Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1.

Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, µm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 µm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 µm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion: This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.

Efficacy of Simultaneous Application of Subretinal Tissue Plasminogen Activator and Bevacizumab for Submacular Hemorrhages.

Objectives: The aim of the study was to evaluate the patients who received simultaneous subretinal tissue plasminogen activator (tPA) and bevacizumab for submacular hemorrhages secondary to neovascular age-related macular degeneration. Methods: This retrospective study included patients who underwent pars plana vitrectomy (PPV) with simultaneous subretinal tPA and subretinal bevacizumab with 18% SF6 tamponade. Anatomical and functional results of the patients before surgery and at the 1st, 6th, and 12th months after surgery, additional treatments, and complications after PPV were evaluated. Results: Eight eyes of eight patients were included in the study. The mean age of the patients was 72.38±92.3. The mean time from the onset of symptoms to treatment was 5.13±1.88 days. The patients' mean best-corrected visual acuity (BCVA) was 2.23±0.14 logMAR at baseline. Mean BCVA increased significantly at 1st, 6th, and 12th months to 1.68±0.47 logMAR, 1.58±0.49 logMAR, and 1.51±0.58 logMAR, respectively (p=0.001 at all). The mean central foveal thickness (CFT) in measurable patients was 836.8±627.02 µm at baseline. Mean CFT decreased significantly to 370.13±66.13 µm in the 1st month, 373.38±78.33 µm in the 6th month, and 367.75±116.43 µm in the 12th month (p<0.05). The maximum measurable subretinal hemorrhage height at baseline was 814.2±556.45 µm. The mean number of anti-VEGFs performed for 12 months after surgery was 4.13±2.1. At month 12, the ellipsoid zone could not be detected in 6 (75%) patients. Conclusion: Administration of subretinal bevacizumab and subretinal tPA effectively removes subretinal hemorrhage under the fovea. Intravitreal anti-VEGF treatment must be continued, as choroidal neovascular membrane activity continues after surgery.

Effects of fluorescein on corneal endothelial morphology after fundus fluorescein angiography in patients with diabetic macular edema.

PURPOSE: To evaluate the effects of fluorescein dye on corneal endothelial morphology (CEM) after fundus fluorescein angiography (FFA) in patients with diabetic macular edema (DME). METHODS: In this retrospective study, patients were divided into two groups, nonproliferative diabetic retinopathy (Group-1, NPDR) and proliferative diabetic retinopathy (Group-2, PDR). CEM properties including endothelial cell density (ECD), coefficient of variation of cell area (CV), average cell area (AVG), percentage of hexagonal cells (HEX), and central corneal thickness (CCT) were measured before FFA and at week 1 and month 1 after FFA were collected from patients' charts. RESULTS: The study consisted of 48 patient's 48 eyes in Group-1 and 50 patient's 50 eyes in Group-2. In both groups, the mean ECD, CV, AVG, HEX, and CCT measurements at week 1 and month 1 after FFA did not differ statistically from the mean measurements before FFA (p > 0.05). The mean ECD measurements in Group-1 were higher than that in Group-2 and showed statistically significant differences among the groups (p < 0.01 for all). In the Pearson correlation analysis in Group-1, there was no statistically significant relationship between best-corrected visual acuity (BCVA) and (intraocular pressure) IOP values and ECD, AVG, CV, HEX, and CCT measurements (except central macular thickness [CMT] and HEX) before FFA, at week 1 and month 1 after FFA (p > 0.05). In Group-2 there was no statistically significant relationship between BCVA, IOP, and CMT measurements and ECD, AVG, CV, HEX, and CCT measurements before FFA, at week 1 and month 1 after FFA (p > 0.05). CONCLUSIONS: There is no significant change in CEM after FFA in patients with NPDR and PDR with DME.

Protective effects of melatonin receptor agonists on endotoxin-induced uveitis in rats.

