VOLUMETRIC ANALYSIS OF LAMELLAR MACULAR HOLE: An Optical Coherence Tomography Study.

BACKGROUND: To investigate the cavity of lamellar macular holes (LMH-CV) by using volumetric analysis of optical coherence tomography images. METHODS: Single-center, retrospective, observational case series. The volume of the LMH-CV and epiretinal proliferation was determined. Best-corrected visual acuity, central macular thickness, maximum horizontal diameter and minimum horizontal diameter, and the presence of foveal bump and ellipsoid zone defect were noted. RESULTS: Forty-nine eyes of 46 patients (20 women) were included in the baseline analysis. The natural course group consisted of 25 patients (27 eyes) with a mean follow-up of 19.2 ± 15.7 months. The volume of LMH-CV was found to be a predictive factor for baseline best-corrected visual acuity (P = 0.038, ß-coefficient = 0.338, 95% CI: 0.275-8.893). Whereas no significant change at the last visit was observed in central macular thickness, minimum horizontal diameter, and maximum horizontal diameter, the LMH-CV and epiretinal proliferation volume increased significantly (P = 0.036, P < 0.001, respectively). Eyes with foveal bump had larger minimum horizontal diameter, maximum horizontal diameter, and LMH-CV volume (P = 0.008, P < 0.001, P = 0.024, respectively). Eyes with ellipsoid zone defect showed larger LMH-CV and epiretinal proliferation volume, but thinner central macular thickness (P = 0.038, P = 0.004, P = 0.012, respectively). CONCLUSION: Volumetric analysis of LMH-CV detects changes in the natural course of lamellar macular hole earlier than the measurement of horizontal diameters. Further studies will clarify whether volumetric analysis of the lamellar macular hole is useful as an additional biomarker in the management of lamellar macular hole.

Natural Course of Optic Disc Pit Maculopathy: An Optical Coherence Tomography Study.

PURPOSE: The aim of this study was to analyze the impact of OCT characteristics on the natural course of optic disc pit maculopathy (ODP-M). METHODS: This was a single-center, retrospective, observational case series. Patients with ODP-M were included in the study. Baseline demographic characteristics, central macular thickness (CMT), IPP, subretinal fluid (SRF), subretinal precipitations, outer retinal fluid (ORF), and outer retinal layer hole were evaluated. The changes in the OCT characteristics were analyzed with respect to the best-corrected visual acuity (BCVA) from baseline to the last visit. RESULTS: Twenty-two eyes of 22 patients were evaluated with a mean follow-up time of 37.6 (median 22) months. The mean BCVA was 0.31 logMAR at baseline and 0.28 logMAR at the final visit (p = 0.521). Baseline BCVA was significantly related to CMT (ß coefficient 0.001, p = 0.002). Mean BCVA increased in 7 patients (group 1), remained stable in nine (group 2), and decreased (group 3) in 6 patients. No significant difference was found between the groups regarding the baseline BCVA, CMT, and extent of retinal fluid. In patients with subretinal deposits, BCVA remained stable in 3 patients and worsened in one. ORF was recorded in all patients. In patients with SRF, the mean change of BCVA during follow-up differed significantly, depending on the presence (0.07 logMAR) or absence (-0.125 logMAR) of SRF (p = 0.019). CONCLUSION: Among the OCT characteristics, SRF was a negative prognostic factor in ODP-M. Most ODP-M patients showed improved or stable vision over 3 years of follow-up. Therefore, observation may be considered in patients with reasonable vision and without SRF even when they present with remarkable OCT findings.

RELATIONSHIP BETWEEN STAGES OF DIABETIC RETINOPATHY AND LEVELS OF BRAIN-DERIVED NEUROTROPHIC FACTOR IN AQUEOUS HUMOR AND SERUM.

