Changes in pupil size, ocular wavefront aberrations, and accommodation in healthcare workers using FFP3 masks.

PURPOSE: To evaluate changes in pupil size, ocular wavefront aberrations (WA), and accommodation in healthcare workers after 4-h usage of Filtering Facepiece class 3 (FFP3) masks. MATERIAL AND METHODS: This prospective study included 22 healthy healthcare workers. Pupil size, ocular WA, and accommodation changes before and after FFP3 mask usage were evaluated using a Hartmann Schack aberrometer. Accommodative responses to stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were assessed. Ocular high-order aberrations (HOAs) were recorded at baseline and at every accommodative stimulus. Oxygen saturation (SpO2) was measured by pulse oximetry before and after the mask usage. RESULTS: The mean age was 36.6 ± 8.5 years. The SpO2 significantly decreased from 98.95 to 97.95% after usage of the FFP3 mask (p < 0.001). The mean pupil size did not significantly differ before (6.22 ± 0.75 mm) and after (6.38 ± 0.83 mm) the 4-h mask usage (p = 0.093). The mean total RMS of the total HOAs was 0.36 ± 0.17 before and 0.39 ± 0.15 after the mask usage (p = 0.071). Post-mask accommodation showed a significant decrease at the 2 D (p = 0.041), 2.5D (p = 0.022), and 3 D (p = 0.025) stimuli. CONCLUSION: The present study shows that after 4 h-usage of FFP3 mask, both SpO2 and accommodative response to increasing stimuli might be significantly decreased.

Evaluation of Schlemm Canal Parameters Using Swept-Source Optical Coherence Tomography in Eyes That Underwent Keratoplasty.

OBJECTIVES: In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups. METHODS: The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal. RESULTS: There was no statistically significant difference between the groups for age and gender ( P ˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141µm 2 and 160.77±65.08 µm, respectively, in the nasal quadrant and 2.623±1.277 µm 2 and 158.81±68.05 µm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups ( P <0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters. CONCLUSION: This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.

Müller Muscle-Conjunctival Resection for Treatment of Contralateral Ptosis following Unilateral External Levator Advancement.

BACKGROUND: One of the main causes of unsatisfactory outcomes after unilateral blepharoptosis surgery is asymmetry of the upper eyelid height, which occurs as a result of a contralateral eyelid droop. Therefore, the authors evaluated the efficacy of Müller muscle-conjunctival resection (MMCR) for the treatment of contralateral ptosis following unilateral external levator advancement (ELA). METHODS: This study analyzed 26 eyelids of 26 patients with upper eyelid height asymmetry following unilateral ELA who underwent contralateral MMCR retrospectively. The phenylephrine test was performed before ELA and before MMCR. The main outcome measures were symmetry outcomes and clinical outcomes. RESULTS: The mean patient age was 55.81 ± 7.98 years (range, 44 to 70 years); 15 were female (57.7%). The Hering dependency was observed in 13 of the patients (50%) before ELA. An adequate response to phenylephrine was observed before MMCR but not before ELA. Symmetry outcomes after MMCR were perfect (<0.5 mm), good (≥0.5 mm and <1 mm), and fair (≥1 mm) in seven, 17, and two patients, respectively. An optimal upper eyelid height was noted in 47 of the 52 eyelids after the MMCR, whereas three of the 52 eyelids had minimal overcorrection, and two eyelids had undercorrection. The mean change in marginal reflex distance 1 of the contralateral eyelid droop was greater for patients with than without the Hering dependency ( P < 0.0001) after ELA but not after MMCR. Two patients (7.6%) underwent revision ELA surgery. CONCLUSION: MMCR and use of the phenylephrine test to predict the eyelid position may represent an alternative approach in patients who require management of contralateral ptosis following unilateral ELA. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Oct biomarkers of treatment-naive diabetic macular edema in patients with non-proliferative and proliferative diabetic retinopathy.

