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.

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.

Correlation between optical coherence tomography angiography and multifocal electroretinogram findings in patients with diabetes mellitus.

BACKGROUND: Diabetic retinopathy is characterized by microvascular, neural and glial cell damage. Optical coherence tomography angiography (OCTA) can detect subclinical microvasculopathy while multifocal electroretinography (mfERG) can detect subclinical local retinal dysfunction before onset of clinically observable retinopathy. Here, we investigated the relationship between retinal dysfunction in multifocal electroretinography and vascular changes in optical coherence tomography angiography. METHODS: The study included 63 eyes of 63 diabetic patients without retinopathy (DM+DR-) and 68 eyes of 68 patients with non-proliferative diabetic retinopathy (NPDR). In addition, 64 eyes of 64 age and sex-matched subjects were included as the control group (CG). All subjects were evaluated using OCTA and mfERG. RESULTS: The vascular density in the superficial and deep capillary plexus was significantly decreased in the DM+DR-group and the NPDR group compared with the CG group (except for the superficial foveal area, NPDR group vs. CG group) (p < 0.05). The vascular density of the superficial and deep parafoveal region was significantly decreased in the NPDR group compared to the DM+DR-group (p < 0.05). In circles of 2-, 5- and 10°, the amplitudes of the N1 and P1 waves were statistically significantly decreased in both the DM+DR- group and the NPDR group compared with the CG (p < 0.05). When the NPDR group was compared with the DM+DR- group, there was a statistically significant decrease in the amplitude of the N1 and P1 waves in the circles of 2- and 5° (p < 0.05). According to the correlation analysis, the amplitude and implicit times of the N1 and P1 waves showed weak-to-moderate correlation with vascular density (p < 0.05). CONCLUSIONS: The decreased peaks of mfERG wave provides evidence regarding neurodegenerative effect of DM-associated hyperglycaemia. The decreased vascular density caused by hyperglycaemia was topographically associated with the retinal dysfunction and neurodegeneration.

Anterior ischemic optic neuropathy and cilioretinal artery occlusion secondary to polyarteritis nodosa: A case report.

INTRODUCTION: Polyarteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions affecting the middle and small arteries. CASE PRESENTATION: A 23-year-old male presented to our ophthalmology clinic with a 1-day history of sudden vision loss in his left eye. Posterior segment examination the left eye showed optic disc borders were faint, hyperemic and fluffy with cilioretinal artery occlusion signs present. Optical coherence tomography revealed the presence of localized intracellular edema from optic disc to superior-hemi of fovea, including fovea. On optical coherence tomography angiography, there was a decrease in vessel density in the superficial and deep capillary plexus in the area matching the cilioretinal artery trace, and choroidal vessel density decreased. Wide field fundus fluorescein angiography showed a large choroidal filling defect (ischemia area) and the cilioretinal artery were not filled in the temporal quadrant. These findings made us think that short ciliary arteries were affected and were the causal of the choroidal ischemia and infarction of optic nerve. DISCUSSION: PAN-associated choroidal ischemia, cilioretinal artery occlusion and ischemic optic neuropathy are rare. If ischemic retinal condition is seen in young patients, PAN should be considered in the differential diagnosis as it may cause life-threatening complications in its advanced stages.

First Year Results of Suprachoroidal Adipose Tissue Derived Mesenchymal Stem Cell Implantation in Degenerative Macular Diseases.

BACKGROUND AND OBJECTIVES: This study shows the clinical data of 1-year follow-up of 8 patients with degenerative macular diseases who received suprachoroidal adipose tissue derived mesenchymal stem cell (ADMSC) implantation. METHODS AND RESULTS: This prospective, single-center, phase 1/2 study enrolled 8 eyes of 8 patients with degenerative macular diseases of various reasons who underwent suprachoroidal implantation of ADMSCs. All patients had severe visual field defects and severe visual loss. All patients had defective multifocal electroretinography (mf ERG). The worse eye of the patient was selected for the operation. Patients were evaluated on the first day, first month, sixth month and at 1 year postoperatively. Best corrected visual acuity (BCVA), anterior segment and fundus examination, color photography, optical coherence tomography (OCT) and visual field (VF) examination were carried out at each visit. Fundus fluorescein angiography (FFA) and mfERG recordings were performed at the end of the sixth months. All 8 patients completed the 1 year follow-up. None of them had any systemic or ocular complications. Seven of the patients experienced visual acuity improvement, visual field improvement and improvement in the mfERG recordings. We found choroidal thickening in OCT of the four treated eyes. CONCLUSIONS: Even though the sample size is small, stem cell treatment with suprachoroidal implantation of ADMSCs seems to be safe and the improvements were encouraging. To optimize the cell delivery technique and to evaluate the effects of this therapy on visual acuity and the quality of life of these patients, future studies with larger number of cases will be necessary.

