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.

Effect of adalimumab on choroidal thickness and choroidal vascularity index in eyes with non-infectious uveitis using enhanced-depth imaging optical coherence tomography.

OBJECTIVE: To evaluate the effect of adalimumab (ADA) on choroidal thickness (ChT) and choroidal vascularity index (CVI) in eyes with non-infectious uveitis (NIU). METHODS: Thirty-seven eyes with NIU including Behçet disease (BD), sarcoidosis, ankylosing spondylitis (AS), juvenile idiopathic arthritis and idiopathic arthritis, 38 eyes of non-uveitic (NU) patients including BD, AS and rheumatoid arthritis, and 40 healthy control eyes were included. ADA was used for anti-TNF-naive adult (80 mg) or paediatric (40 mg) patients with refractory NIU, then 40 mg every 2-week (20 mg in children<30 kg) with controls at weeks 1, 4, 12, and 24. Images were used to measure central, nasal, and temporal ChT, and the luminal area (LA), stromal area, and total choroidal area (TCA) were analysed using enhanced-depth imaging optical coherence tomography (EDI-OCT) by ImageJ software. The CVI was then calculated as the ratio of LA to TCA. RESULTS: Mean ages were similar between the groups. Mean (SE) subfoveal ChT measurements for each location were also similar (for each, p > 0.05). However, calculated CVI values in eyes with NIU (0.63 ± 0.007) were significantly (p < 0.001) lower than NU eyes (0.66 ± 0.006) and controls (0.70 ± 0.007) (p < 0.001). Moreover, CVI was significantly lower in NU eyes compared to controls (p < 0.001). There were no significant CVI changes between the consecutive visits after ADA therapy in eyes with NIU (for each, p > 0.05). CONCLUSIONS: Decreased CVI in NIU and NU eyes indicates that systemic inflammation affects the choroidal vasculature and perfusion both in the presence and absence of ocular involvement. Although CVI may be used as a possible novel tool in monitoring ocular involvement and progression of NIU, CVI does not seem to be a biomarker for treatment monitoring in NIU.

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.

Evaluation of lamina cribrosa and peripapillary vascular density in thyroid orbitopathy and effect of intravenous methylprednisolone therapy.

OBJECTIVE: To evaluate optic nerve head changes in patients with thyroid orbitopathy (TO) and investigate the effects of intravenous methylprednisolone (IV MTP) on these changes. METHODS: Eighty-two eyes of 41 patients with TO with and without dysthyroid optic neuropathy (DON) and 40 eyes of 40 healthy control subjects were included in the study. Lamina cribrosa thickness (LCT) and depth (LCD) measurements, peripapillary retinal nerve fibre layer thickness (RNFLT), and radial peripapillary capillary vascular density were measured using optical coherence tomography and optical coherence tomography angiography. Visual field examination and proptosis were evaluated. Patients with DON and active non-DON received IV MTP for 12 weeks, and the effect of this treatment was evaluated. RESULTS: Peripapillary vascular density decreased in patients with DON compared with the other groups (p < 0.001 for all); there was no difference in the total, superior hemi-sector, and inferior hemi-sector of the RNFLT between the groups. LCT was decreased in the TO group (p < 0.001). After IV MTP treatment, the LCT and best-corrected visual acuity were increased. Thyroid-stimulating hormone receptor antibody levels, intraocular pressure, the superior hemi-sector of the RNFLT, and proptosis were decreased compared with the control subjects (p = 0.012, p = 0.008, p = 0.043, and p < 0.001, respectively). CONCLUSIONS: The RNFLT may not always increase in DON. Lamina cribrosa morphology may change in patients with TO. IV MTP therapy has a positive effect on the LCT but not on radial peripapillary capillary vascular density or LCD.

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.

Automated evaluation of parapapillary choroidal microvasculature in thyroid eye disease.

