes da transição para o tratamento com aflibercepte intravítreo e aos 6, 12, 18, 24 e 30 meses de tratamento com o aflibercepte intravítreo. Resultados: Satisfizeram aos critérios de inclusão 33 olhos. A mediana da idade dos pacientes foi de 73,57 ± 7,98 anos. Dos pacientes, 21 (61,8%) eram homens e 12 (35,3%) eram mulheres. Antes da transição para o tratamento com o aflibercepte intravítreo, os pacientes receberam em média 16,8 ± 8,8 injeções de ranibizumabe (faixa 6-38).Depois da transição, o número médio de injeções de aflibercepte foi de 9,09 ± 3,94. Não houve diferenças significativas na melhor acuidade visual corrigida depois da mudança para o aflibercepte em qualquer das avaliações. Houve diminuição significativa da espessura macular central aos 6, 12, 18 e 30 meses (respectivamente, p=0,01, p=0,03, p=0,05, p=0,05 e p<0,001). Conclusão: Pacientes com degeneração macular neovascular relacionada à idade que mudaram seu tratamento para o aflibercepte intravítreo devido à falta de resposta ao ranibizumabe intravítreo, tiveram melhora anatômica significativa da retina; mas embora esse estado tenha persistido, não foi observado nenhum ganho funcional significativo.(AU)

Switch to aflibercept in the treatment of neovascular age-related macular degeneration: 30-month results.

PURPOSE: This study was conducted to evaluate visual function and changes in the central macular thickness of patients with unresponsive neovascular age-related macular degeneration who were switched from ranibizumab (Lucentis®) to aflibercept (Eylea®) treatment at 30 months. METHODS: This retrospective study examined patients with neovascular age-related macular degeneration who were switched to aflibercept after ≥6 previous intravitreal ranibizumab injections at 4- to 8-week intervals. All patients were switched to intravitreal aflibercept (2.0 mg) and analyzed after 3 consecutive injections followed by a prore nata dosing regimen and after 30 months of treatment. Best corrected visual acuity, biomicroscopic examination, intraocular pressure, fundus examination, and central macular thickness were recorded at the start of treatment, before the transition to intravitreal aflibercept treatment, and at 6, 12, 18, 24, and 30 months of intravitreal aflibercept treatment. RESULTS: A total of 33 eyes met the inclusion criteria. The median age of the patients was 73.57 ± 7.98 years, and 21 (61.8%) patients were males and 12 (35.3%) were females. Before the transition, the patients received a mean of 16.8 ± 8.8 ranibizumab injections (range 6-38).After the transition to intravitreal aflibercept treatment, the mean number of aflibercept injections was 9.09 ± 3.94. No significant differences were observed in best corrected visual acuity after the aflibercept switch in any of the months. The central macular thickness was significantly decreased at 6, 12, 18, and 30 months (p=0.01, p=0.03, p=0.05, p=0.05, p<0.001, respectively). CONCLUSION: Patients with neovascular age-related macular degeneration who were switched to intravitreal aflibercept treatment due to unresponsiveness to intravitreal ranibizumab exhibited a significant anatomic improvement in the retina, and although this state persisted, there was no significant functional gain.

Thiol/disulfide homeostasis in retinitis pigmentosa patients.

PURPOSE: This research is aimed at determination of total oxidant status, total antioxidant status, serum thiol-disulfide, catalase, albumin, ischemia-modified albumin, and ceruloplasmin in patients suffering from retinitis pigmentosa and drawing a comparison with these parameters determined from healthy controls. METHODS: The study involved 35 patients of retinitis pigmentosa and 33 controls who were healthy individuals of comparable gender and age. Native thiol, total thiol, disulfide concentration, disulfide/native thiol, disulfide/total thiol, native thiol/total thiol ratios, total oxidant status, total antioxidant status, catalase, ceruloplasmin, albumin, and ischemia-modified albumin were determined from peripheral blood samples and comparison was drawn between the measurements of retinitis pigmentosa and controls. RESULTS: The two groups were similar in gender and age distributions. It was found that retinitis pigmentosa group demonstrated greater total oxidant status, ischemia-modified albumin, and disulfide concentrations as compared to controls (p < 0.001). However, total antioxidant status, catalase, native thiol, total thiol, albumin, and ceruloplasmin of the two groups did not show statistically significant difference (p > 0.05). Moreover, disulfide/total thiol and disulfide/native thiol ratios of the retinitis pigmentosa group were significantly greater in comparison to controls (p < 0.05). CONCLUSION: The researchers reached the conclusion that thiol oxidation in retinitis pigmentosa patients caused the dynamic thiol/disulfide homeostasis to shift toward the generation of disulfide. This is a novel research that involves analysis of thiol/disulfide homeostasis in retinitis pigmentosa patients using a novel automated assay. The researchers identified the cause for persistent oxidative stress and damage reported in retinitis pigmentosa patients. Still, future research is required for analysis of progression of antioxidant-oxidant state through various retinitis pigmentosa stages.

