Posterior vitreous attachment as a risk factor for endophthalmitis following intravitreal antivascular endothelial growth factor injection.

PURPOSE: To evaluate the importance of the status of posterior vitreous in eyes with endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF). METHODS: The absence or existence of posterior vitreous detachment (PVD) was elicited in 23 eyes of 23 patients with injection related endophthalmitis, during pars plana vitrectomy (PPV) and compared with 24 control eyes of 24 patients who received intravitreal anti-VEGF without any complication. RESULTS: Thirtten (54.2%) out of 24 patients in the control group had full PVD, whereas only 2 (9.5%) out of 23 eyes in endophthalmitis group (p < 0.001) had full PVD. In all eyes without PVD, posterior vitreous was inducted to be detached at least from optic nerve and macular area without any iatrogenic tear. CONCLUSION: The absence of PVD is a factor that increases the risk of endophthalmitis after intravitreal injections. Uncomplicated separation of the posterior vitreous from the retina in PPV contributes to better prognosis.

Evaluating the effectiveness of inflammatory markers in pediatric open globe injury using a modified pediatric ocular trauma score.

BACKGROUND: This study aims to assess pediatric patients with Open Globe Injury (OGI) using the Modified Pediatric Ocular Trauma Score (MPOTS) and to investigate the correlation between Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lympho-cyte ratio (PLR) parameters with the prognosis determined by MPOTS. METHODS: In this retrospective study, we included pediatric patients with OGI. Recorded data encompassed demographic details, injury type, duration from injury to surgery, complete ophthalmological examinations, initial and final visual acuities, anterior segment and fundus findings, and NLR and PLR values. Patients were categorized into three groups based on their MPOTS scores: Grade I (≤30 points), indicating high risk; Grade II (35-65 points), moderate risk; and Grade III (≥70 points), low risk. Differences between categories were statistically evaluated. RESULTS: The study comprised 22 patients. In Category I, the duration from injury to surgery was longer (p=0.018). The most common injury type in this category was globe rupture, occurring in four (50%) patients, with a significant difference noted between the groups (p=0.041). Category I exhibited lower final visual acuity and higher NLR and PLR values compared to the other categories (p<0.050 for all values). Both NLR and PLR demonstrated significant negative correlations with MPOTS (respectively, r=-0.869, p<0.001; r=-0.809, p<0.001). CONCLUSION: The Modified Pediatric Ocular Trauma Score is an effective and practical method for assessing the prognosis of pediatric patients with Open Globe Injury (OGI). Furthermore, there is evidence indicating a negative correlation between MPOTS and the increase in NLR and PLR values that often follows OGI in this patient population.

Evaluation of retinal and choroidal vascular structures in patients with anxiety disorder.

PURPOSE: To evaluate the retinal and choroidal vascular structures in patients with anxiety disorders. METHODS: Thirthy-four eyes of 34 patients who were diagnosed with any anxiety disorders were compared with 32 eyes of 32 age- and sex-matched controls. Central macular thickness (CMT), foveal vascular zone (FAZ) area, total retinal vascular densities of superficial and deep capillary plexus (VDSCP, VDDCP), outer retinal and choriocapillary layers (ORL, CCL) blood flow rates, central subfoveal choroidal thickness (SFCT) and choriodal vascularity index (CVI) were evaluated with optical coherence tomography angiography (OCT-A) and enhanced depth imaging optical coherence tomography (EDI-OCT). RESULTS: No statistical differences were found between the study and control groups in terms of CMT, FAZ area, VDSCP, VDDCP, ORL and CCL blood flow rates. The mean SFCT was 346.26 ± 64.26 µm in patients with anxiety disorder and was found to be statistically significantly thicker than the control group (319.56 ± 37.19 µm) (p = 0.042). Besides, CVI was significantly lower in the study group (71.09 ± 2.64 vs 73.13 ± 3.31, p = 0.008). CONCLUSION: In people with anxiety disorders, the SFCT was found to be thicker and CVI was found to be lower than normal subjects. Although anxiety and stress are important factors in central serous chorioretinopathy, multifactorial factors, including ocular factors, play a role in the pathophysiology of the disease. There is a need for prospective studies with larger series on the subject.

