Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

Background: In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. Objective: To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). Design: This was a retrospective case-control study. Methods: This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. Results: SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively). Conclusions: In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Electrophysiological effects of hyperbaric oxygen treatment on the healthy retina.

PURPOSE: The study aimed to investigate the electrophysiological effects of hyperbaric oxygen treatment (HBOT) on the retina after ten sessions in healthy eyes. METHODS: This prospective, interventional study evaluated forty eyes of twenty patients who were treated with HBOT of ten sessions with the diagnosis of an extraocular health problem. All patients underwent a complete ophthalmologic examination, including assessments of best-corrected visual acuity (BCVA), slit-lamp and pupil-dilated fundus examinations, full-field electroretinography (ffERG) measurements before and after HBOT within 24 h of the 10th session. The ffERG was recorded according to the International Society for Clinical Electrophysiology of Vision protocol using the RETI-port system. RESULTS: The mean age of patients was 40.5 years ranging from 20 to 59 years. Thirteen patients were administered HBOT for avascular necrosis, six patients for sudden hearing loss, and one patient for chronic osteomyelitis of the vertebra. BCVA acuity was 20/20 in all eyes. The mean spherical refractive was 0.56 dioptre (D), and the mean cylindrical refractive error was 0.75 D. Dark-adapted b-wave amplitude in 3.0 ERG was the only variable for the b-wave that showed a statistically significant decrease (p = 0.017). The amplitude of the a-waves in dark-adapted 10.0 ERG and light-adapted 3.0 ERG reduced significantly (p = 0.024, p = 0.025). The amplitude of N 1-P 1 in light-adapted 30 Hz Flicker ERG also demonstrated a statistically significant decrease (p = 0.011). Implicit times did not differ significantly in any of the ffERG data (p > 0.05). CONCLUSIONS: HBOT caused the deterioration of a-wave and b-wave amplitudes in ffERG after ten treatment sessions. The results showed that photoreceptors were adversely affected in the short term after HBOT treatment.

Effect of Upper Lid Blepharoplasty Surgery on Corneal Topography and Corneal High-Order Aberrations.

The objective of this study was to prospectively investigate the effect of upper eyelid blepharoplasty surgery for dermatochalasis on corneal topographic data and high-order aberrations (HOAs). Fifty eyelids of 50 patients with dermatochalasis who underwent upper lid blepharoplasty surgery were prospectively studied. A Pentacam (Scheimpflug camera, Oculus) device was used to measure corneal topographic values, astigmatism degree, and HOAs before and at 2 months after upper eyelid blepharoplasty. The mean age of the patients included in the study was 55.96 ± 12.4 years, 40 (80%) were female and 10 (20%) were male. We found no statistically significant difference in the pre-and postoperative values of corneal topographic parameters (p > 0.05 for all). In addition, we observed no significant postoperative change in the root mean square values of low, high, and total aberration values. In HOAs, we detected no significant change in spherical aberration, horizontal and vertical coma, and vertical trefoil; we only found a statistically significant increase in horizontal trefoil values after surgery (p < 0.05). In our study, we found that upper eyelid blepharoplasty did not cause significant changes in corneal topography, astigmatism, and ocular HOAs. However, studies are reporting different results in the literature. For this reason, it is important for patients considering upper eyelid surgery to be warned about visual changes that may occur after surgery.

Choroidal structural alterations and choroidal vascularity index in bipolar disorder patients.