Objectives: Melatonin has an important role in regulating a variety of physiological functions of the body. We investigated the protective effects of Agomelatine (AGO) and Ramelteon (RAME) on Endotoxin-Induced Uveitis (EIU) in rats. Materials and Methods: 70 rats were randomly divided into fourteen groups. Healthy group normal saline, (IP), Uveitis group (200 µg/kg lipopolysaccharide (LPS), SC), DEX group (200 µg/kg LPS plus 1 mg/kg dexamethasone, IP), AGO20 group received 200 µg/kg LPS plus 20 mg/kg AGO, AGO40 group received 200 µg/kg LPS plus 40 mg/kg AGO, RAME2 group received 200 µg/kg LPS plus 2 mg/kg RAME, and group RAME4 received 200 µg/kg LPS plus 4 mg/kg RAME. Each group had two subgroups: the 3rd and 24th hr. The eye tissues were collected and investigated biomicroscopically (clinical manifestations and scoring, molecularly(qRT-PCR analyses of tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and caspase 3 and caspase 9 mRNA expression), biochemically (Superoxide dismutase activity (SOD), Glutathione (GSH), and malondialdehyde levels (MDA)) and histopathologically (staining with Harris Hematoxylin and Eosin Y). Results: Melatonin receptor agonist treatment reduced the clinical score count of ocular inflammation in the uveitic rats. TNF-α, VEGF, caspase 9, and caspase 3 levels markedly decreased in the uveitic rats. Melatonin receptor agonists significantly ameliorated fixed changes in GSH, SOD, and MDA levels. Melatonin receptor agonists also ameliorated histopathological injury in eye tissues associated with uveitis. Conclusion: Melatonin receptor agonists ameliorated the inflammatory response in EIU. These findings suggest that melatonin receptor agonists may represent a potential novel therapeutic drug for uveitis treatment.

Evaluation of Systemic Endothelial Dysfunction in Retinal Vein Occlusions.

Objectives: Our aim in this study was to evaluate the systemic endothelial dysfunction status and carotid intima-media thickness (CIMT) in patients with retinal vein occlusion (RVO). Methods: Seventy-six patients who presented to the clinic with the diagnosis of RVO and 76 age- and gender-matched healthy individuals without a RVO history were included in the study. The patients' best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measures, and diabetes, hypertension, hyperlipidemia, carotid artery disease, body mass index, and smoking histories were recorded. The endothelial function levels of the patients, pulse wave velocity (PWV), flow-mediated dilation (FMD), and CIMT were measured. Endothelial dysfunction was detected by applying the FMD technique to the brachial artery. CIMT was evaluated by B-mode ultrasonography. Serum hematological parameters were evaluated. Results: BCVA (logMAR) was 1.39±1.30 in patients with RVO and 0.028±1.22 in the control group (p<0.001). CMT was 588.76±104.02 µm in patients with RVO and 265.20±45.11 µm in the control group (p=0.001). Hypertension, diabetes, and hyperlipidemia were found to be significantly higher in patients with RVO (p-value 0.001, 0.002, and 0.001, respectively). There was a significant difference between the groups in terms of FMD, PWV, and CIMT (all of them, p<0.001). Conclusion: The deterioration of FMD and PWV, which are indicators of endothelial dysfunction in patients with RVO, suggests that systemic endothelial dysfunction may play a role in the pathogenesis of RVO. Comprehensive studies with more patient participation are needed.

Elevated serum fibrinogen/albumin ratios in patients with acute central serous chorioretinopathy.

PURPOSE: To evaluate the serum fibrinogen/albumin ratios in patients with acute and chronic central serous chorioretinopathy, and healthy control samples. METHODS: Serum fibrinogen/albumin ratios were assessed in patients with acute (Group-1, 30 eyes) and chronic (Group-2, 30 eyes) central serous chorioretinopathy, and compared with healthy control (Group-3, 30 eyes) samples. RESULTS: Fibrinogen/albumin ratios were significantly higher in Group-1 (104.72 ± 12.34) than in Group-2 (75.83 ± 10.06) and in Group-3 (72 ± 9.54) (p = 0.001). No significant correlation was found between age, CMT, and BCVA with fibrinogen/albumin ratios in the Pearson correlation analysis. In the ROC curve analysis, the most appropriate cut-off value of the fibrinogen/albumin ratio for acute CSCR was ≥87.8 and the optimal cut-off value for the fibrinogen/albumin ratio for chronic CSCR was ≥68.6. CONCLUSION: The fibrinogen/albumin ratio may be useful as an inflammatory biomarker to monitor the systemic inflammatory state during the treatment and follow-up in patients with acute CSCR.