Long term outcomes of Yamane technique in various indications.

INTRODUCTION: To describe the clinical and refractive outcomes of Yamane transconjunctival sutureless intrascleral intraocular lens (SIS IOL) fixation technique in aphakic and dislocated IOLs. METHODS: The aphakic and IOL dispositioned patients who underwent Yamane surgery in Bozyaka Research and Training Hospital were evaluated retrospectively. The demographic data, preoperative & postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), indication for surgery, additional surgical interventions, complications, the final status of retina, and central macular thickness (CMT) through spectral-domain optic coherence tomography (SD-OCT) were recorded. RESULTS: A total of 30 eyes of 30 patients were evaluated. The indication for surgery was aphakia in 24 patients, lens dislocation in 1 patient, and IOL dislocation in 5 patients. The mean age of participants was 64.17 ± 14.69 years, and the mean follow-up was 46.07 ± 7.96 months. The mean BCVA was improved from 0.25 ± 0.22 (-0.94 ± 0.83 log MAR) to 0.49 ± 0.24 in decimals (-0.37 ± 0.27 log MAR) (p:0.041). The mean subjective refraction improved from 10.06 ± 3.10 to -1.45 ± 0.73 D in the final visit (p < 0.05). The mean of cylindrical refraction was -1.22 ± 1.03 D in the postoperative period. At the time surgery, 36.6% of patients required at least one additional surgical procedure. During follow-up period, two (6.7%) out of 30 of patients had retinal detachment, two of the patients (6.7%) occured epiretinal membrane, one of the patients (3.3%) had cystoid macular edema. CONCLUSION: Yamane SIS IOL fixation technique is an effective and reliable surgical option in complicated cases that require additional surgical interventions in long-term follow-up.

Predictive value of the characteristics of intraretinal cystoid spaces on early response to antivascular endothelial growth factor treatment in patients with cystoid diabetic macular edema / Valor preditivo das características dos espaços cistoides intraretinianos na resposta precoce ao tratamento com fator de crescimento endotelial antivascular em pacientes com edema macular cistoide diabético

ABSTRACT Purpose: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. Methods: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. Results: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). Conclusion: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.

RESUMO Objetivo: Avaliar se as características da tomografia de coerência óptica de domínio espectral dos espaços cistoides intraretinianos prevêem resultados visuais em pacientes que recebem terapia de injeção intravítrea com fator de crescimento endotelial antivascular (bevacizumab 1,25 mg/0,05 ml) para edema macular cistoide diabético. Métodos: A relação entre as propriedades dos espaços cistoides antes da injeção e os resultados anatômicos e funcionais após a injeção foi investigada em pacientes que receberam três injeções intravítreas para edema macular cistoide. A melhor acuidade visual corrigida para a melhora funcional e a espessura do subcampo central para a melhora anatômica foram avaliadas. Além disso, foi avaliada a relação da localização dos espaços cistoides com a integridade dos fotorreceptores e camadas internas da retina. Resultados: Em 36 olhos de 36 pacientes, a melhor acuidade visual corrigida foi significativamente aprimorada (p=0,002), e a espessura média do subcampo central foi diminuída após injeções (p=0,003). O aprimoramento da melhor acuidade visual corrigida foi limitado nos olhos com cistos na camada nuclear externa (p=0,045). A reflexividade intracística foi maior nos olhos que falharam na melhor acuidade visual corrigida do que nos olhos com resultados visuais bem-sucedidos (p=0,028). A zona elipsoide interrompida esteve presente em 13 (59,0%) de 22 olhos com cistos na camada nuclear externa, e em apenas 1 de 14 olhos (7,1%) sem cistos na camada nuclear externa (p=0,009). A desorganização das camadas internas da retina esteve presente em 15 dos 22 olhos (68,1%) com cistos na camada nuclear externa, enquanto apenas 2 em 14 olhos (14,2%) sem cistos na camada nuclear externa tiveram desorganização das camadas internas da retina (p=0,013). Conclusão: Características dos espaços cistoides intrarretinianos podem prever prognóstico em pacientes com edema macular cistoide diabético e ganho visual pode ser limitado nos olhos com cistos na camada nuclear externa.