Six-month results of suprachoroidal adipose tissue-derived mesenchymal stem cell implantation in patients with optic atrophy: a phase 1/2 study.

PURPOSE: This prospective clinical case series aimed to investigate the safety and efficacy of suprachoroidal adipose tissue-derived mesenchymal stem cell (ADMSC) implantation in patients with optic nerve diseases. METHODS: This prospective, single-center, phase 1/2 study enrolled 4 eyes of 4 patients with optic atrophy of various reasons who underwent suprachoroidal implantation of ADMSCs. The best-corrected visual acuity (BCVA) in the study was HM at 1 m. The worse eye of the patient was operated. Patients were evaluated on the first day, first week, first month, third and sixth months postoperatively. BCVA, anterior segment and fundus examination, color photography, optical coherence tomography (OCT) and visual field examination were carried out at each visit. Fundus fluorescein angiography and multifocal electroretinography (mfERG) recordings were performed at the end of the first, third and sixth months and anytime if necessary during the follow-up. RESULTS: All 4 patients completed the six-month follow-up. None of them had any systemic or ocular complications. All of the patients experienced visual acuity improvement, visual field improvement and improvement in the mfERG recordings. We found choroidal thickening in OCT of the 4 patients. CONCLUSION: Even though the sample size is small, the improvements were still encouraging. Stem cell treatment with suprachoroidal implantation of ADMSCs seems to be safe and effective in the treatment for optic nerve diseases that currently have no curative treatment options.

Suprachoroidal Adipose Tissue-Derived Mesenchymal Stem Cell Implantation in Patients with Dry-Type Age-Related Macular Degeneration and Stargardt's Macular Dystrophy: 6-Month Follow-Up Results of a Phase 2 Study.

This prospective clinical case series aimed to investigate the safety and efficacy of suprachoroidal adipose tissue-derived mesenchymal stem cell (ADMSC) implantation in patients with dry-type age-related macular degeneration (AMD) and Stargardt's macular dystrophy (SMD). This study included four patients with advanced-stage dry-type AMD and four patients with SMD who underwent suprachoroidal implantation of ADMSCs. The best-corrected visual acuity (BCVA) in the study was 20/200. The worse eye of the patient was operated on. Patients were evaluated on the first day, first week, and first, third, and sixth months postoperatively. BCVA, anterior segment and fundus examination, color photography, fundus autofluorescence, optical coherence tomography, and visual field examination were carried out at each visit. Fundus fluorescein angiography and multifocal electroretinography (mf-ERG) recordings were performed at the end of the first, third, and sixth months and anytime if necessary during the follow-up. All eight patients completed the sixth month follow-up. None of them had any systemic or ocular complications. All of the eight patients experienced visual acuity improvement, visual field improvement, and improvement in mf-ERG recordings. Stem cell treatment with suprachoroidal implantation of ADMSCs seems to be safe and effective in the treatment of dry-type AMD and SMD.

COMPARISON OF CORNEAL WETTING PROPERTIES OF DIFFERENT DISPERSIVE OPHTHALMIC VISCOSURGICAL DEVICES: An Optical Coherence Tomography Study.

PURPOSE: To compare corneal wetting performances of different dispersive ophthalmic viscosurgical devices. METHODS: Three different types of dispersive ophthalmic viscosurgical devices, hydroxypropyl methylcellulose %2 (HPMC), sodium hyaluronate %3-sodium chondroitin sulphate %4 (HACS), and sodium hyaluronate %3 (HA), were applied on corneal surfaces of 10 healthy volunteer subjects repeatedly at 3 different time points. Corneal wetting properties of the ophthalmic viscosurgical devices were compared qualitatively and quantitatively by anterior segment optical coherence tomography for 30 minutes. RESULTS: Sodium hyaluronate 3% and HACS applications had a higher mean precorneal ophthalmic viscosurgical device thickness than HPMC application at all time points (seventh minute HPMC: 105.2 ± 25.3 µm, HA: 561.4 ± 115.8 µm, HACS: 481.2 ± 55 µm, P < 0.001). All HPMC applications were terminated by the 12th minute because of insufficient corneal wetting. Mean survival estimate time was significantly shortest for HPMC (11.5 ± 0.5 minutes, P < 0.001) and longest for HA (29.7 ± 0.28 minutes). It was slightly shorter for HACS (26.9 ± 0.87 minutes, P = 0.007) than the HA application. CONCLUSION: Sodium hyaluronate 3% and HACS provide superior corneal covering compared with HPMC with an effect that can be maintained up to 30 minutes. They may be an effective option for corneal wetting during long vitreoretinal surgeries with longer duration of effect and fever number of applications.

