Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic.

PURPOSE: To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. METHODS: The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. RESULTS: ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. CONCLUSION: ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

Evaluation of the optic nerve head and macular vessel density in keratoconus patients using optical coherence tomography angiography- a cross-sectional study.

PURPOSE: Our study evaluated macular and optic disc vascular density (VD) changes in patients diagnosed with keratoconus, as compared with gender and age-matched healthy controls, in relation to the keratoconus stage. METHODS: This comparative cross-sectional study included adult patients who received a diagnosis of keratoconus at the Cornea Clinic. All scans consisted of two 4.5 mm × 4.5 mm images of the optic disc area and 6 × 6 mm images of the macular area using optical coherence tomography angiography. RESULTS: The study included 67 patients (26 women (38.8%) and 41 men (61.2%)) and 74 controls (31 women (41.9%) and 43 men (58.1%)). The mean ages of the keratoconus group and the control group were 30.0 ± 8.0 and 31.1 ± 7.5, respectively. Macular VD (whole, superficial, and deep) and peripapillary VD (whole) values were decreased statistically significant compared with the control group (p < 0.01 and p = 0.015, respectively). The keratoconus stage was negatively correlated with both the macular VD (p = 0.048, r = -0.314) and whole-peripapillary VD values (p = 0.03, r = -0.34). CONCLUSION: Keratoconus might affect the posterior and anterior segments due to similar etiologies, including diminished collagen quality. Therefore, examination of the posterior segment should be performed thoroughly in keratoconus patients.

Serum vascular endothelial growth factor, insulin-like growth factor-1 and aflibercept levels in retinopathy of prematurity.

PURPOSE: To evaluate the serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) after intravitreal injection of aflibercept (IVA) and the transition of aflibercept into systemic circulation in infants with severe retinopathy of prematurity (ROP). STUDY DESIGN: Prospective study. METHODS: This single-centered prospective cohort study included infants who received IVA for the treatment of type 1 ROP in zone I and posterior zone II. Blood samples were collected before IVA and at 1 day and 1, 2, 4, and 8 weeks after IVA. VEGF, IGF-1 and aflibercept levels were measured. RESULTS: Thirty eyes of 15 infants received IVA of 1 mg/0.025 mL. Serum VEGF levels decreased significantly at 1 day and 1, 2, 4, and 8 weeks after IVA compared with baseline (P < 0.05). Serum aflibercept levels decreased significantly 1, 2, 4, and 8 weeks after IVA compared with the level at 1 day after IVA (P < 0.05) and increased significantly at 1 day, 1, 2, and 4 weeks after IVA compared with the baseline level (P < 0.05). No significant difference was detected between serum IGF-1 levels any time in any infant (P > 0.05). CONCLUSION: Serum VEGF levels are suppressed for at least 8 weeks, and aflibercept could be detected in the systemic circulation at 4 weeks after injection. Clinicians should be cautious about changes in systemic VEGF levels and passage of the agent into systemic circulation after IVA in infants.