PURPOSE: The purpose of the study was to investigate the parapapillary choroidal microvasculature in thyroid eye disease (TED) using optical coherence tomography angiography (OCTA). METHODS: Only one eye of each subject was included in the study. Patients with TED and controls were included in the study. Participants were divided into three groups: control, inactive TED (ITED) and active TED (ATED). OCTA scans of the optic discs were obtained in a 4.5 × 4.5-mm rectangular area. Radial peripapillary capillary (RPC) density and peripapillary retinal nerve fibre layer (pRNFL) thickness were automatically calculated by the device software. Parapapillary choroidal microvasculature (PPCMv) density was automatically calculated using MATLAB software. RESULTS: Forty-one patients with TED and 40 controls were included in the study. RPC density was significantly decreased in the ATED and dysthyroid optic neuropathy (DON) group compared to the controls and ITED group. There was significant increase in pRNFL in the ATED group. PPCMv density increased in the ATED group compared to the controls in whole ring area. The RPC density was significantly correlated with the TSHr Ab level (r < - 0.396, p < 0.001). Clinical activity score correlated positively with PPCMv density (r = 0.349, p = 0.001) but negatively with RPC density (r = - 0.321, p = 0.004). CONCLUSION: Changes in peripapillary microvascular perfusion may play a role in the development of DON. As the severity of TED increases with clinical activity, so do the changes observed in peripapillary parameters. The decrease in RPC density may be due to compression caused by optic disc oedema, which may result in reduced blood flow. The increase in PPCMv density may be related to factors such as orbital congestion.

Bilateral Acute Iris Transillumination and Elevated Intraocular Pressure After COVID-19 Infection.

Bilateral acute iris transillumination (BAIT) is characterized by abundant pigment discharge into the anterior chamber. Atonic pupil and severe intraocular pressure (IOP) elevations may be observed. Generally, there is a viral upper respiratory tract infection or systemic fluoroquinolone usage before BAIT. Two cases with a recent history of coronavirus disease 2019 (COVID-19) presented with a complaint of decreased vision. Elevated IOP and iris transillumination defects were observed in both patients. Both patients were diagnosed with BAIT. Although elevated IOP was controlled with medical treatment in 1 patient, glaucoma surgery was performed in the other patient because it could not be controlled with medical treatment. As both patients received no systemic treatment for COVID-19, the pressure rise seems to be directly related to the viral infection alone through the inflammatory process. Atypical ocular presentations of COVID-19 should be kept in mind as it can have serious consequences.

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.

Prompt and Sustained Suppression of Intraocular Inflammation with Adalimumab in Pediatric Patients with Non-Infectious Uveitis Resistant to Traditional Managements: A 6-Month Follow-Up Research.

PURPOSE: To assess the efficacy of adalimumab (ADA) on visual acuity (VA), ocular inflammation, vitreous haze and central macular thickness (CMT) in pediatric refractory non-infectious uveitis. METHODS: Thirty-one eyes of 16 pediatric patients with uveitis of various etiologies were treated with ADA. VA, intraocular active inflammatory cells, vitreous haze, and CMT were evaluated at the baseline and 2nd, 4th, 12th, and 24th weeks following ADA treatment. RESULTS: Twenty-three of 31 eyes had active and the remaining 8 eyes had inactive uveitis (with frequent relapse) before ADA therapy. VA (LogMAR) increased at 12th week following ADA treatment (p< .001). Intraocular inflammation degrees significantly improved within 4 weeks (p< .001). Vitreous haze decreased at fourth week and stabilized at 12th week (p= .038). CMT started to decrease within weeks and stabilized at 12th week (p= .006). CONCLUSIONS: ADA was found to be safe and effective to suppress intraocular inflammation in pediatric non-infectious uveitis, which prevented sight-threatening complications.

Computed Tomographic Thickness of Retrobulbar Optic Nerve Is Decreased in Glaucoma Patients and Is Negatively Correlated With Disease Severity.

Purpose The purpose of the study was to quantitatively measure the width of the retrobulbar optic nerve-sheath complex by computed tomography (CT) in glaucoma and evaluate its relationship with optic nerve changes and visual field loss parameters. Methods Sixty-six eyes of 33 patients with bilateral asymmetric glaucomatous optic nerve damage and 20 eyes of 20 age- and sex-matched control subjects without glaucoma were included. Axial retrobulbar optic nerve-sheath complex was measured by CT in the eyes with advanced glaucomatous damage (group 1); in the fellow eyes of the same patients with moderate glaucomatous damage (group 2); and in control subjects (group 3). Measurements were obtained at three different points: just behind the globe, near the optic canal, and in the middle. Results Mean age and sex distribution between groups were comparable (p>0.05). The mean diameters of the retrobulbar optic nerve at three measurement points in group 1 (4.00±0.42mm, 3.49±0.44mm, 3.18±0.45mm) were significantly (for each, p<0.05) lower when compared with the corresponding points of group 2 eyes (4.24±0.41mm, 3.77±0.47nn, 3.47mm±0.44mm) and normal controls (4.58±0.44mm, 4.15±0.45mm, 3.92±0.48mm). Optic disc changes and visual field parameters were negatively correlated with retrobulbar optic nerve diameter (for each, p < 0.05). Conclusion Radiological alterations of the retrobulbar optic nerve in glaucomatous eyes revealed a decreased optic nerve diameter which correlated with disease severity. Optic nerve dimensions below the lower limit for normal individuals may be considered pathologically reduced and, therefore, CT measurements of the retrobulbar nerve may be additive to the traditional triad of raised intraocular pressure, field defects, and optic disc changes in some cases with opaque optic media preventing the fundus examination or with optic nerve anomalies.