Dexamethasone intravitreal implant in the crystalline lens: a case report.

This report describes the therapeutic effects and outcomes of an accidental injection of an intralenticular sustained-release dexamethasone implant (Ozurdex®) in three patients with diabetic macular edema. All three patients underwent accidental injections of sustained-release intravitreal dexamethasone implants into the crystalline lens by the same surgeon. After the accidental injection of Ozurdex® into the crystalline lens, a remarkable reduction in the macular edema and an improvement in visual acuity were observed, suggesting that a positive outcome can be achieved without immediate surgery.

Dexamethasone intravitreal implant in the crystalline lens: a case report / Implante intravítreo de dexametasona nas lentes do cristalino: um relato de caso

ABSTRACT This report describes the therapeutic effects and outcomes of an accidental injection of an intralenticular sustained-release dexamethasone implant (Ozurdex®) in three patients with diabetic macular edema. All three patients underwent accidental injections of sustained-release intravitreal dexamethasone implants into the crystalline lens by the same surgeon. After the accidental injection of Ozurdex® into the crystalline lens, a remarkable reduction in the macular edema and an improvement in visual acuity were observed, suggesting that a positive outcome can be achieved without immediate surgery.

RESUMO Este estudo descreve os efeitos terapêuticos e os resultados de uma injeção acidental de implante intralenticular de dexametasona de liberação sustentada (Ozurdex®) em três pacientes com edema macular diabético. Todos os três pacientes foram submetidos a injeções acidentais de implantes intravítreos de dexametasona de liberação sustentada na lente do cristalino pelo mesmo cirurgião. Após a injeção acidental de Ozurdex® na lente do cristalino, observou-se uma redução notável no edema macular e uma melhora na acuidade visual, sugerindo que um resultado positivo pode ser alcançado sem cirurgia imediata.

Comparison of pain during intravitreal dexamethasone, ranibizumab and aflibercept injection.

BACKGROUND: This study aimed to compare pain scores of patients during intravitreal aflibercept, ranibizumab or dexamethasone implant injection procedures. METHODS: This study included 162 eyes of 162 patients, who received intravitreal ranibizumab, aflibercept or dexamethasone implant injections at our clinic. Following the injection, patients were asked to rate their pain from 0 (no pain) to 10 (worst pain) using a visual analogue pain score survey (VAS). VAS was evaluated according to age, sex, indication for the injection, number of previous intravitreal injections, and lens status in the study eye. RESULTS: The mean VAS in the ranibizumab, aflibercept or dexamethasone implant groups was 3.38 ± 2.31, 3.82 ± 2.46, and 3.61 ± 2.94, respectively. Female patients reported a higher average pain score than male patients (p = 0.02). Also, phakic patients reported a higher average pain score than pseudophakic patients (p = 0.01). Pain did not significantly correlate with indication for the injection, number of injections, and injection drugs (p > 0.05). CONCLUSION: Pain associated with intravitreal injection is generally mild and associated with sex, age, and lens status. There was no significant difference in pain between intravitreal injections of dexamethasone implant, ranibizumab or aflibercept.

Inner Retinal Layer Disease: Multiple Sclerosis.