PURPOSE: The aim of this study was to compare bipolar disorder (BD) patients with age- and sex-matched healthy individuals in order to assess the choroidal structural alterations, retinal nerve fiber layer (RNFL) thickness, and retinal changes in BD patients using encanhed depth imaging optic coherence tomography (EDI-OCT). METHOD: For this research, 39 eyes of BD patients and 36 eyes of age-matched healthy volunteers were used. Five locations were used to assess the choroidal thickness (CT): subfoveal, 500 µm nasal and 1500 µm nasal to the fovea, 500 µm temporal and 1500 µm temporal to the fovea. Image-J was used to determine the total choroidal area (TCA), luminal area (LA), and choroidal vascularity index (CVI). The Spectralis-OCT device was used to evaluate the central macular thickness (CMT), retinal nerve fiber layer (RNFL), and ganglion cell layer (GCL). The data were statistically compared. RESULTS: BD patients had significantly decreased subfoveal, nasal, and temporal CTs than controls (for all three, p = 0.0001). The results of CMT and GCL were found to be thinner than controls. (for all p = 0.0001) In comparison to the controls, the mean TCA and LA were decreased in the BD group. (p = 0.0001, p = 0.0001, respectively,). Between the RNFL and CVI values in the BD and control groups, there was no statistically significant difference (p>0.05). CONCLUSION: The results of this investigation showed that the retina and choroid of patients with BD had considerable anatomical changes.

Evaluation of the choroidal vascular index and choroidal changes in migraine subgroups.

PURPOSE: To investigate binarized choroidal structural parameters, retinal nerve fiber layer (RNFL) thickness, and retina changes duringattack-free periods in patients with migraine using enhanced depth imaging optic coherence tomography (EDI-OCT), and compare patients with migraine with aura and without aura (MwA and MoA, respectively) and aura subgroups (visual aura, non-visual aura), with age and sex-matched healthy subjects. METHOD: This observational, prospective study included 102 patients with migraine and 36 healthy controls. Central macular thickness (CMT), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and choroidal thickness (CT) were measured using a Spectralis OCT device. The choroid vascularity index (CVI) was evaluated using the Image-J software. CVI was calculated as the proportion of the luminal area (LA) to the total choroidal area (TCA). RNFL, CMT, CT, and CVI measurements were compared statistically. RESULTS: Choroidal thickness at 1500 µm temporal of the fovea was found to be statistically significantly thinner in the MwA and MoA groups compared with the control group (p ≤ 0.01). There was a significant difference in the subfoveal CT values of the MwA and control groups (p < 0.05). The mean RNFL thickness of patients with migraine with visual aura was found to be statistically significantly thinner than in the migraine group with non-visual aura (98.73 ± 8.4 and 109.4 ± 16.8) (p < 0.05). There were no statistically significant differences between the RNFL CMT, GCC, and CVI values in the MwA, MoA, and control groups (p > 0.05). CONCLUSION: We found that the choroidal thickness was significantly decreased in patients with migraine, especially in the MwA group. In the visual aura subgroup, the mean RNFL thickness was significantly decreased compared with the non-visual aura subgroup.

Posterior pole analysis and ganglion cell layer measurements in Alzheimer's disease.

AIM: To compare posterior pole analysis and ganglion cell layer (GCL) of patients with Alzheimer's disease (AD) and controls. METHOD: Patients diagnosed with mild and moderate AD included in the study. Posterior pole analysis and GCL measurements were investigated by dividing the macula into superior and inferior hemifields and 5 corresponding zones. RESULTS: There were no significant differences between groups for retinal thickness measurements in any retinal zone. GCL measurements showed lower measurements in moderate AD group for GCL thickness in the superior zone 2 (p:0.025) and inferior zone 2 (p = 0.048) compared to mild AD and controls. A moderate AD status was found to cause a decrease of 5.349 µm in the GCL-SZ2 value [p:0.037]. CONCLUSION: GCL measurements in the moderate AD group show significant thinning in superior and inferior Zone 2, which may be a biomarker for AD.

Ozone-induced retinal vascular reactivity as assessed by optical coherence tomography angiography.