Evaluation of Ring Amplitude and Factors Affecting Ring Amplitude in Multifocal Electroretinography in Diabetic Eyes.

PURPOSE: The aim of this paper was to evaluate the ring amplitudes in diabetic patients and to evaluate the effect of the risk factors for diabetic retinopathy on the ring amplitudes. We also aimed to investigate the success of ring amplitudes in classifying diabetic retinopathy. METHODS: The study included 32 eyes of 32 diabetic patients without retinopathy (DM), 34 eyes of 34 patients with mild non-proliferative diabetic retinopathy (NPDR) without macular edema, and 62 eyes of 62 age- and sex-matched controls (CG). All subjects were evaluated using mfERG. The relationship between age, diabetes duration, HbA1c and ring amplitudes and the effect of diabetes and hypertension on ring amplitudes were evaluated. Three-way ROC analysis was performed to evaluate the discrimination power of the ring amplitudes. RESULTS: In the comparison of the ring amplitudes, the amplitudes of the DM and NPDR groups were statistically significantly decreased compared to the CG (p < .05). A moderate to strong correlation was found between the duration of diabetes, HbA1c and ring amplitudes (p < .05). The effect of diabetes decreased towards the peripheral rings and hypertension did not affect ring amplitudes. Volume under the ROC surface of R1 = 0.65 had p < .05 and 95% CI [0.50-0.72], and the best cut-off point pair to differentiate the three classes was found to be c1 = 217.3, c2 = 151.2 in three-way ROC analysis. CONCLUSION: In conclusion, the effects of diabetes are unevenly distributed on the retina topographically. Diabetes affects the central rings more than peripheral rings in multifocal ERG. Both ring densities and ring ratios are effective ways to identify early changes in retinal function.

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.

Reliable, Noncontact Imaging Tool for the Evaluation of Meibomian Gland Function: Sirius Meibography.

OBJECTIVES: To investigate the correlation between the clinical grading of the severity of meibomian gland dysfunction (MGD) and meibomian gland area (MGA) loss detected using Sirius meibography in the upper and lower eyelids and to correlate these parameters with dry eye signs and symptoms. METHODS: One hundred thirty eyes of 130 volunteer patients were enrolled. Meibomian gland dysfunction was defined as the presence of signs consistent with meibomian gland terminal duct obstruction and categorized between grades 1 and 4. Upper and lower MGA loss percentages were evaluated using Sirius meibography by two blinded examiners. Patients were categorized into two groups (positive and negative for MGD) based on their Ocular Surface Disease Index (OSDI) scores (≥15 and <14, respectively) and MGD grades (≥1 and 0, respectively). RESULTS: The MGA loss percentage and ocular surface test results of the MGD group were greater than in the non-MGD group in both eyelids (P=0.001). Meibomian gland dysfunction grade and MGA loss for the lower eyelid was greater than that of the upper eyelids (P=0.002 and P<0.001, respectively). The OSDI score, tear film break-up time, and lissamine green staining were all significantly correlated with MGD grade and MGA loss in both eyelids (P<0.001). For the average measures of the MGA loss percentage in each scan, the intraclass correlation value was found as 0.994 (95% confidence interval [CI]: 0.992-0.995) for reader 1 and 0.988 (95% CI: 0.982-0.992) for reader 2. CONCLUSIONS: Our findings suggest that Sirius meibography, a noncontact imaging device, is a reliable tool for evaluating meibomian gland structure in patients with MGD and non-MGD of various ages and regardless of sex.

Retinal vessel diameter obtained by optical coherence tomography is spared in Parkinson's disease.