OBJECTIVES: This study was an analysis of the retinal layer thickness in multiple sclerosis (MS) patients using spectral-domain optical coherence tomography (SD-OCT). METHODS: A total of 42 patients diagnosed in the neurology clinic with MS according to the McDonald Criteria and 21 healthy individuals were included in the study and 4 groups were created. The first group comprised 21 eyes of 21 MS patients without eye involvement, the second group was made up of 21 eyes of 21 MS patients with a history of optic neuritis, the third group included the other eye of patients in the second group without a history of optic neuritis, and the fourth group was a control group of 21 eyes of 21 healthy individuals. SD-OCT was used to visualize and measure the retinal layers and the thickness was analyzed using the device software. RESULTS: The mean age of the patient groups was 35.39±7.52 years, while it was 32.86±2.60 years in the control group. The mean duration of the disease was 9.81±6.65 years with a mean of 4.84±2.38 attacks. The ganglion cell layer (GCL) and the inner plexiform layer (IPL) of all of the patients were thinner compared with the control group in the parafoveal and perifoveal areas. All regions of the retinal nerve fiber layer (RNFL) of patients in the second group were thinner than those of the control group. The RNFL, GCL, and IPL in the central, parafoveal and perifoveal macular rings in group 3 were thinner than the group 1 measurements; however, this difference was not statistically significant. Although the RNFL, GCL, and IPL layer thicknesses were lower in group 2 than group 3, only the difference in the parafoveal GCL thickness was statistically significant. CONCLUSION: This study demonstrated that MS affects retinal layer thickness, and particularly the inner retinal layers.

Anticataractogenic effect of betaine in chick embryo hydrocortisone-induced cataract model.

Background & objectives: Cataract is one of the leading causes of blindness in the world. The aim of the present study was to investigate anticataractogenic effect of betaine in chick embryo hydrocortisone (HC)-induced cataract model. Methods: The study included 60 fertilized eggs divided into six groups each having 10 eggs: one group treated with only HC (HC group); three treated with both HC and different doses of betaine (HC/B 1.00, HC/B 0.50 and HC/B 0.25 groups) and two non-HC groups treated with only phosphate-buffered saline (PBS group) or betaine (B group). After the injections, lenses of the embryos were removed and classified into five stages according to the lens opacification. The amounts of reduced glutathione (GSH) in the removed lenses were measured. Results: All the lenses in non-HC-treated groups were clear, whereas in the HC-treated group, 90 per cent of the lenses had cataract (stages 4 and 5). The mean score of lens opacity was significantly lower in all HC/B groups compared to HC group (2.4-3.5 vs. 4.4, P<0.05). Among HC/B groups, the HC/B 0.25 group had significantly lower mean score of lens opacity compared to remaining HC/B groups treated with higher doses of betaine. In addition, the mean reduced GSH level was significantly higher in HC/B 0.25 group compared to HC, HC/B 1.00 and HC/B 0.50 groups (P<0.001). Interpretation & conclusions: The present results show beneficial anti-cataract and anti-oxidant effects of 0.25 µmol/egg betaine on HC-induced cataract in the chick embryo.

Relationship between SIRT1 gene expression level and disease in age-related cataract cases

Background/aim: Age-related cataract is the most important visual impairment all over the world. Epigenetic modifications, especially overexpression of histone deacetylases, have become the focus of interest for cataract development in recent years. Sirtuin 1 (SIRT1), a class II histone deacetylase and a member of the sirtuin family, is one of the best-characterized histone deacetylases and has a pivotal role in age-related diseases. However, the association of SIRT1 with age-related cataracts has not yet been fully elucidated. Therefore, we aimed to determine the expression of SIRT1 in age-related cataract patients. Materials and methods: Expressions of SIRT1 were evaluated by quantitative polymerase chain reaction (qPCR) in patients and healthy controls. RNA samples were collected from the anterior capsule and peripheral blood samples of age-related cataract patients. Human lens epithelial cell line B3 and peripheral blood samples of healthy subjects were used as controls. Results: We determined that the expression of SIRT1 in blood and anterior capsule samples increased significantly compared to the control group (P < 0.05). Conclusion: The expression level of SIRT1 plays a vital role in the development of age-related cataract and it can be used as a biomarker. Thus, SIRT1 inhibitors can be used in the treatment of age-related cataract disease.