Static and dynamic pupillary characteristics in multiple sclerosis.

PURPOSE: To examine the static and dynamic pupillary functions with automated pupillography in multiple sclerosis (MS) patients with preserved visual acuity. METHODS: Forty-seven MS patients with preserved visual acuity were included in the study group and 43 healthy volunteers in the control group. The visual evoked potential of the patients was obtained. After routine ophthalmologic examination contrast sensitivity and the retinal nerve fiber layer (RNFL) thickness were measured. Finally scotopic, mesopic, and photopic pupillographies followed by dynamic pupillography were undertaken, and the pupillary dilatation speed was calculated. RESULTS: The contrast sensitivity and RNFL thickness of the MS group were significantly lower than those of the control group (p < 0.05; for both). In the MS and control groups, the scotopic pupil diameters were 5.48 ± 1.03 and 5.28 ± 0.78 mm, mesopic pupil diameters were 4.82 ± 0.83 and 4.48 ± 0.70 mm, and photopic pupil diameters were 3.84 ± 0.79 and 3.42 ± 0.49 mm, respectively (p = 0.315, p = 0.044, and p = 0.004, respectively). In dynamic pupillography, the pupil in the MS group was more dilated than control group at all time sections examined except the sixth second (p < 0.05; for all). Although the mean pupillary dilation speed in the first second was higher in the MS group (p = 0.044), there was no significant difference between the groups for the other time intervals examined (p > 0.05; for all). There was no correlation between pupillary parameters and P100-wave latency, RNFL thickness, or contrast sensitivity (p > 0.05; for all). CONCLUSIONS: Static and dynamic pupillary functions may be affected in MS patients with preserved visual acuity. Although scotopic pupillary functions are preserved, mesopic, and photopic pupil functions are weakened.

Factors Associated with Pain Level in Patients Receiving Intravitreal Injection.

PURPOSE: To identify the factors associated with the pain level in patients receiving intravitreal injection. METHODS: A total of 120 patients were prospectively evaluated, and 104 were included in the study. Patients were asked to rate their pain intensity from 0 to 10 on the visual analog scale. Factors that were possibly associated with pain level were evaluated using a sociodemographic data form, state anxiety inventory, and the hospital anxiety and depression scale. RESULTS: Of the participants, 54 (51.9%) were female, and 50 (48.1%) were male, with a mean age of 65 ± 9.01 years. There was a positive correlation between pain level and state anxiety scores (r = 0.30; P < 0.001) and a negative correlation between hospital anxiety score (r = -0.23; P = 0.02) and hospital depression score (r = -0.27; P = 0.01). The correlation between pain score and education level was significantly higher in primary and secondary school graduates (P < 0.01). Smokers were observed to have higher pain scores (6.50 ± 2.21 in smokers and 4.87 ± 2.50 in nonsmokers; P = 0.01). Among diagnostic groups, pain scores were found to be significantly lower in the diabetic retinopathy (DR) group (6.82 ± 1.99 in age-related macular degeneration, 5.94 ± 2.27 in retinal vein occlusion, and 3.58 ± 1.97 in DR; P < 0.001). When pain scores were evaluated according to the drug injected, the group receiving bevacizumab injection was observed to have higher pain scores (7.32 ± 1.81 in bevacizumab, 4.00 ± 2.08 in aflibercept, and 3.92 ± 1.96 in ranibizumab; P < 0.001). Based on the multiple regression analysis, the state anxiety score, hospital anxiety score, hospital depression score, and smoking status were observed not to be significant predictors. The level of education, diagnosis, and active substance were found to have a statistically significant effect on pain perception. CONCLUSION: In this study, pain levels have been found to be high in smokers, those with a low educational level, individuals receiving bevacizumab for intravitreal injection, and those having a higher level of state anxiety, whereas patients with DR have lower pain scores.