BACKGROUND: This study aimed to investigate the retinal vascular reactivity (RVR) of the macular and peripapillary capillary network in response to ozonated autohemotherapy (AHT) using optical coherence tomography angiography (OCTA). METHODS: This was a single-centre prospective study. All participants that were planned to have a combination of major and minor ozone AHT underwent a complete ocular examination and OCTA imaging before and after the ozone AHT. Foveal avascular zone (FAZ) metrics and vessel density (VD) of superficial (SCP), deep capillary plexus (DCP), and radial peripapillary capillary (RPC) plexus were assessed using the built-in software. RESULTS: A total of 40 right eyes of 40 individuals were included. No significant differences were observed for the mean values of the FAZ metrics and choriocapillaris flow area following ozone AHT compared with baseline values (p > 0.05). The mean whole VD of SCP and DCP was 47.80 ± 2.18% and 53.09 ± 3.00% before treatment, which decreased to 47.68 ± 2.7% and 52.38 ± 3.07% after treatment (p = 0.660 and p = 0.097, respectively). No significant differences were observed in the vascular densities of both SCP and DCP in any quadrant (p > 0.05). The RPC density did not show significant alterations compared with baseline values, except the inferior-hemi region. The VD in the inferior-hemi peripapillary quadrant was significantly increased after ozone AHT (p = 0.034). CONCLUSION: The ozone AHT did not cause evident RVR in the macular area, whereas the peripapillary area showed a partial response.

The effect of hyperbaric oxygen therapy on retina, choroidal thickness, and choroidal vascularity index.

PURPOSE: To determine the acute and cumulative effect of hyperbaric oxygen therapy (HBOT) on retina and choroid tissue in healthy eyes. MATERIAL AND METHODS: Thirty-five subjects who were planned to undergo HBOT for non-ophthalmologic indications comprised the population of this prospective study. Central macular thickness (CMT), retinal nerve fiber layer (RNFL), and choroidal thickness (CT) (3 points: subfoveal area, 500 µm nasal and fovea temporal) were measured using spectral-domain optical coherence tomography (SD-OCT) before HBOT and half an hour after the 1st and 20th sessions of HBOT. The subfoveal choroidal area was segmented using ImageJ software with the binarization technique on enhanced depth imaging (EDI) OCT images. Choroidal area (CA), luminal area (LA), and stromal area (SA) were calculated. Choroidal vascularity index (CVI) was determined as the ratio between LA and CA. RESULTS: The right eyes of 35 patients aged between 22 and 59 years were enrolled in the study. The mean CMT values of the patients were 259.36 ± 22.31 µm, 256.94 ± 22.72 µm, and 254.58 ± 23.02 µm before HBOT, after the 1st session, and after the 20th session, respectively. The change in CMT values before and after HBOT was statistically significant (p=0.001). When the patients' RNFL, CT, CA, SA, LA, and CVI changes before and after the HBOT were examined, no statistically significant difference was found (p>0.05). CONCLUSIONS: Our study jointly evaluates the effect of HBOT on the vascular and stromal components of the choroid and macula in healthy eyes. Due to its thinning effect on the macula, it can be preferred as an adjunctive and facilitating treatment option in addition to current treatments in patients with macular edema due to retinal vascular disorders.

Intravitreal dexamethasone implant results in the treatment of non-infectious uveitis.

OBJECTIVE: The objective of this study was to evaluate the efficacy of intravitreal dexamethasone implant in non-infectious uveitic macular edema. METHODS: Between April 2013 and February 2017, 27 eyes of 21 patients were included in the study at Haydarpasa Numune Training and Research Hospital. The files of patients who underwent intravitreal dexamethasone implantation for non-infectious uveitic macular edema and followed up at least 6 months were retrospectively reviewed. The patients were evaluated in terms of best-corrected visual acuity (BCVA) and central macular thickness (CMT) before and at the 1st, 3rd, and 6th months after injection and the need for re-injection. RESULTS: Twenty-seven eyes of 21 patients were included in the study. The mean age of the patients was 39.2±11.7 years. The mean monitoring time was 24.15±10.08 months. In patients who received single-dose intravitreal dexamethasone implant, the decrease in CMT measurements and improvement in BCVA measurements at 1, 3, and 6 months after injection compared to baseline was found to be statistically significant (p=0.001 for each). Recurrence was detected in 33.3% (n=9) of the cases during follow-up; in cases with recurrence, second implants were repeated after an average of 9.67±3.12 months. The third dexamethasone implantation was applied due to the second relapse of four cases from nine relapsing cases. Third implants were performed at an average of 12.50±4.79 months. During the follow-up period, the most common complications in our patients were cataract (37%) and increased intraocular pressure (40.7%). CONCLUSION: Intravitreal dexamethasone implantation is an effective and reliable treatment option in non-infectious uveitic macular edema. There was no difference between the first dose and re-implantations in terms of efficacy and safety.