Central corneal thickness, axial length, anterior chamber and optic disc structure in patients with central and branch retinal vein occlusion.

PURPOSE: To compare the central corneal thickness (CCT), the structural properties of the anterior chamber and optic disc in patients with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and controls. MATERIAL AND METHODS: In this prospective study, 31 eyes of 31 CRVO patients (group 1) (mean age: 65.7 ± 10.2 male/female:16/15), 42 eyes of 42 BRVO patients (group 2) (mean age: 61.5 ± 9.9, male/female: 21/21), and 41 controls (mean age: 61.2 ± 15.3, male/female:15/26) were enrolled. Intraocular pressure (IOP), corrected IOP (IOPcorr), central corneal thickness (CCT), anterior chamber depth & volume (ACD & ACV), iridocorneal angle (ICA), axial length (AL), retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, cup to disc ratio (C/D), cup & rim volume, the scleral canal diameter (SCD), and mean & pattern deviation in visual field of the eyes with CRVO/BRVO, their fellow eyes and control eyes were evaluated. RESULTS: There was no significant difference in IOP among groups (p:0.239), while IOPcorr was significantly higher in eyes with CRVO compared with eyes with BRVO (p:0.003). Central corneal thickness was significantly thinner in CRVO than both BRVO and controls (p:0.005, p:0.002 respectively). The difference in the RNFL thickness was significant among groups (p:0.019), and it was detected significant between CRVO eyes and controls (p:0.05). Anterior chamber volume was lower in eyes with BRVO than in normal eyes (p:0.009). There was no significant difference in AL, ACD, rim volume, cup volume, GCL thickness, C/D ratio, ICA, and PSD among groups. CONCLUSION: The patients with CRVO tend to have thinner corneas, and the evaluation of IOP and CCT can be overlooked during retinal follow-up. Intraocular pressure values corrected with CCT should always be take into account to prevent possible optic nerve damage.

Predictive value of the characteristics of intraretinal cystoid spaces on early response to antivascular endothelial growth factor treatment in patients with cystoid diabetic macular edema.

PURPOSE: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. METHODS: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. RESULTS: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). CONCLUSION: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.

PARS PLANA VITRECTOMY WITH AND WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR DIABETIC PATIENTS WITH MACULA INVOLVED TRACTIONAL RETINAL DETACHMENT.

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on anatomical and functional results in pars plana vitrectomy performed eyes with tractional retinal detachment affecting the macula because of diabetes mellitus. METHODS: Patients without ILM peeling were considered as Group 1, and patients with ILM peeling were considered as Group 2. The main outcomes were the best-corrected visual acuity at 6 months and the rate of epiretinal membrane formation within 6 months. The rate and the indications for resurgery were determined. Parameters affecting the final best-corrected visual acuity were determined by regression analysis. RESULTS: Final best-corrected visual acuity was significantly better in eyes with ILM peeled off than in eyes with no peel-off ( P = 0.012). Less secondary epiretinal membrane was formed in Group 1 ( P = 0.009). There was no difference between groups in resurgery rates ( P = 0.143). The need for resurgery because of epiretinal membrane was higher in Group 1 rather than Group 2 ( P = 0.001). The only factor affecting the final best-corrected visual acuity was ILM peeling. CONCLUSION: In patients with tractional retinal detachment affecting the macula because of diabetes, ILM peeling in addition to pars plana vitrectomy and membrane excision does not affect the need for resurgery but contributes positively to anatomical and functional outcomes.