Impression cytology and meibomian glands in conjunctivochalasis.

PURPOSE: To evaluate the tear parameters, meibomian glands and lid margin and tarsal conjunctival impression cytology in patients with conjunctivochalasis (CCH). METHODS: The study included 57 patients diagnosed with CCH and 35 healthy volunteers. Tear break-up time (TBUT) was measured and Schirmer test was performed. Meibomian gland morphologies, dropout rates, and meiboscores were evaluated using meibography. Finally, impression cytology samples were taken by pressing the impression filters on the lower lid margin and lower tarsal conjunctiva. The samples were evaluated according to the Nelson grading system. RESULTS: Schirmer test was longer and TBUT was shorter in the study group (p = 0.035 and p < 0.001, respectively). The median of meibomian gland dropout rate was 33.45% (Interquartile range [IQR]; 23.17%-49.75%) and 18.80% (IQR; 12.35%-26.50%) in the study and control groups, respectively (p < 0.001). There was no significant difference in terms of lid-margin cytology between the two groups (p = 0.481). In tarsal conjunctiva cytology, the median value of Nelson grade of the study group was 2 (IQR; 1-2) and that of the control group was 1 (IQR; 1-2) (p = 0.040). When Nelson grade-2 and above was accepted as the pathological limit, it was found that 27.5% of the study group and 15.2% of the control group showed pathological findings (p = 0.204). CONCLUSIONS: In patients with CCH, damage occurs in the tarsal conjunctiva with the effects of redundant conjunctival folds. In these patients, atrophy occurs in the meibomian glands and tear stability is impaired. Therefore, CCH should not be overlooked in clinical practice.

Comparison of central corneal thickness measurements with three different optical devices.

PURPOSE: The purpose of this study was to compare and evaluate the agreement of central corneal thickness (CCT) values obtained with three different devices working according to optical principle in healthy eyes. METHODS: 60 eyes of 60 individuals (30 men and 30 women) were enrolled in this study. CCT measurements performed with Scheimpflug-Placido topographer (Sirius), spectral-domain optical coherence tomography (RTVue) with an anterior segment module, and optical biometer (AL-Scan) were compared. Bland-Altman analysis was used to demonstrate agreement between methods. RESULTS: The mean age was 30.07 ± 7.313 years (range, 18-47 years). The mean CCT values obtained by RTVue, Sirius, and AL-Scan were 518.25 ± 36.38 µm, 526.08 ± 36.33 µm, and 513.50 ± 39.09 µm, respectively. The mean differences in CCT were 7.83 ± 14.15 µm between Sirius and RTVue, 12.58 ± 11.87 µm between Sirius and AL-Scan, and 4.75 ± 4.50 µm between RTVue and AL-Scan. The mean CCT was statistically different among the three groups (p < 0.05). All three modalities of CCT measurements correlated closely with each other, with Pearson's correlation coefficients ranging from 0.924 to 0.961. The 95% limits of agreement were -19.90 to 35.56 µm between Sirius and RTVue, -10.69 to 35.85 µm between Sirius and AL-Scan, and -4.07 to 13.58 µm between RTVue and AL-Scan. CONCLUSION: Different results could be obtained through different noncontact devices in CCT measurements. Although the measurement values obtained by these devices show a high level of correlation, it would be a more correct approach to not use them directly interchangeably in clinical practice. Evaluation and follow-up of CCT should be performed using the same device.

Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis?