The novel model: Experimental optical coherence tomography-guided anterior segment imaging chick embryo model.

PURPOSE: The aim of this study was to present an experimental optical coherence tomography (OCT)-guided anterior segment (AS) imaging chick embryo model. Through this model, we aimed to reveal similarities and differences between human cornea, AS tissues, and chick embryo tissues by quantitative image analysis. METHODS: Ex vivo, the chick embryos' globes were determined by detailed AS camera of spectral-domain (SD)-OCT in 10 fertilized specific pathogen-free eggs on the 20th day. Quantitative image analysis of anterior chamber tissues was performed with SD-OCT in detail. After imaging, cross sections of the chick embryo globes containing cornea with anterior chamber were histologically examined and compared with human tissues. The similarities of our model with data in the human cornea and AS studies in the literature were compared. RESULTS: SD-OCT imaging was able to successfully delineate the AS tissues of chick embryos such as the cornea, iris, lens, pupil, conjunctiva, ciliary body, anterior chamber, and lens. Quantitative semi-automated measurements showed the following: mean central corneal thickness: 213.4 ± 7.05 µm (197-223 µm), mean anterior chamber depth: 878.9 ± 41.74 (804-919 µm), mean anterior chamber area: 2.43 ± 0.16 mm2 (2.17-2.73 mm2), mean corneoscleral junction (limbal) thickness: 322.8 ± 20.05 µm (289-360 µm), and mean iris thickness: 230.4 ± 13.27 µm (203-245 µm). In addition, detailed histological comparisons of the AS tissues with human tissues were evaluated to be very similar. CONCLUSION: In conclusion, this chick embryo model mimics human tissues and it can be considered as a platform for the study of teratogen-induced malformations and AS dysgenesis during gestation of AS tissues. In addition, this study demonstrates the feasibility of SD-OCT in the quantitative assessment of AS structures in chick embryo model.

Comparison of anterior segment measurements using Sirius Topographer® and Nidek Axial Length-Scan® with assessing repeatability in patients with cataracts.

PURPOSE: The purpose of this study is to evaluate anterior segment measurements obtained using CSO Sirius Topographer® (CSO, Firenze, Italy) and Nidek Axial Length (AL)-Scan® (Nidek CO., Gamagori, Japan). METHODS: A total of 43 eyes of 43 patients were included in this prospective study. The central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white distance (WTW), flat keratometry (K1), steep keratometry (K2), and mean keratometry (K) values were randomly measured three times with each device by the same examiner. The intraclass correlation coefficient of repeatability was analyzed. The compatibility of both devices was evaluated using the 95% limits of the agreement proposed by Bland and Altman. RESULTS: Examiner achieved high repeatability for all parameters on each device except the WTW measured by Sirius. All measurements except WTW and K1 taken with the Sirius were higher than that taken with the Nidek AL-Scan®. The difference in CCT, ACD, and WTW values was statistically significant. CONCLUSION: High repeatability of the measurements was achieved on both devices. Although Km, K1, and K2 measurements of the Sirius and the AL-Scan® showed good agreement, WTW, CCT, and ACD measurements significantly differed between two devices. Thus, anterior segment measurements except for Km, K1, and K2 cannot be used interchangeably between Sirius and Nidek AL-Scan® devices.

Repeatability and reproducibility of automatic segmentation of retinal layers in healthy subjects using Spectralis optical coherence tomography.

PURPOSE: To evaluate the repeatability and reproducibility of automatic segmentation in healthy subjects using a Spectralis optical coherence tomography (OCT) system. METHODS: A total of 60 eyes from 60 patients were included in this prospective study. Spectral-domain optical coherence tomography images were generated using the Spectralis OCT system. An automated algorithm was used to segment the macular retina into nine layers and evaluate the thickness of each layer in the foveal, inner, and outer Early Treatment Diabetic Retinopathy Study (ETDRS) subfield rings. The eyes were imaged three times by an examiner to assess intraobserver repeatability and imaged once by a second examiner to assess interobserver reproducibility. The first scan was used for reference, whereas the second and third scans were collected using the device's follow-up mode. Intraclass correlation coefficients (ICCs) of repeatability and reproducibility were analyzed. RESULTS: The examiners achieved high repeatability and reproducibility for all parameters. Good agreement was found for all parameters in all ETDRS subdivisions with an ICC of >0.96 for all measurements. CONCLUSION: It is possible to obtain cross-sections from the same location using the device's follow-up mode, making it virtually impossible to distinguish between repeated measurements taken with the device by different examiners.