A Comparative Evaluation of Globe Trauma Features in a Tertiary Care Hospital Before and During the COVID-19 Pandemic

Objectives: To compare the clinical features, preoperative evaluation, and surgical approaches of globe trauma patients presenting to the emergency department before and during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: We retrospectively analyzed 54 eyes of 54 patients with traumatic globe perforation who underwent primary globe repair. The patients were divided into two groups according to the official start of the COVID-19 pandemic in Turkey: Group 1, 1 May 2019-11 March 2020 and Group 2, 11 March 2020-1 January 2021. The demographic features, trauma history, time from trauma to admission and from admission to surgery, COVID-19 serology (polymerase chain reaction [PCR]) result, ophthalmological examination findings at admission, surgical interventions, and postoperative clinical features were obtained from the patients' records. Results: The mean ages of the patients in Group 1 (n=21) and Group 2 (n=33) were 42.76±20.72 and 37.78±23.47 years, respectively (p=0.431). During the pandemic, garden/farm injuries increased while workplace injuries decreased. In Groups 1 and 2 respectively, time from trauma to admission was 461.4±1228.6 and 935.4±2039.6 min (p=0.342), time from admission to surgery was 604.2±679.8 and 392.7±306.9 min (p=0.125), and length of hospital stay was 7.23±4.96, and 3.78±2.28 days (p<0.005). All patients had a COVID-19 PCR test and all resulted negative. There was no significant difference between the groups in terms of the clinical features of the ocular and adnexal injuries, surgical interventions, or postoperative complications (p>0.05). Preoperative visual acuity was found to be an important prognostic factor associated with postoperative visual acuity. Conclusion: Globe injuries require urgent intervention in terms of visual morbidity. Patterns of injury differ during the pandemic due to both restrictions and lifestyle changes. During the pandemic, patients were discharged as soon as possible after emergency treatment to minimize the time spent in the hospital.

The prognostic role of optical coherence tomography in diabetic macular edema patients undergoing early dexamethasone implant shift.

PURPOSE: To determine the prognostic characteristics of optical coherence tomography (OCT) parameters by evaluating diabetic macular edema (DME) patients with early dexamethasone (DEX) shift after three doses of intravitreal ranibizumab (RNB) injection. METHODS: Fifty-four eyes of 34 patients who had DEX implant after three doses of RNB were included in this retrospective study. Early DEX shift includes patients who received direct DEX implant replacement after three doses of RNB load. Baseline OCT values and factors affecting best corrected visual acuity (BCVA) and central macular thickness (CMT) response were analyzed with logistic regression analyses. RESULTS: The presence of subretinal fluid and hyperreflective spot (HRS) >20 were found to be a negative predictive factor for anatomical response. (p = 0.009, p = 0.001, respectively) Low initial BCVA creates a positive effect on visual gain.( p = 0.041) Giant outer nuclear layer cysts, completely disrupted inner segment-outer segment and HRS > 20 have a negative effect on visual gain. (p = 0.025, p = 0.043, p = 0.023, respectively) According to the receiver operating characteristic analysis, the subretinal fluid volume threshold at which >20% reduction in CMT occurs was determined to be 0.85 mm3. (sensitivity 70%, specificity 84% area under the curve 0.817, p = 0.021). CONCLUSION: The presence of high number of HRS and high subretinal fluid volume at the baseline negatively affect prognosis even in patient groups with early DEX shift.

Relief of Cystoid Macular Edema-Induced Focal Axonal Compression with Anti-Vascular Endothelial Growth Factor Treatment.

Purpose: To evaluate the mechanical compression of retinal nerve fiber layer (RNFL) by intraretinal cysts in macular edema and its relief with anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: Optical coherence tomography scans were used to measure RNFL thickness and reflectance at seven preselected points at and around the peak of the edema before and after anti-VEGF treatment in 10 patients (11 eyes) with branch retina vein occlusion (BRVO) and diabetic macular edema (DME). Scans through nonedematous retina and from the fellow eyes were taken as controls. Correlations were sought between the changes in retinal and RNFL thickness, RNFL reflectance, and the size of the intraretinal cysts. Results: Postinjection RNFL thickness decreased significantly only at peak point of the edema (18.1 ± 2.7 vs. 13.8 ± 1.2 µm; P = 0.038), at its nasal edge (20.1 ± 2.7 vs. 15.5 ± 1.4 µm; P = 0.026), and 500 µm away from its nasal border (35.7 ± 6.0 vs. 20.1 ± 2.7 µm; P = 0.006) suggesting focal stagnation of the axoplasmic flow owing to compression at its peak point. Significant postinjection decreases in RNFL reflectivity were also noted at peak point of the cyst (164.9 ± 10.3 vs. 141.5 ± 12.6 arbitrary units [AU]; P = 0.037), at its nasal edge (166.8 ± 7.8 vs. 135.1 ± 10.2 AU; P = 0.02), and 1500 µm away from temporal edge (160.2 ± 6.2 vs. 141.1 ± 6.4 AU; P = 0.022). Cyst proximity to RNFL (D50 = 50 µm) was the only determinant significantly affecting the magnitude of the RNFL thickness change after anti-VEGF treatment (P = 0.001). Conclusions: Intraretinal cysts due to BRVO and DME locally compress overlying axons and induce anatomic changes suggestive of axoplasmic stagnation. This compression can be relieved with anti-VEGF treatment. Translational Relevance: Focal compression of RFNL by retinal cysts may indicate a need for early treatment of macular edema to prevent axonal loss, especially in patients with low axonal reserve.

Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema with Serous Retinal Detachment.

PURPOSE: To evaluate the effectiveness of intravitreal injection of ranibizumab (IVR) in treating diabetic macular edema (DME) with serous retinal detachment (SRD) based on spectral domain optical coherence tomography (SD-OCT) patterns. METHODS: One hundred thirty-four eyes of 134 patients with DME who underwent SD-OCT evaluation were included in this study. We retrospectively analyzed the medical records of patients who received IVR for the treatment of DME. Their eyes were classified into three groups according to the following SD-OCT features: SRD, diffuse retinal thickness and cystoid macular edema. The three groups were compared regarding changes in best-corrected visual acuity and central foveal thickness (CFT) after IVR. RESULTS: The mean age was 61.4 ± 9.2 years (range, 44 to 81 years). The average length of the follow-up period was 9.4 ± 3.4 months (range, 6 to 24 months). The mean CFT value was significantly reduced in all groups (p < 0.001) after treatment. Increases in best-corrected visual acuity were statistically significant for the diffuse retinal thickness and cystoid macular edema groups (p < 0.001 and p < 0.001, respectively). However, there was no significant improvement after IVR injection in the SRD group (p = 0.252). In the SRD group, patients with ellipsoid zone disruption and external limiting membrane disruption demonstrated poorer visual gains at the last follow-up visit (p < 0.005 and p = 0.002, respectively). CONCLUSIONS: A significant reduction in CFT with required IVR injections in DME with SRD was achieved but was accompanied by a worse functional outcome in the SRD group. The presence of subretinal fluid on SD-OCT in study eyes may be a poor prognostic factor for visual acuity.

Evaluation of systemic risk factors in different optical coherence tomographic patterns of diabetic macular edema.

AIM: To elucidate the relationship between systemic risk factors and different patterns of diabetic macular edema (DME) determined with optical coherence tomography (OCT). METHODS: In this cross-sectional study, DME was classified by OCT as diffuse retinal thickness (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD) and the relationship between the systemic risk factors and DME patterns was evaluated. RESULTS: Of the 57 patients with DME, 21 (36.8%) had DRT, 24 (42.1%) had CME and 12 (21.0%) had SRD. Micro- or macro-albuminuria was significantly higher in the DRT pattern (61.9%) compared with the SRD (50.0%) and CME patterns (25.0%; P=0.040). Hemoglobin A1c (HbA1c) level was significantly higher and patients were younger in the DRT pattern group (P=0.034, P=0.032). Best corrected visual acuity was the worst and central macular thickness was the thickest in the CME pattern group. CONCLUSION: Micro- or macro-albuminuria may be more frequent and HbA1c level may be higher in patients with DRT. These patients are also seen to be younger than patients with non-DRT.

The influence of selective laser trabeculoplasty on the success of trabeculectomy.