PURPOSE: The aim of the study was to determine aqueous humor and serum levels of brain-derived neurotrophic factor (BDNF) in diabetic patients with and without retinopathy. METHODS: The study included diabetic patients with or without retinopathy, who had an indication for cataract surgery. The study groups were diabetic patients without retinopathy (Group 2), with nonproliferative diabetic retinopathy (Group 3), and with proliferative retinopathy (Group 4). To quantitatively determine the amount of BDNF in samples, the RayBio Human BDNF ELISA kit (Norcross, GA), based on an enzyme-labeled immunosorbent assay was used. RESULTS: The median serum BDNF levels were significantly lower in all the study groups than in the control group (P values: 0.038 Group 2, 0.02 Group 3, and 0.002 Group 4). Serum BDNF was lower in Group 4 than in Group 3 (P = 0.030), and in Group 3 than in Group 2 (P = 0.04). The median aqueous humor BDNF levels were significantly decreased in all groups (P values: 0.047 Group 2, 0.021 Group 3, and 0.007 Group 4). There was no significant difference between Groups 2, 3, and 4 (P = 0.214). CONCLUSION: The serum and aqueous humor BDNF levels decreased in patients with diabetes mellitus (DM) before the emergence of clinical signs of retinopathy.

Comparison of Samfilcon A and Lotrafilcon B silicone hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy.

PURPOSE: To compare the efficacy of Samfilcon A and Lotrafilcon B bandage contact lenses after photorefractive keratectomy (PRK). METHODS: In this study, patients with bilateral PRK were assigned for the fitting of Lotrafilcon B lens and Samfilcon A lens. The patients were examined on the day of surgery and on postoperative days 1, 2 and 3. Slit biomicroscopy was performed to assess epithelial defect size in the postoperative examinations. The subjective evaluation of pain and visual symptoms was recorded on postoperative days 1, 2 and 3. RESULTS: Analysis was made of 68 eyes of 34 patients who fulfilled the criteria and had PRK for correction of low to moderate myopia/astigmatism. On postoperative days 1 and 2, pain and epiphora scores were significantly lower in eyes with Samfilcon A lens (p < 0.001 for all), and on postoperative day 3, the differences were not significant (p = 0.414 and p = 0.180, respectively). There was no significant difference between the two lenses in respect of the levels of photophobia. The difference in epithelial defect size was statistically lower in eyes with Samfilcon A lens compared to Lotrafilcon B on day 1 (16.89 mm2 vs. 21.07 mm2; p = 0.003) and day 2 (1.49 mm2 vs. 2.46 mm2; p < 0.001). The difference was not significant on day 3. (0.05 mm2 vs. 0.05 mm2; p = 1.000). CONCLUSIONS: The Samfilcon A lens is superior to the Lotrafilcon B lens in reducing postoperative pain and accelerating re-epithelialization.

Evaluation of the correlation between quantitative measurement of the foveal avascular zone and retinal vessel density and outer retinal disruptions in diabetic patients

Background/aim: The aim of the current study was to evaluate the correlation between the integrity of the outer retinal layers on optical coherence tomography (OCT) and objective parameters of retinal microvascular perfusion on optical coherence tomography angiography (OCTA). Materials and methods: A total of 105 eyes of 54 diabetic patients were included in the study. Integrity of the outer retinal layers including the external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) was assessed by spectral-domain optical coherence tomography. The foveal avascular zone (FAZ) area and vessel density (VD) measurements in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in all the Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were evaluated by OCTA. Associations between the quantitative measurement of the FAZ and retinal VD measurements and outer retinal disruptions were evaluated. Results: The FAZ area was correlated with outer retinal layer disruption both in the superficial plexus (r = 0.244, 0.228, 0.212, P = 0.013, 0.02, 0.031 for the ELM, EZ, and IZ, respectively) and the deep capillary plexus (r = 0.298, 0.234, 0.197, P = 0.002, 0.019, 0.048 for the ELM, EZ, and IZ, respectively). A significant relationship was also found between the VD measurements in the SCP and DCP in ETDRS sectors and the outer retinal layers disruption. Conclusion: The results of the current study show a significant relationship between the quantitative OCTA parameters and the integrity of the outer retinal layers. This finding reveals a correlation between retinal capillary nonperfusion and outer retinal disruption in eyes with diabetic retinopathy.

Mechanical versus transepithelial phototherapeutic keratectomy epithelial removal followed by accelerated corneal crosslinking for pediatric keratoconus: Long-term results.

