Acute Effects of Neodymium-Doped Yttrium Aluminum Garnet Laser Capsulotomy on Anterior Segment Parameters in Capsular Bag Distension Syndrome.

Background: Capsular bag distension syndrome (CBDS) can be effectively treated using either Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy or surgery. Assessing anterior segment, particularly immediately after Nd:YAG laser capsulotomy, could provide clinically relevant information on ocular dynamics, refractive changes, and complication mechanisms, especially in late postoperative CBDS. Objective: To explore the acute effects of Nd:YAG laser posterior capsulotomy on anterior segment parameters in late postoperative CBDS. Methods and results: In this study, 20 patients underwent Nd:YAG laser posterior capsulotomy after cycloplegia, during which milky-white fluid material migrated into the anterior vitreous. Anterior segment parameters were assessed before and immediately after laser using Scheimpflug-Placido topographer. The main outcome measures were differences in best-corrected visual acuity (BCVA), aqueous depth (AqD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume (CV), and central corneal thickness (CCT) at the baseline versus at immediately after laser. The mean age and duration since surgery for CBDS presentation were 70.25 ± 6.21 and 6.15 ± 1.31 years, respectively. The AqD, ACV, ICA, and spherical equivalent increased significantly compared with baseline (4.18 vs. 4.02 mm, p = 0.001; 177 vs. 173.55 mm3, p = 0.004; 51.15° vs. 50.15°, p = 0.023; -1.00 vs. -2.00 D, p = 0.003, respectively). These changes were also associated with significantly improved BCVA an hour after capsulotomy [0.2 (0.05-0.2)] relative to baseline [0.3 (0.2-0.5)], (p = 0.001). CCT and CV decreased nonsignificantly; horizontal AC diameter and K1 and K2 increased nonsignificantly (p > 0.05). Conclusions: Nd:YAG laser posterior capsulotomy appears to be an effective CBDS treatment for acutely improving vision, potentially due to immediate refractive changes caused by altered anterior segment parameters.

Audiometric Evaluation of the Relationship between Sensorineural Hearing Loss and Chronic Glaucoma.

Objectives: To assess hearing function in chronic glaucoma patients in comparison to healthy individuals. Materials and Methods: This cross-sectional study included 24 primary open-angle glaucoma (POAG) patients (24 ears) and 22 pseudoexfoliative glaucoma (PEG) patients (22 ears) who were followed for at least 5 years in the Afyonkarahisar Health Sciences University Ophthalmology Department, as well as 21 age- and gender-matched healthy individuals (21 ears, control group). Following a thorough ophthalmological examination that included visual acuity and intraocular pressure measurements, as well as anterior and posterior slit-lamp biomicroscopy, audiometry was performed in all participants to determine hearing function. Results: Mean ages in the POAG, PEG, and control groups were 64.50±7, 66.90±4.51, and 64.38±4.36 years, respectively. The mean deviation in standard automated perimetry was -14.47±2.89 in the POAG group and -15.02±2.87 in the PEG group (p=0.306). When compared with the control group, the POAG group had significantly higher hearing thresholds at 500 (p=0.011) and 1,000 Hz (p=0.003), while the PEG group had significantly higher hearing thresholds at 250 (p=0.009), 500 (p=0.009), 1,000 (p=0.001), 2,000 (p=0.005), 4,000 (p=0.001), 8000 (p=0.010), and 10,000 Hz (p=0.009). Conclusion: Both glaucoma and hearing loss are common chronic diseases that have an impact on the well-being of older people. Potential hearing problems in chronic glaucoma patients make routine ocular and otolaryngology examinations in older patients critical for prompt diagnosis and treatment.

Quality assessment and comparison of two- and three-dimensional YouTube videos as additional educational tools for cataract surgery: "METAVERSE".

BACKGROUND: To compare the content and quality of 3D YouTube videos with 2Ds as additional educational tools for phacoemulsification surgery. METHODS: This cross-sectional study included 2D and side-by-side 3D phacoemulsification videos found on YouTube by searching for "phacoemulsification," "phaco," and "cataract." Data was collected on video length (min), time since upload (days), number of views, likes, dislikes, cataract type, chop technique, and visualization system. Video popularity and interaction were calculated by video power index, interaction index, and viewing rate. Two senior ophthalmologists (SOs) and two ophthalmology residents (ORs) evaluated videos using the DISCERN, global quality score (GQS), and usefulness scoring systems. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC). RESULTS: A total of 457 videos were screened, with 85 in 2D and 85 in 3D deemed appropriate for analysis. 2D videos received significantly more views, likes, dislikes, days since upload, video power index, and viewing rate than 3Ds (p < 0.001). Video length and interaction index in 3D videos were significantly greater than in 2Ds (p < 0.001). All video scoring systems revealed that 3D videos outperformed 2Ds in ORs (p < 0.05). ICC confirmed good inter-rater reliability agreement even at the lowest value (SOs: 0.924, 95% CI, 0.910-0.937; ORs: 0.892, 95% CI, 0.878-0.908). CONCLUSIONS: 3D YouTube videos as additional educational tools could help not only SOs but also ORs fully comprehend the breadth and depth of ocular surgeries, particularly phacoemulsification, by improving depth perception. They can also be used to review previously learned procedures, observe new ones, and recall old ones.