Repeatability and reproducibility of automatic segmentation of retinal layers in healthy subjects using Spectralis optical coherence tomography / Repetibilidade e reprodutibilidade da segmentação automática de camadas retinianas em sujeitos saudáveis com tomografia de coerência óptica Spectralis

ABSTRACT Purpose: To evaluate the repeatability and reproducibility of automatic segmentation in healthy subjects using a Spectralis optical coherence tomography (OCT) system. Methods: A total of 60 eyes from 60 patients were included in this prospective study. Spectral-domain optical coherence tomography images were generated using the Spectralis OCT system. An automated algorithm was used to segment the macular retina into nine layers and evaluate the thickness of each layer in the foveal, inner, and outer Early Treatment Diabetic Retinopathy Study (ETDRS) subfield rings. The eyes were imaged three times by an examiner to assess intraobserver repeatability and imaged once by a second examiner to assess interobserver reproducibility. The first scan was used for reference, whereas the second and third scans were collected using the device's follow-up mode. Intraclass correlation coefficients (ICCs) of repeatability and reproducibility were analyzed. Results: The examiners achieved high repeatability and reproducibility for all parameters. Good agreement was found for all parameters in all ETDRS subdivisions with an ICC of >0.96 for all measurements. Conclusion: It is possible to obtain cross-sections from the same location using the device's follow-up mode, making it virtually impossible to distinguish between repeated measurements taken with the device by different examiners.

RESUMO Objetivo: Avaliar a repetibilidade e a reprodutibilidade da segmentação automática com tomografia de coerência óptica Spectralis em indivíduos saudáveis. Métodos: Foram incluídos neste estudo prospectivo um total de 60 olhos de 60 pacientes. As imagens de tomografia de coerência óptica de domínio espectral (SD-OCT) foram geradas com Spectralis OCT (Heidelberg Engineering, Heidelberg, Alemanha). Um algoritmo automatizado foi utilizado para segmentar a retina macular em nove camadas e quantificar a espessura de cada camada em anéis de subcampo ETDRS fovetais, internos e externos. Os olhos de cada paciente foram imaginados três vezes pelo primeiro examinador para avaliar a repetibilidade intra-observador e uma vez pelo segundo examinador para avaliar a reprodutibilidade entre observadores. A primeira verificação foi definida como a varredura de referência, enquanto a segunda e a terceira varredura foram as varreduras de seguimento e foram realizadas com o uso do modo de acompanhamento, respectivamente. O coeficiente de correlação intraclasse (ICC) de repetibilidade e reprodutibilidade foi analisado. Repetibilidade e reprodutibilidade das medidas obtidas foram analisadas utilizando o coeficiente de correlação intraclasse. Resultados: Os examinadores alcançaram alta repetibilidade e reprodutibilidade para todos os parâmetros. Foi encontrado um bom acordo para todos os parâmetros em todas as subdivisões de ETDRS com um coeficientes de correlação intraclasse superior a 0,96 para todas as medições. Conclusão: É possível obter seções transversais do mesmo local usando o modo de acompanhamento, o que torna praticamente impossível distinguir entre medições repetidas do dispositivo independentemente do examinador.

Lens opacities in children using methylphenidate hydrochloride.