Purpose: To evaluate whether the C-reactive protein (CRP)/albumin ratio (CAR) in patients with uveitis during an attack is a marker that can give information about the activity, severity and prognosis of the disease.Methods: This study included 35 patients with an uveitis attack and 35 healthy volunteers. The localization and severity of uveitis were recorded. Patients' complete blood count (CBC) during the attack, CRP, CAR, erythrocyte sedimentation rate(ESR), neutrophil/lymphocyte ratio(NLR), and platelet/lymphocyte ratio(PLR) were recorded.Results: The mean age was 34.1 ± 12.5 years for the 35 uveitis cases and 30.1 ± 4.1 years for the healthy volunteers. CRP and CAR were significantly higher in uveitis patients (p = .015 and 0.011, respectively). While CRP and CAR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = .036 and 0.022, respectively), only CAR was significantly higher in severe posterior and panuveitis than mild ones(p = .017).Conclusion: CAR may be an important parameter in determining the activation of the uveitis.

Ocular Surface and Conjunctival Cytology Findings in Patients With Confirmed COVID-19.

PURPOSE: To assess the effect of severe acute respiratory syndrome coronavirus-2 infection on the conjunctiva and tear film. METHODS: Thirty-eight patients with confirmed COVID-19 and 31 healthy controls were included in this prospective and observational study. Individuals with COVID-19 formed the patient group, and healthy individuals formed the control group. Conjunctival impression cytology (CIC), TBUT, Schirmer II test, and ocular surface disease index were evaluated in all participants. RESULTS: No significant difference was observed regarding the mean age and gender between the groups (P=0.786 and P=0.122, respectively). The mean TBUT and Schirmer II test results did not differ between the two groups (P=0.496 and P=0.447, respectively). The CIC results revealed decreased density and cell size of goblet cells and moderate to high enlargement, squamous changes, and increased nucleocytoplasmic ratio in nongoblet epithelial cells in the COVID-19 group compared with the control group. Based on the Nelson classification in CIC samples, 60.6% of the COVID-19 group and 19.4% of the control group had changes consistent with grade 2 or above. The presence of neutrophils in CIC was significantly higher in the COVID-19 group (P<0.001), whereas the presence of lymphocyte was similar between the two groups (P=0.247). CONCLUSION: This study revealed the pathological conjunctival alterations in patients with COVID-19 and demonstrated that pathological ocular surface alterations may present even at the beginning of COVID-19 without clinically significant ocular manifestation.

Serum Inflammation Biomarkers in Patients with Keratoconus.

Purpose: To evaluate inflammation-sensitive parameters, namely the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), eosinophil count, erythrocyte distribution width (RDW), and CRP/albumin ratio in patients with keratoconus (KC).Methods: Thirty-five patients with KC and 30 healthy people (control group) were included in the study. Complete blood count measurements were performed in all subjects, and NLR, PLR and the CRP/albumin ratio were calculated.Results: NLR was determined as 2.01 ± 0.53 in patients with KC and 1.97 ± 0.41 in the control group. PLR was 146.20 ± 23.32 in the KC group and 121.45 ± 31.75 in the healthy group. The CRP/albumin ratio was determined as 0.33 ± 0.09 in the KC group and 0.29 ± 0.11 in the healthy group.Conclusion: Although no significant difference was found between the groups in terms of NLR, CRP/albumin ratio and RDW levels, PLR was significantly higher in the KC group.

The Relationship of the Urotensin-2 Level in the Aqueous Humor with Systemic Diseases and Pupil Size: Comparative Study.