Retinal ultrastructural, electrophysiological, and microvascular morphological outcomes in diabetic macular edema treated with intravitreal bevacizumab.

BACKGROUND: Investigation of retinal ultrastructural, electrophysiological, and microvascular morphological changes, as well as correlations between these changes and visual outcome in naïve diabetic macular edema (DME) patients after intravitreal bevacizumab therapy (IVBT). METHODS: This prospective interventional study enrolled 31 DME patients' eyes treated with monthly IVBT for three months. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and fundus fluorescein angiography, optical coherence tomography (OCT), microperimetry, as well as optical coherence tomography angiography (OCTA) were performed before and after IVBT. Patients were grouped based on BCVA improvement after three consecutive IVBT: group 1: > 10 letters, group 2: ≤ 5 letters, and group 3: between 6 and 10 letters. RESULTS: Mean BCVA increased significantly from 34.2 to 39.9 letters (p < 0.001). Central macular thickness decreased significantly from 335.1 to 276.4 µm (p < 0.001). Fixation stability, retinal sensitivity, and local deficit all improved significantly (p < 0.001 for all). There was no statistically significant change in IOP (p = 0.665). Although OCTA parameters did not change significantly, lower foveal avascular zone (FAZ) area, higher foveal vessel density 300 µm area around FAZ and deep plexus vascular density were associated with highly improved BCVA, retinal sensitivity, and local deficit. Also, there were no significant intergroup differences in gender, age, baseline BCVA, HbA1c, IOP, phakic/pseudophakic lens ratio, concomitant hypertension, and superficial capillary plexus vascular density. CONCLUSIONS: IVBT was associated with significantly improved BCVA, retinal ultrastructural integrity, and electrophysiological patterns in naive DME patients. Improvements in retinal electrophysiology correlated with ultrastructural improvements, which could be predicted using OCTA.

How Traumatic is Intravitreal Ozurdex Injection?

BACKGROUND: This study intended to illustrate a rare case of pyogenic granuloma (PG) in retinal vein occlusion (RVO) patient after dexamethasone (DEX) implant therapy. CASE DESCRIPTION: A 58-year-old female who underwent DEX implant therapy a month ago due to RVO presented with a mass in her right eye. Anterior segment analysis revealed a slowly enlarging, round, fleshy vascular mass indicating PG located at the injection site. Although surgical excision was planned, because of the Covid-19 pandemic, a patient could not come for surgery. Ocular examination revealed a spontaneous PG disappearance three months later. A small mass could, however, be detected using an anterior segment optical coherence tomography. CONCLUSION: While superficial PG regression can only be observed by slit-lamp biomicroscopy, extensive root ingrowth can be clearly differentiated by anterior segment optical coherence tomography. Besides, depending on the nature, size, location, and associated symptoms, some PG may be left to regress but with close monitoring.

Paracentral Acute Middle Maculopathy Revealing a Giant Aortic Aneurysm.

BACKGROUND: This report describes a case with paracentral acute middle maculopathy revealing a giant aortic aneurysm. CASE DESCRIPTION: A 41-year-old man presented with unilaterally unexplained sudden vision loss in the left eye. Fundoscopy revealed a slightly pale r -26etinal reflex in the superior retinal hemifield. SDOCT revealed blurred boundaries between retinal segments and prominent edema in the middle retinal layers. OCTA revealed decreased vascular density in the deep capillary plexus. FA showed low arterial circulation mainly in the superior retinal hemifield. Humphrey VFT revealed an inferior altitudinal defect in the left eye, implying a related circulatory disturbance in the corresponding region.A thorough systemic work-up, including a cardiovascular etiological investigation, revealed giant aortic aneurysm in the ascending aorta, necessitating emergency surgery. CONCLUSION: This report highlights the importance of a systemic etiological investigation in patients with PAMM to rule out any potential cardiovascular issues.

Impacts of Camellia sinensis fermentation end-product (black tea) on retinal microvasculature: an updated OCTA analysis.