PURPOSE: The purpose of this to investigate whether selective laser trabeculoplasty (SLT) has any effect on the success of trabeculectomy. PATIENTS AND METHODS: Thirteen-one eyes of 29 primary open-angle glaucoma patients who underwent SLT before trabeculectomy and 29 eyes of 27 patients with the same inclusion criteria which underwent trabeculectomy without prior SLT in the Sifa University and in the Batigöz Eye Hospital in January 2012 and November 2012 were reviewed. All patients underwent trabeculectomy for uncontrolled open-angle glaucoma with the same technique. The results were evaluated 3, 6, 12, 18, and 24 months later after surgery. The statistical analysis was performed with the Mann-Whitney U-test. Fisher's Exact Chi-square test was used to compare the continuous and categorical variables. RESULTS: The mean intraocular pressure (IOP) before surgery was 24.1 ± 1.9 in the SLT-performed group and 26.7 ± 1.6 in the non-SLT-performed group. Twenty-four months later, the mean IOP was 15.1 ± 1.2 in the SLT-performed group and 15.4 ± 1.4 in the non-SLT performed group. There was no difference in the IOP drop after trabeculectomy between the two groups (P = 0.531). CONCLUSIONS: SLT has no influence on trabeculectomy success.

An Evaluation of the Relationship Between Clinically Unilateral Pseudoexfoliation Syndrome and Age-Related Macular Degeneration.

BACKGROUND AND OBJECTIVE: To evaluate the relationship between age-related macular degeneration (AMD) and clinically unilateral pseudoexfoliation syndrome (XFS). PATIENTS AND METHODS: Seventy-six patients (152 eyes) with bilateral AMD and clinically unilateral XFS were included. Eyes with AMD were divided into three stages (early, intermediate, and late), based on the Beckman Initiative for Macular Research Classification Committee of fundus findings. The distribution of AMD lesions was assessed in both groups, and the subfoveal choroidal thickness (SFCT) was measured using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT). RESULTS: There were significantly more early and intermediate-stage AMD cases in eyes with XFS than in non-XFS fellow eyes (P < .05). In contrast, there were significantly fewer wet AMD cases in XFS eyes than in non-XFS fellow eyes (P < .05). SFCT in all AMD stages was significantly lower in eyes with XFS (P < .05). CONCLUSION: XFS was associated with a lower prevalence of wet AMD. Further studies are required to elucidate this association. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:12-19.].

Comparision of Optical Low Coherence Reflectometry Versus Ultrasonic Biometry in High Hypermetropia.

PURPOSE: To compare anterior chamber depth (ACD), axial length (AL), and lens thickness (LT) measurements obtained by the Lenstar LS 900 (Haag-Streit AG) optical low-coherence reflectometry with those obtained by the A-scan contact ultrasound among patients with moderate and high hypermetropia. METHODS: Fifty-two eyes of 52 patients with moderate and high hypermetropia (spherical equivalent of +4 D or more) were examined in this study measurements of ACD, AL, and LT obtained by Lenstar were compared with those obtained by applanation A-scan ultrasound. All measurements were obtained by two independent examiners. The interdevice agreements were evaluated with Bland-Altman analyses. RESULTS: The mean age of the patients was 54.78±12.77 years (range 18-74 years). The mean spherical equivalent refractive power was +5.16±1.12 D (+4.0 to +8.75). The mean values of ACD, AL, and LT with A-scan were 3.05±0.34, 21.55±0.75, and 4.33±0.49 mm, respectively, whereas these values were 2.99±0.45, 21.58±0.78, and 4.20±0.44 mm, respectively, with Lenstar. There was statistically significant difference of LT between the two methods (P=0.02). The mean differences (lower/upper limit of agreement) of the ACD, AL, and LT values for A-scan ultrasound and Lenstar were -0.06 (-0.594/0.474), 0.04 (-0.380/0.459), and -0.12 (-0.739/0.502), respectively. CONCLUSION: Among patients with moderate and high hypermetropia, the biometric measurements of ACD, AL, and LT by ultrasound and optical biometry were determined to be correlated and there was a high degree of agreement between contact A-scan ultrasonic biometry and Lenstar.

Evaluation of the effect of daily activities on intraocular pressure in healthy people: is the 20 mmHg border safe?