Purpose: To detect the presence of urotensin-2 (U-II) in the aqueous humor and evaluate the relationship between aqueous humor level and systemic diseases and pupil size. Methods: The study included 88 patients who underwent cataract surgery. Those with a pupil diameter (PD) of up to 4 mm were considered to have small dilation, those with 4-7 mm of dilatation were considered to have moderate dilation, and those with a PD of more than 7 mm considered to have large dilation. Patients with HT (hypertension) were classified as group 1, those with DM (diabetes mellitus) as group 2, and those with HT+DM as group 3, and those without any systemic disease as group 4. The U-II levels in humor aqueous samples taken from anterior chamber were measured. Results: When compared with the control group, it was observed that the level of U-II in the aqueous humor of the HT, DM, and DM+HT groups was significantly higher (P < 0.05). At the same time, when we compared the DM+HT group with the other groups, the level of U-II in the aqueous humor was significantly higher compared to the group with DM (P < 0.05). The U-II levels of the aqueous humor were higher in the patients with small pupils compared to the remaining groups (P < 0.005). Conclusion: U-II may play a role in small pupil pathophysiology. In addition, it was determined that patients with HT and/or diabetes had higher U-II levels in the aqueous humor than healthy individuals.

A New Treatment Experience in Pseudomonas Keratitis: Topical Meropenem and Cefepime.

PURPOSE: To compare the efficacy of topical meropenem and cefepime treatments with respect to moxifloxacin as new treatment options in an experimental Pseudomonas keratitis model. METHODS: Twenty-four rabbits in which keratitis are induced using Pseudomonas aeruginosa were divided into four groups according to treatment options. A solution of 50 mg/mL meropenem was prepared and topically applied to the first group, 50 mg/mL cefepime solution to the second group, topical 0.5% moxifloxacin drop to the third group, and topical isotonic (0.9% saline) solution to the fourth (control) group. The eyes were examined before and after treatment to score the clinical severity. After the subjects were sacrificed, their corneas were excised. To determine the efficacy of treatments, clinical score, bacterial load, and histopathological and immunohistochemical findings were evaluated. RESULTS: When the three treatment groups were compared, there was a significant difference in the colony-forming unit (CFU) value, polymorph-nuclear leukocyte (PMNL) infiltration, and matrix metalloproteinase (MMP)-9 immunoreactivity (P=0.022, P=0.038, and P=0.037, respectively). The CFU values, PMNL infiltration scores and MMP-9 immunoreactivity were significantly lower in the meropenem and moxifloxacin groups compared with the cefepime group (P<0.05 for all). There was no significant difference between the meropenem and moxifloxacin groups in respect of the CFU values, PMNL infiltration, and MMP-9 immunoreactivity (P=0.842, P=0.784, and P=0.699, respectively). CONCLUSION: The results of our study indicate that topical meropenem is at least as effective as topical moxifloxacin in the treatment of Pseudomonas keratitis. The meropenem and moxifloxacin are safer and suitable in the limited corneal invasion than cefepime. Thus, topical meropenem may be an alternative drug in the treatment of this condition. Clinical studies are needed to be conducted to assess this possibility more accurately.

Keratoconus: a potential risk factor for osteoarthritis.

PURPOSE: This study was undertaken to compare the distal femoral cartilage thickness in patients with keratoconus (KC) with that of age- and sex-matched healthy controls, in order to identify a potential risk factor for early osteoarthritis in patients with KC and to allow initiation of early rehabilitation. METHODS: Thirty-six KC patients between 18 and 35 years of age and 36 healthy controls were included in this study. Keratometry readings (K1, K2), central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), and corneal volumes (CV) were measured using a Sirius imaging system (Costruzioni Strumenti Oftalmici, Italy). Also, the distal femoral cartilage thickness (DFCT) was assessed bilaterally using ultrasound by the same physiatrist. Lateral femoral condyle (LFC), intercondylar area (ICA), medial femoral condyle (MFC), and body mass index (BMI) values were recorded. RESULTS: Patient and control groups were comparable in terms of age, gender, and BMI. On the other hand, patients with KC had a significant reduction in right LFC, MFC thickness and left ICA, MFC as compared to controls (p < 0.05). In the corneal topographic evaluation of the groups, it was observed that K1, K2, CCT, and ACD values differed significantly. CONCLUSIONS: Detection of thinner DFCT in KC patients suggests that these patients may be future candidates of osteoarthritis.

Alterations in optical coherence tomography angiography findings in patients with high myopia.