PURPOSE: To assess clinical findings of eye examination in children having attention deficit hyperactivity disorder (ADHD) administered with methylphenidate hydrochloride. METHODS: Fifty-seven consecutive patients diagnosed of ADHD and administered with oral methylphenidate hydrochloride treatment for at least one year were involved in this study (Group 1). Sixty healthy subjects (Group 2) having demographic features similar to group 1 were involved as a control group. All patients underwent detailed ophthalmological examination. RESULTS: One hundred and seventeen consecutive subjects with a mean age of 11.2 ± 2.4 years (7-18 years) were enrolled. Fifty-seven consecutive patient (32 males, 25 females) under oral methylphenidate hydrochloride treatment (Group 1) and 60 healthy control subjects (30 males, 30 females) (Group 2)) were recruited for this prospective study. The mean methylphenidate hydrochloride dosage was 0.9 ± 0.1 mg/kg/day and the mean duration of methylphenidate hydrochloride usage was for 2.73 ± 0.73 years (1-7 years). High intraocular pressure was not observed in any of the patients in our study. We detected lens opacities in five eyes of five patients in group 1 (p = 0.019). The patient with the highest degree of cataract formation had been using MPH for 84 months and this patient's cataract score was P4. CONCLUSION: Long-term use of methylphenidate may cause lens opacities. In particular, patients who have been using methylphenidate for more than two years should go for regular eye examination.

Effect of smoking on the thickness of retinal layers in healthy smokers.

PURPOSE: To compare the thicknesses of the retinal layers in smokers with those of nonsmoking healthy subjects using spectral-domain optical coherence tomography (SD-OCT). METHODS: One hundred and eight subjects were included in the study. Two groups were separated as smokers and nonsmokers. Both groups were chosen to be similar in terms of age and gender. SD-OCT images were generated with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). An automated algorithm was developed to segment the macular retina into eight layers and quantitate the thickness of each layer for the fovea, parafovea and perifovea. RESULTS: The mean smoking history was 18.33 ± 8.45 years (range: 10-40). The mean number of pack-years was 22.22 ± 15.51 (range: 10-80). No significant difference was observed regarding retinal layer measurements between the smoker and nonsmoker groups. Also, no significant difference was observed for central macular thicknesses at 1000, 3000, and 6000 µm between two groups. CONCLUSION: The thickness of retinal layers in healthy smokers was similar to those of healthy individuals.

Corneal endothelial cell density in healthy Caucasian population.

AIM: To reveal the changes of corneal endothelial characteristics with aging among Caucasian population. METHODS: Non-contact specular microscopy was performed in 564 eyes of 282 healthy Caucasian Turkish patients. Endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were measured. RESULTS: The mean age was 42 ± 17.1 (6-85) years. The MCD of the population was 2732 ± 305 cell/mm2 (range, 1904-3802 cell/mm2). The MCA was 368 ± 41 m2 (range, 263-522 m2). The mean CV in cell size was 34 ± 7 (range, 25-68), the mean percentage of hexagonal cells was 46 ± 8% (range, 25-76%), and CCT was 513 ± 39 (range, 407-623). There was statistically significantly negative correlation (p < 0.05) between age and cell density, hexagonality, and pachymetry. There was statistically significant correlation (p < 0.05) between age and MCA. CONCLUSION: We report the normal values of corneal endothelial characteristics in Caucasian Turkish eyes. Over the age of 20, the MCD of Caucasian eyes is more than the Indian and Iranian eyes and less than the Chinese eyes. Caucasian population's cell density in under the age of 20 is 3101 ± 268 cell/mm2.

Comparison of central corneal thickness estimated by an ultrasonic pachymeter and non-contact specular microscopy.

PURPOSE:: To compare central corneal thickness (CCT) measurements of healthy individuals obtained with ultrasonic pachymetry (UP) and non-contact specular microscopy (NCSM). METHOD:: In total, 148 eyes of 74 subjects with no ocular or systemic diseases were included in the study. Central corneal thickness measurements of all patients performed with UP and NCCM were compared. RESULTS:: A total of 74 subjects (38 females) were included in this study. The mean age was 45.2 ± 18.4 (range 12-85) years. The mean central corneal thickness of all 148 eyes was 546.9 ± 40 µm with UP and 510.8 ± 42 µm with NCSM. The mean central corneal thickness measured with NCSM was 35 µm thinner than that measured with UP (p<0.001). A high degree of agreement was found between the two methods (r=0.942, p<0.001). CONCLUSIONS:: Our results suggest that NCSM measures thinner corneas than UP and that the correction formula we identified should be applied when comparing between these two devices.