PURPOSE: The aim of this prospective study was to evaluate the intraocular pressure (IOP) variations during daily activities such as reading, speaking and carrying in regard to investigating whether an elevation or decrease exists. SUBJECTS AND METHODS: Forty-four eyes of 44 healthy subjects were evaluated. The IOP was measured in relaxation and after reading, speaking and carrying a shopping bag for 5 min on different days, respectively. The subjects rested for 15 min between the activities. Mean initial IOP levels were compared with mean IOP levels after reading, speaking and carrying a shopping bag with paired t test. A p value of 0.05 was considered as statistically significant. RESULTS: We observed no changes in mean IOP after reading (p = 0.188). Mean IOP was increased after speaking and carrying compared with mean basic IOP (p = 0.001 and p = 0.001, very significant, respectively). The mean IOP began to decrease 15 min after speaking and carrying and came back to the baseline values one hour later. CONCLUSIONS: The IOP is not stable during daily activities. Simple actions such as carrying or speaking have an increasing effect on IOP. This should be taken into consideration in glaucoma patients during control measurements, especially in patients in whom the IOP was near to the 20 mmHg border.

Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.

PURPOSE: To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. MATERIALS AND METHODS: Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. RESULTS: Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. CONCLUSION: Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.

Chemokine CXCR-4 and cyclooxygenase-2 in the pathogenesis of pterygium

Background/aim: This study aimed to investigate the expression of chemokine receptor 4 (CXCR-4) and cyclooxygenase-2 (COX-2) in the epithelium and stroma of pterygium tissue in comparison with healthy conjunctiva. Materials and methods: The expression of CXCR4 and COX-2 was investigated by immunohistochemistry in the epithelium and stroma of the pterygium tissue of 29 eyes and compared with healthy conjunctival tissues. The correlation between CXCR4 and COX-2 expression as well as the correlation of these markers with the area of pterygium were evaluated statistically. Results: COX-2 staining scores were 1.75 ± 0.63 in the epithelium and 1.20 ± 0.62 in the stroma of the pterygium tissue. Mean CXCR-4 staining in the epithelium was 0.069 ± 0.37, whereas it was 5.0 ± 2.84 cells in the stroma. There was almost no staining of COX-2 and CXCR4 in the control samples. There was a strong positive correlation between the expression of CXCR-4 and COX-2 in the stroma of the pterygium. Conclusion: CXCR-4 and COX-2 may play important roles in the pathogenesis of pterygium.

The Evaluation of Anatomic and Functional Changes in Unilateral Moderate Amblyopic Eyes Using Optical Coherence Tomography and Pupil Cycle Time.

PURPOSE: To investigate whether macular anatomic structure and afferent visual system function differ among amblyopic eyes, non-amblyopic fellow eyes, and controls, using spectral-domain optical coherence tomography (SD-OCT), and pupil cycle time (PCT). METHODS: This observational, cross-sectional study included 30 patients with unilateral amblyopia and 30 healthy subjects. Optical coherence tomography (OCT) and pupil cycle time (PCT) were used to evaluate patients with unilateral amblyopia and were compared with their non-amblyopic fellow eyes and age- and gender-matched healthy eyes (30 participants). The amblyopic eyes were separated into two groups: anisometropic amblyopia (n = 16) and strabismic amblyopia (n = 14). OCT maps were used to calculate central macular thickness (CMT), retinal nerve fiber layer thickness (RNFLT), and ganglion cell-inner plexiform layer (GC-IPL) thickness. RESULTS: The average RNFLT, GC-IPL thickness, and CMT did not show any significant differences among the amblyopic eyes, non-amblyopic fellow eyes and controls (p > 0.05, Kruskal-Wallis test). Mean PCT was 773.57 ± 64 msn in strabismic eyes, 771.25 ± 58 msn in anisometropic eyes, 778.00 ± 72 msn in non-amblyopic fellow eyes, and 774.75 ± 69 msn in control eyes. The differences among the amblyopic eyes, its fellow and control eyes were not statistically significant (p > 0.05, Kruskal-Wallis test). CONCLUSIONS: In this study, we investigated morphological and functional differences among amblyopic eyes, non-amblyopic fellow eyes and controls by using SD-OCT and PCT. We did not find anatomical or functional changes in amblyopic eyes.