Evaluation of the effect of fluorescein angiography on retinal vessel diameter: an optical coherence tomography study.

PURPOSE: To evaluate the effect of fluorescein angiography on retinal vessel diameter with Optical Coherence Tomography (OCT). METHODS: In this cross-sectional study, a total of 81 eyes of 81 patients who were performed fluorescein angiography (FA) procedure were included. Retinal vessels were examined with the Spectral-domain OCT at baseline and immediately after FA procedure. A cube scan consisting of seven horizontal scans were placed at the inferior border of the disk to include the inferior temporal retinal vessels. Vessels diameters were measured at five measurement points (480-1440 µm inferiorly from the optic disk border). RESULTS: The mean age of the study subjects was 58.02 ± 14.1 years. At baseline, the mean diameter of the retinal artery was 120.16 ± 24.56 µm and of the vein 157.94 ± 32.34 µm at the measurement point of 480 µm, with a gradual decrease to 114.91 ± 25.59 and 152.17 ± 28.17 µm, respectively, at 1440 µm. After FA procedure, the mean diameter of the retinal artery was 122.85 ± 26.35 and of the vein 158.30 ± 32.21 µm at the measurement point of 480 µm, with a gradual decrease to 115.22 ± 22.91 and 151.94 ± 28.93 µm, respectively, at 1440 µm. There were no statistical differences for either of these comparisons at any of the points of both artery and vein measurements. CONCLUSION: There was not any clinically significant change in retinal artery diameter such as a dilatatory response after FA procedure in patients with hypertension, diabetes, and age-related macular degeneration (AMD).

Changes in retinal vessel diameters in migraine patients during attack-free period.

AIM: To evaluate the retinal vessel diameters in patients with migraine by optical coherence tomography (OCT). METHODS: In this cross-sectional study, 124 eyes of 62 patients with a diagnosis of unilateral migraine during attack-free period and 42 age- and sex-matched control subjects were included. Migraine patients were divided into the ≤2 migraine attacks per month group and the ≥5 migraine attacks per month group. All subjects underwent complete ophthalmological and neurological examinations before measurements. Retinal vessel diameters and choroidal thickness were examined with the Spectralis OCT. RESULTS: The mean diameters of the arteries in the eyes on the headache side of control group, ≥5 migraine attacks per month and ≤2 migraine attacks per month group at 480 µm from the optic disk (Raster 3) were 119.54±46.69, 136.68±25.93 and 119.34±31.75 µm respectively with a steady decline to 105.57±32.15, 118.18±31.87 and 108.05±38.77 µm at 1440 µm (Raster 7), the last measurement point, respectively. The retinal artery diameter measurements were significantly increased in ≥5 migraine attacks per month patients at four out of five measured points compared to control group (P<0.05). There were no statistical differences at any of the points of vein measurements. The choroidal thickness measurements were significantly decreased in ≥5 migraine attacks per month patients at all measured points compared to control group (P<0.05). CONCLUSION: The retinal artery diameter is found to increase significantly and the choroidal thickness is found to decrease in the eyes on the headache side in ≥5 migraine attacks per month patients compared to control group.

Ocular symptoms as the initial signs of zinc deficiency.

A 2-year-old boy with a history of food allergy presented with severe edema and erythema, excoriations and honey-colored crusting on both lower eyelids, and erythematous rash on his perioral region. An evaluation for micronutrient deficiencies revealed low plasma zinc level. The patient was started on a regimen of zinc supplementation, and at 4 weeks' follow-up there was nearly complete resolution of the lesions.

Functional Amblyopia and Deficient Binocular Vision as Initial Clinical Features in Duane's Syndrome.

PURPOSE: To investigate and report the clinical characteristics at initial presentation in patients who had Duane Syndrome, especially binocular vision and functional amblyopia. METHODS: The medical files of patients with Duane's syndrome were reviewed. The main outcome measures of the study were the initial clinical characteristics including amblyopia and associated risk factors including deficiences of binocular vision. RESULTS: The review identified 99 patients with Duane Syndrome. The median age of patients was 6 years. The frequency of amblyopia at initial presentation was 23 percent. Forty-five patients had measurable stereopsis and 58 patients had binocular vision fusion. CONCLUSIONS: Amblyopia and altered binocular function are important among the clinical features of Duane Syndrome which should be highlighted at initial examination.