PURPOSE: To compare the 36-month outcomes of mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal before accelerated corneal crosslinking (CXL) for pediatric keratoconus. SETTING: Atatürk Training and Research Hospital, Ankara, Turkey. DESIGN: Retrospective case series. METHODS: Eyes that had accelerated CXL after mechanical (Group 1) or transepithelial PTK (Group 2) epithelial removal were evaluated preoperatively and 12, 24, and 36 months postoperatively. The uncorrected (UDVA) and corrected distance visual acuities, spherical equivalent (SE), manifest astigmatism, and corneal tomographic and aberrometric parameters were assessed. RESULTS: The study included 40 eyes of 35 consecutive keratoconus patients younger than 18 years with a 36-month follow-up. Group 1 comprised 15 patients, and Group 2 comprised 20 patients. Both groups had a significant improvement in UDVA (P = .001 and P = .02, respectively) and a significant decrease in maximum keratometry (K) and thinnest corneal thickness (all P < .001) 36 months postoperatively. The improvements in maximum K, topographic astigmatism, and spherical aberration were greater in Group 2 than in Group 1 at 12 months (P = .03, P = .01, and P = .04, respectively). After 12 months, the outcomes in the 2 groups were more similar. CONCLUSIONS: The initial visual and topographic outcomes of transepithelial PTK ablation were better than those of mechanical epithelium removal before accelerated CXL in pediatric patients with keratoconus. Over the long-term, the results were similar between the 2 groups.

Decentration and Tilt of Intraocular Lens after Posterior Capsulotomy.

PURPOSE: To assess the effect of posterior capsular opacification (PCO) and Neodymium-doped:Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy on tilt and decentration of intraocular lens (IOL) at vertical and horizontal meridians. METHODS: The study included 64 eyes of 64 patients. IOL decentration and tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Corrected distance visual acuity (CDVA) and manifest refraction were also determined. Between-group differences of IOL position change and the effect of Nd:YAG laser capsulotomy were analyzed. RESULTS: In the PCO group, before capsulotomy, CDVA was significantly lower than that after capsulotomy and of the control group values (p = 0.001 for both). No significant difference was observed in CDVA between the control group and the PCO group after capsulotomy (p = 0.854). Before capsulotomy, the angle of tilt and decentration at both meridians was significantly higher than that in the control group (tilt: p < 0.001; for both decentrations: p = 0.001, p = 0.003, respectively). A significant decrease was observed in the angle of tilt at both meridians (horizontal p = 0.001, vertical p = 0.001) from before to after capsulotomy in the PCO group. Although decentration was increased after capsulotomy, no significant position change was observed (horizontal p = 0.350, vertical p = 0.107). The angle of tilt and decentration at both meridians was significantly higher in the PCO group after capsulotomy compared to the control group (p < 0.001 for all). CONCLUSIONS: PCO is associated with not only axial displacement, but also tilt and decentration of IOL at the vertical and horizontal meridians. Laser capsulotomy decreased IOL tilt but had no effect on decentration. However, these changes did not significantly change the visual acuity between the control group and the PCO group after capsulotomy.

Contact Lens Compliance With Ophthalmologists and Other Health Professionals.

PURPOSE: To assess the compliance with contact lens (CL) use among ophthalmologists and other health professionals, and to identify the main noncompliant behaviors. METHODS: A cross-sectional, comparative study was designed for soft CL wearers. Twenty-five ophthalmologists, 24 medical doctors other than ophthalmologists, 20 nurses (health professionals), and 52 lay people (members of the public) subjects were included in the interview. The compliance rate for each behavior were determined and compared. Users were asked to rate their subjective use to calculate self-evaluation scores. RESULTS: The compliance rate was found to be the highest among ophthalmologists; however, the difference was not significant (P=0.083). Although the level of compliance was not associated with the subjects' age, duration of lens wear, or wearing days per week (P>0.05), an association was found with the number of wearing hours per day (P=0.010). Increased wearing hours per day was found to increase the rate of poor compliance (P=0.010). Significant differences were found between the groups in storing lenses in fresh solution, lens wearing time according to the ophthalmologist recommendation, and follow-up visits according to ophthalmologist recommendation (P<0.001, P=0.036, P=0.001, respectively). Self-evaluation scores among ophthalmologists, health professionals, and the lay people were 7.56±0.86, 7.59±1.29, and 7.67±1.60, respectively, and no significant differences existed between the groups (P=0.930). CONCLUSION: No differences were evident between the groups in terms of good compliance with CL wear and care practices. As this result shows that compliance with CL wear and care practices is not only related to the level of knowledge, different methods should be developed to increase compliance.