PURPOSE: To define the alterations in retinal vessel diameter in Parkinson's disease (PD) by optical coherence tomography (OCT). METHODS: This is a case-control study including 41 eyes of 41 patients with diagnosis of PD and 35 eyes of 35 age- and sex-matched control subjects. All subjects underwent complete neurological and ophthalmological examinations before measurements. Retinal vessel diameters and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were evaluated with spectral domain OCT (SD-OCT) with a circular scan centered at the optic disc. The diameters of the superior nasal and temporal arteries and veins, and inferior nasal and temporal arteries and veins were measured and then compared between the groups. Correlations with the duration of the disease, usage of levodopa, and pRNFL thicknesses between retinal vessel diameters were examined with Pearson and Spearman correlation analysis. RESULTS: Average pRNFL thickness is significantly decreased in PD compared to age- and sex-matched controls (p < 0.05). At all measurement points, retinal artery diameter measurements were decreased in the PD group compared to controls, but the differences did not reach statistical significance. Diameters of the retinal veins also did not show any significant difference in the PD and control groups. Superior temporal artery diameter was significantly decreased in patients using levodopa compared to nonusers (p = 0.022). There were no statistically significant correlations between pRNFL thicknesses or disease duration with retinal vessel diameters in PD group. CONCLUSIONS: Parkinson's disease does not seem to have an impact on the retinal vessel diameters obtained by SD-OCT.

Retinal single-layer analysis with optical coherence tomography shows inner retinal layer thinning in Huntington's disease as a potential biomarker.

PURPOSE: There have been ongoing clinical trials of therapeutic agents in Huntington's disease (HD) which requires development of reliable biomarkers of disease progression. There have been studies in the literature with conflicting results on the involvement of retina in HD, and up to date there is not a study evaluating the single retinal layers in HD. We aimed to evaluate the specific retinal changes in HD and their usability as potential disease progression markers. METHODS: This cross-sectional study used spectral-domain optical coherence tomography with automatic segmentation to measure peripapillary retinal nerve fiber layer (pRNFL) thickness and the thickness and volume of retinal layers in foveal scans of 15 patients with HD and 15 age- and sex-matched controls. Genetic testing results, disease duration, HD disease burden scores and Unified HD Rating Scales motor scores were acquired for the patients. RESULTS: Temporal pRNFL, macular RNFL (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer and outer plexiform layer thicknesses and IPL, retinal pigment epithelium and outer macular volume were found lower in HD compared to controls, while outer nuclear layer and outer retinal layer thickness were increased (p < 0.05). We found significant correlations between inner retinal layer thicknesses, most significantly with mRNFL and GCL and disease progression markers. CONCLUSION: The outcomes of this study points out that retinal layers, most significantly mRNFL and GCL, are strongly correlated with the disease progression in HD and could serve as useful biomarkers for disease progression.

Ocular complications of severe corneal abrasions after cosmetic blepharopigmentation.

A 53-year-old woman with hemiparesis and poor dexterity, underwent cosmetic blepharopigmentation on the both upper eyelids in the dermatology clinic of a private hospital. She was not asked for any information on her medical history and no informed consent was obtained and the procedure was performed without any protective ocular shields. The patient experienced severe lacrimation, discomfort, and increased sensitivity to light during and after the procedure. She also noticed blurred vision after the procedure. Ophthalmologic examination revealed tender and oedematous eyelids and corneal abrasions in both of her eyes. Topical antibiotics and preservative-free lubricants were able to recover her from her signs and symptoms at 1-week follow-up. It is recommended that cosmetic blepharopigmentation should be applied cautiously with patient's informed consent after obtaining a thorough medical history and with protective ocular shields to avoid potential complications.

The Effects of Anti-Vascular Endothelial Growth Factor Drugs on Retinal Pigment Epithelial Cell Culture.

OBJECTIVES: To assess the effects of anti-vascular endothelial growth factor (VEGF) drugs on retinal pigment epithelium cell culture. MATERIALS AND METHODS: Aflibercept (0.5 mg/mL), bevacizumab (0.3125 mg/mL), and ranibizumab (0.125 mg/mL) were applied to retinal pigment epithelium cell cultures isolated from the enucleated eyes of New Zealand white rabbits. Viability, apoptosis, proliferation, and senescence of the cells were evaluated in control and drug-treated cultures at the end of 72 hours. RESULTS: Cells treated with aflibercept showed increased viability and decreased apoptosis compared to the control culture and both the bevacizumab- and ranibizumab-treated groups (p<0.05). Statistically increased apoptosis and decreased viability were found in the bevacizumab and ranibizumab-treated groups compared with the control group (p<0.05). There were no statistically significant differences in cell proliferation and senescence between the groups (p>0.05). CONCLUSION: Anti-VEGF drugs did not affect senescence or proliferation of retinal pigment epithelium cells. Aflibercept was found to decrease apoptosis and increase cell viability, while ranibizumab and bevacizumab increased apoptosis and reduced cell viability in retinal pigment epithelium culture.