The Relation of White-on-White Standard Automated Perimetry, Short Wavelength Perimetry, and Optic Coherence Tomography Parameters in Ocular Hypertension.

PURPOSE: The purpose of this study is to examine the demographics, clinical properties, and the relation between white-on-white standard automated perimetry (SAP), short wavelength automated perimetry (SWAP), and optical coherence tomographic (OCT) parameters of patients with ocular hypertension. MATERIALS AND METHODS: Sixty-one eyes of 61 patients diagnosed with ocular hypertension in the Ankara Numune Education and Research Hospital ophthalmology unit between January 2010 and January 2011 were included in this study. All patients underwent SAP and SWAP tests with the Humphrey visual field analyser using the 30.2 full-threshold test. Retinal nerve fiber layers (RNFL) and optic nerve heads of patients were evaluated with Stratus OCT. RESULTS: Positive correlation was detected between SAP pattern standard deviation value and average intraocular pressure (P=0.017), maximum intraocular pressure (P=0.009), and vertical cup to disc (C/D) ratio (P=0.009). Positive correlation between SWAP median deviation value with inferior (P=0.032), nasal (P=0.005), 6 o'clock quadrant RNFL thickness (P=0.028), and Imax/Tavg ratio (P=0.023) and negative correlation with Smax/Navg ratio (P=0.005) were detected. There was no correlation between central corneal thickness and peripapillary RNFL thicknesses (P>0.05). CONCLUSIONS: There was no relation between SAP median deviation, pattern standard deviation values and RNFL thicknesses and optic disc parameters of the OCT. By contrast significant correlation between several SWAP parameters and OCT parameters were detected. SWAP appeared to outperform achromatic SAP when the same 30-2 method was used.

Comparison of central corneal thickness estimated by an ultrasonic pachymeter and non-contact specular microscopy / Comparação da espessura central de córnea estimada por um paquímetro ultrassônico e por um microscópio especular sem contato

ABSTRACT Purpose: To compare central corneal thickness (CCT) measurements of healthy individuals obtained with ultrasonic pachymetry (UP) and non-contact specular microscopy (NCSM). Method: In total, 148 eyes of 74 subjects with no ocular or systemic diseases were included in the study. Central corneal thickness measurements of all patients performed with UP and NCCM were compared. Results: A total of 74 subjects (38 females) were included in this study. The mean age was 45.2 ± 18.4 (range 12-85) years. The mean central corneal thickness of all 148 eyes was 546.9 ± 40 μm with UP and 510.8 ± 42 μm with NCSM. The mean central corneal thickness measured with NCSM was 35 μm thinner than that measured with UP (p<0.001). A high degree of agreement was found between the two methods (r=0.942, p<0.001). Conclusions: Our results suggest that NCSM measures thinner corneas than UP and that the correction formula we identified should be applied when comparing between these two devices.

RESUMO Objetivo: Comparar as medidas de espessura central corneana (CCT) de indivíduos saudáveis obtidos pela paquimetria ultrassônica (UP) e microscopia especular sem contato (NCSM). Método: Cento e quarenta e oito olhos de 74 indivíduos que não tinham doenças oculares ou sistêmicas foram incluídos no estudo. Medidas da espessura central corneana de todos os pacientes foram comparadas entre UP (SP 100, Tomey, Nagoya, Japão) e do NCSM (NSP-9900, Konan Medical, Inc., Hyogo, Japão). Resultados: Um total de 74 indivíduos (38 mulheres) foram incluídos neste estudo. A idade média foi de 45,2 ± 18,4 (variação 12-85) anos. A medida média da espessura central corneana de todos os 148 olhos foi 546,9 ± 40 μm com UP e 510,8 ± 42 μm com NCSM. A espessura central corneana média avaliada pelo NCSM foi de 35 μm mais fina do que a UP (p<0,001). Foi encontrado um elevado grau de concordância entre os dois métodos (r=0,942, p<0,001). Conclusões: Nossos resultados sugerem que a microscopia especular sem contato mede córneas mais finas em comparação com a UP e que o fator de correção identificado deve ser aplicado ao fazer comparações entre esses dois aparelhos.