Correlation of Dry Eye Workshop Dry Eye Severity Grading System With Tear Meniscus Measurement by Optical Coherence Tomography and Tear Osmolarity.

OBJECTIVES: To compare tear meniscus measurements obtained by optical coherence tomography (OCT) and tear osmolarity with dry eye severity according to the Dry Eye Workshop (DEWS) classification system. METHODS: Forty-four eyes of 22 patients with dry eye disease (DED) were recruited in this prospective study. In all eyes, ophthalmic examination was performed in the same order as follows: Ocular Surface Disease Index (OSDI) survey, tear film osmolarity measurement with TearLab Osmolarity System, tear meniscus measurements by OCT, corneal fluorescein staining scoring, conjunctival lissamine green staining scoring, tear film breakup time assessment, and anesthetized Schirmer test. Dry eye disease severity was graded according to the DEWS dry eye severity grading system, and the patients were divided into two groups. Group 1 composed of the patients with grades 1 and 2 DED, and group 2 composed of the patients with grades 3 and 4 DED. RESULTS: The mean tear osmolarity value was significantly higher in group 2 (318.9±12.8 mOsm/L) than in group 1 (308.1±8.5 mOsm/L) (P<0.01). The mean tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) values were significantly lower in group 2 (172.9±73.5 µm, 121.57±46.2 µm, and 0.013±0.012 mm, respectively) than in group 1 (218.5±70.2 µm, 157.94±49.1 µm, and 0.022±0.013 mm, respectively) (P=0.05, P=0.02, and P=0.026, respectively). There was a negative correlation between TMH and OSDI at the level of 45% (r=-0.450; P<0.05), between TMD and OSDI at the level of 47% (r=-0.470, P<0.05), and lastly between TMA and OSDI at the level of 48.5% (r=-0.485, P<0.05). There was no correlation between OSDI and tear osmolarity (P>0.05). CONCLUSIONS: Both tear osmolarity and tear meniscus OCT measurements comply with the DEWS grading system, and they can be used in the diagnosis and follow-up of dry eye patients in addition to conventional tests.

Measurement of Subfoveal Choroidal Thickness in Pseudoexfoliation Syndrome Using Enhanced Depth Imaging Optical Coherence Tomography.

BACKGROUND/AIM: Pseudoexfoliation (PSX) syndrome is associated with blood flow disturbances; however, its exact effect on choroidal blood flow and thickness remains to be elucidated. This study compared subfoveal choroidal thickness in normal eyes and in eyes with PSX using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This prospective, cross-sectional study included 35 eyes of 35 patients (20 males, 15 females) with unilateral or bilateral PSX and 26 eyes of 26 healthy volunteers (13 males, 13 females). Besides a comprehensive ocular and physical examination, all subjects underwent EDI-OCT examination using an Optovue RTVue OCT device (Optovue Inc., Fremont, Calif., USA). RESULTS: The mean choroidal thickness (CT) and ocular perfusion pressure (OPP) were lower in the PSX group than in the healthy controls (249.4 ± 46.3 vs. 282.5 ± 55.8 µm, p = 0.014 and 40.7 ± 5.8 vs. 44.3 ± 4.3 mm Hg, p = 0.007, respectively). In addition, both systolic blood pressure and diastolic blood pressure measurements were lower among the PSX patients. However, no correlation was found between CT and OPP. CONCLUSION: The findings of this study suggest that PSX is associated with an overall thinning of the subfoveal choroid and a significant decrease in OPP. Future studies are warranted to further examine these relations.