PURPOSE: The aim of this study was to determine the macular changes using optical coherence tomography (OCT) and OCT-angiography (OCT-A) in eyes with high myopia. Determining the alterations in vascular structures can provide a clearer understanding of the pathophysiological mechanisms of this disease and help define new treatment options and preventive measures. MATERIALS AND METHODS: Ninety-two patients with high myopia (axial length ≥ 26 mm) and 70 control cases without any known systemic or ocular diseases were enrolled in this prospective study. One eye of each patient was included in the statistical analyses. RESULTS: Retinal nerve fiber layer (RNFL) thickness and Early Treatment Diabetic Retinopathy Study (ETDRS) macula map values were lower in myopia compared with the controls. Both superior and inferior ganglion cell complex (GCC) thicknesses were significantly thinner in the high myopia compared with the controls (p < 0.001). Regarding the OCT-A findings, although superficial or deep foveal avascular zones (FAZ) did not significantly differ between the two groups, the density values of superficial and deep microvessels were significantly lower in the high myopia group compared with the control cases. CONCLUSIONS: In patients with high myopia, with an increase in the axial length and a decrease in RNFL and GCC thicknesses, the vascular densities of the superficial and deep retina were reduced in the macular region.

Evaluation of Meibomian Glands in Obstructive Sleep Apnea-Hypopnea Syndrome.

PURPOSE: To evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters. METHODS: The study included 59 individuals (32 subjects with OSAHS, 27 control subjects) who underwent polysomnography in the Chest Diseases Clinic. The right eyes of all individuals were evaluated in the Ophthalmology Clinic. The first noninvasive tear break-up time (f-NTBUT) and the average noninvasive tear break-up time were measured, and Schirmer test was applied. Meibography was taken (Sirius; CSO, Florence, Italy), and meiboscore was used for indexing meibography. Finally, a sample was taken for conjunctival impression cytology. RESULTS: In the study and control groups, the median of f-NTBUT was 2.1 seconds [interquartile range (IQR); 1.5-5.0] and 5.7 seconds (IQR; 2.9-8.8) and the median of average noninvasive tear break-up time was 5.6 seconds (IQR; 3.6-9.5) and 7.2 seconds (IQR; 4.2-10.7), respectively (P = 0.007 and P = 0.487, respectively). The mean Schirmer value was 16.3 ± 5.9 mm (range; 5-25) and 17.3 ± 6.6 mm (range; 5-30) in the study and control groups (P = 0.604). In upper eyelid meibography, the median of loss in the meibomian glands was 20.10% (IQR; 11.60%-40.80%) in the study group and 14.70% (IQR; 10.40%-21.30%) in the control group (P = 0.043). In lower eyelid meibography, the median of loss in the meibomian glands was 19.00% (IQR; 13.60%-35.30%) in the study group and 12.40% (IQR; 9.10%-16.40%) in the control group (P = 0.002). The median of the Nelson grade in conjunctival impression cytology was 1 (IQR; 0-1) in the study group and 1 (IQR; 0-1) in the control group (P = 0.445). CONCLUSIONS: The loss in the meibomian glands together with the shortened f-NTBUT shows that there could be a predisposition in OSAHS for evaporative dry eye originating from meibomian gland damage.

Comparative Effect of Feeding Human Milk as Opposed to Formula on Visual Function and Ocular Anatomy.

Background/Objective: Performance of ocular examinations on children who were breastfed, fed with formula, and combination of the two for the first 6 months of age. Subsequently, refractive errors, allergic conjunctivitis, and retinal nerve fiber layer (RNFL) thickness were evaluated. Materials and Methods: The present study included a total of 242 eyes of 121 children (aged 60-84 months, 65 males, 56 females) admitted to the outpatient clinic of our institution. The patients were divided into three groups according to their feeding pattern during their first 6 months postdelivery: breastfed children (Group 1, n = 40), children fed with a combination of breast and formula milk (Group 2, n = 41), and children exclusively fed with formula-milk (Group 3, n = 40). All patients underwent detailed ophthalmologic examinations, and measurements of the RNFLs were recorded. Results: No significant difference was observed between the groups in terms of refractive error. In Group 3, we found that allergic conjunctivitis was significantly higher than in the other groups. In addition, in Group 3, the thickness of the RNFL was found to be significantly higher in the superior quadrants of both the eyes of children than in Groups 1 and 2 (p < 0.05). Conclusions: We found that the type of feeding experienced by infants in their first 6 months has no effect on refractive error but has significant effects on both allergic conjunctivitis and RNFL. To determine the cause of this difference in the RNFL and to further validate the present study, future studies with larger patient groups and animal experiments are needed.