BACKGROUND: Tea, second only to water, is one of the most regularly consumed drinks in the world. Its potentially beneficial effects on general health may be enormously important. Optical coherence tomography angiography (OCTA) now allows clinicians to examine the acute retinal morphological changes caused by black tea consumption. The purpose of this study was to investigate the acute impacts of a Camellia sinensis fermentation end-product (black tea) on retinal microvasculature in healthy individuals using OCTA. RESULTS: In this study, 60 healthy people were divided into two groups: group 1 (n = 30) received black tea (2 mg/250 mL of water) and group 2 (n = 30) received only 250 mL of water. Following consumption, AngioVue Analytics software automatically analyzed the foveal, parafoveal, perifoveal macular superficial and deep vascular plexus densities, foveal avascular zone (FAZ) area, FAZ perimeter and foveal vessel density in a 300 µm wide region around the FAZ (FD-300). Male-to-female ratios were 19:11 and 15:15 in groups 1 and 2, respectively (P = 0.217). Mean age was 33.27 ± 7.92 years in group 1 and 31.00 ± 7.30 years in group 2 (P = 0.254). Changes in foveal, perifoveal and parafoveal macular vessel density between groups 1 and 2 were not statistically significant. In addition, no significant differences regarding FAZ, FAZ perimeter and FD-300 were observed. CONCLUSION: There were no acute effects of black tea on macular microcirculation in healthy individuals. The authors, however, believe that this study could serve as a model for future research on the relationship between regular tea consumption and general ocular physiology. © 2021 Society of Chemical Industry.

An insight on the anatomical and functional consequences of aflibercept therapy in age-related macular degeneration.

BACKGROUND: Evaluation of anatomical and functional recovery of the retina after aflibercept therapy in neovascular age-related macular degeneration. MATERIALS AND METHODS: This prospective study enrolled 33 eyes of 33 naive age-related macular degeneration patients with an average age of 69 (55-82) years. Following a thorough ophthalmological examination, baseline color fundus photography, optical coherence tomography and fluorescein angiography were used to assess the angiographic characteristics and classification of the lesions. Multifocal electroretinography and microperimetry were recorded. In the first three months, all patients received three consecutive intravitreal aflibercept injections on a monthly basis. After the initial three doses, non-responders received additional afibercept injections. The baseline, 3rd and 6th month data were recorded for analysis. RESULTS: The baseline average best-corrected visual acuity (1.05 log MAR) improved dramatically to 0.9 log MAR in the 3rd and 6th months, respectively. The baseline average central macular thickness of 358.5 ± 232.1 µm decreased significantly to 273.0 ± 109.9 µm and 245.5 ± 109.3 µm in the 3rd and 6th months, respectively. The average thickness of the central 1 mm macular region decreased significantly from 349.5 ± 96.4 µm to the 3rd and 6th month values of 320.6 ± 101.9 and 290.5 ± 86.4 µm, respectively. While the mean retinal sensitivity increased significantly from 4.7 ± 3.0 dB to 6.9 ± 3.4 Db, local deficit decreased from -11.6 ± 4.6 dB to -9.4 ± 4.6 dB. Significant improvements were also observed in all rings of N1 and P1 waves. CONCLUSION: Intravitreal aflibercept therapy resulted in significant morphological improvements that were easily identifiable during the 3rd month. Electrophysiological improvements were delayed only to become statistically significant in the 6th month. However, it has been shown that visual acuity and optical coherence tomography parameters alone may be insufficient for both the morphological and functional assessment of the retina.

Cigarette smoking reduces deep retinal vascular density.

BACKGROUND: The purpose of this study was to report the effects of smoking on retinal vascular parameters. METHODS: In this cross-sectional study design, 24 smokers were included as a study group and 26 age- and sex-matched non-smokers as a control group. A detailed ophthalmic examination including review of medical history, visual acuity testing, intraocular pressure measurement by Goldmann applanation tonometry, ocular movement and pupillary reflex examination, slitlamp biomicroscopy as well as dilated funduscopic examination were undertaken in all participants. Participants underwent optical coherence tomography angiography (OCT-A) scanning with RTVue XR Avanti AngioVue OCT-A (Optovue, Fremont, CA, USA) as well as the measurement of axial length using an AL Scan (Nidek Co., Ltd., Gamagori, Japan). RESULTS: The study comprised of 18 men and six women with a mean age of 28.1 ± 4.8 years in the study group and 19 men and seven women with a mean age of 27.4 ± 2.7 years in the control group. The mean exposure to cigarette smoking was 3.3 ± 1.0 pack-years. Total vascular density, parafoveal vascular density and perifoveal vascular density in the deep capillary plexus observed with OCT-A were significantly lower in the smoking group compared to the control group (p = 0.02, 0.01 and 0.01, respectively). CONCLUSION: Retinal vascular changes caused by cigarette smoking may occur even at low pack-year exposure. These changes, which can be demonstrated by OCT-A, may reflect the early impact of cigarette smoking on the microvascular system.