Correlation of the aqueous humor total antioxidant capacity, total oxidant status, and levels of IL-6 and VEGF with diabetic retinopathy status / Correlação entre níveis de humor aquoso da capacidade antioxidante total, estado oxidante total, IL-6, VEGF e status da retinopatia diabética

ABSTRACT Purpose: We aimed to compare the aqueous humor total oxidant status, total antioxidant capacity, and levels of interleukin-6 and vascular endothelial growth factor between patients with diabetic retinopathy and controls and to correlate these levels with the DR status. Methods: Patients who underwent cataract surgery were enrolled. The first group (control group) comprised patients without diabetes; the second group comprised diabetic patients without retinopathy; the third group comprised patients with nonproliferative diabetic retinopathy; and the fourth group comprised patients with proliferative diabetic retinopathy. All patients underwent full ophthalmologic examination before cataract surgery. Prior to surgery, samples of aqueous humor sampling were obtained and stored at -80 °C. Total antioxidant capacity, total oxidant status, and levels interleukin-6 and vascular endothelial growth factor were investigated in these samples and correlated with diabetic retinopathy status. Results: This study analyzed 86 pairs of eyes of 86 patients. All groups were statistically similar in age and sex, but the total antioxidant capacity was lowest in patients with proliferative diabetic retinopathy. Moreover, the total oxidant status and levels of vascular endothelial growth factor and interleukin-6 were found to slightly increase according to the retinopathy status. Conclusion: Oxidative stress, interleukin-6, and vascular endothelial growth factor in the aqueous humor seem to play important roles in the pathogenesis of diabetic retinopathy, especially in the proliferative type.

RESUMO Objetivo: Procurou-se comparar o humor aquoso estado oxidante total, a capacidade antioxidante total, e os níveis de interleucina-6 e do fator de crescimento endotelial vascular entre pacientes com retinopatia diabética e em indivíduos controles, e correlacionar esses níveis com o status da retinopatia diabética. Métodos: Pacientes submetidos à cirurgia de catarata foram incluídos. O primeiro grupo (grupo controle) foi composto por pacientes sem diabetes; o segundo grupo inclui pacientes dia béticos sem retinopatia; o terceiro grupo inclui pacientes com retinopatia diabética não proliferativa; e o quarto grupo inclui pacientes com retinopatia diabética proliferativa. Todos os pacientes foram submetidos a exame oftalmológico completo antes da cirurgia de catarata. Antes da cirurgia, amostras de humor aquoso foram obtidas e armazenadas a -80oC. A capacidade antioxidante total, o estado oxidante total e os níveis de interleucina-6 e fator de crescimento endotelial vascular foram investigados nessas amostras e correlacionados com o status da retinopatia diabética. Resultados: Este estudo analisou 86 pares de olhos de 86 pacientes. Todos os grupos foram estatisticamente semelhantes em idade e sexo, mas a capacidade antioxidante total foi menor em pacientes com retinopatia diabética proliferativa. Além disso, o estado oxidante total e os níveis de fator de crescimento endotelial vascular e interleucina-6 estavam ligeiramente aumentados de acordo com o status da retinopatia. Conclusão: O estresse oxidativo, a interleucina-6 e o fator de crescimento endotelial vascular no humor aquoso parecem desempenhar papel importante na patogênese da retinopatia diabética, especialmente no tipo proliferativo.