PURPOSE: To evaluate and compare the retinal and choroidal spectral-domain optic coherence tomography (SD-OCT) findings of treatment-naïve diabetic macular edema (DME) secondary to non-proliferative and proliferative diabetic retinopathy (NPDR-PDR). MATERIAL AND METHODS: A hundred and thirty-eight eyes of 138 patients with DME were evaluated. Best-corrected visual acuity was recorded, biomicroscopic anterior and posterior segment examination, SD-OCT imaging, and fundus fluorescein angiography (FFA) were performed. Demographic features, OCT characteristics, FFA, and visual acuity measurements were evaluated and compared between the two groups. RESULTS: Sixteen eyes were excluded from the study due to the lack of FFA images. Data of 122 eyes were analyzed for the study. Sixty-five eyes with NPDR (Group 1) and 57 eyes with PDR (Group 2) were enrolled in the study. There was no significant difference in central macular thicknesses (CMT) between the two groups. The eyes with DME + PDR showed a higher rate of the diffuse type of macular edema with more para and peri-foveal extension accompanied by larger cysts than the eyes with DME + NPDR. Disorganization of retinal inner layers, disrupted ellipsoid zone, and the epiretinal membrane were more prominent in the eyes with PDR. Also, there were more prominent macular ischemia on FFA and worse initial visual acuity measurements in the eyes with PDR than those with NPDR. Choroidal thickness (CT) was significantly reduced in the PDR group. CONCLUSION: SD-OCT features of treatment-naïve DME in patients with NPDR and PDR presented some differences. These variations may be related to diabetic retinopathy severity and may provide information about prognosis.

Exploration of fluoroquinolone-induced retinal pigment epithelium layer changes in the pathogenesis of macular degeneration.

PURPOSE: Fluoroquinolone toxicity studies in animals (cats, rabbits and mice) showed that acute retinal degenerations appear clinically related to phototoxicity. The aim of this study was to evaluate the association between the administration of oral fluoroquinolone and the onset of clinically or subclinically detectable acute retinal degeneration in humans. MATERIAL AND METHODS: This study included patients that received oral fluoroquinolone treatment (ciprofloxacin, levofloxacin or moxifloxacin) for variable systemic diseases diagnosed by the Department of Urology and Infectious Diseases (study group, n=76), and age and sex matched otherwise healthy subjects (control group, n=50). All the subjects underwent a detailed ophthalmologic examination including tests for visual acuity, intraocular pressures, color vision, photostress recovery time and contrast sensitivity measurements, central foveal thickness, subfoveal choroidal thickness, ganglion cell complex thickness and 10/2 Humphrey visual field test. Color fundus and fundus autofluorescence photographs were also obtained. Examinations and tests were repeated at 1st week and 1st month in the study group. RESULTS: There was no statistically significant difference among visual acuity, intraocular pressure, photostress recovery time, color vision, contrast sensitivity measurements, central foveal thickness, subfoveal choroidal thickness, average ganglion cell complex thickness, superior ganglion cell complex thickness, inferior ganglion cell complex thickness, focal loss volume, global loss volume, mean deviation, pattern standard deviation values in treatment group at baseline, 1st week and 1st month (p > 0.05, for the comparison of each parameters). There was not any alteration among color fundus and fundus autofluorescence photographs obtained at baseline, 1st week and 1st month in treatment group. All parameters within the study and control groups were similar throughout the study period (p > 0.05, for the comparison of each parameter). CONCLUSION: This study evaluated the association between the administration of oral fluoroquinolone and the onset of acute retinal degeneration. Preliminary results of this study showed that use of oral fluoroquinolone had no detectable impact on retinal degeneration at acute phase.

The Importance of Anatomic Configuration and Cystic Changes in Macular Hole: Predicting Surgical Success with a Different Approach.

PURPOSE: This study aimed to define a novel metric for the area of the macular hole (MH) and cysts located around the hole using an optical coherence tomography (OCT) device. METHODS: This study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. Using the metrics of macular hole index (MHI), tractional hole index (THI), hole forming factor (HFF), macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and our novel metric, the cyst hole area index (CHAI) was calculated. The correlation of the CA, the HA, and the CHAI with other indexes were assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures. RESULTS: The CA showed a strong positive correlation with the base MH size and the maximum MH height (r = 0.624, p < 0.001; r = 0.722, p < 0.001, respectively). The HA showed a strong positive correlation with basal MH size and minimum MH size (r = 0.934, p < 0.001; r = 0.765, p < 0.001). The HA showed a moderate positive correlation with maximum MH height (r = 0.483, p < 0.001, respectively). CHAI showed a moderate positive correlation with minimum MH size (r = 0.297, p = 0.02). CHAI and HA showed a moderate negative correlation with post-operative BCVA (r = -0.39, p = 0.003; r = -0.357, p = 0.006; respectively). ROC curve analysis showed that MHI (0.823), THI (0.750), and HFF (0.722) predicted type 1 closure and that CHAI (0.769) and HA (0.709) predicted type 2 closures. CONCLUSION: MHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively.

Analysis of risk factors and ocular hypotony characteristics in choroidal detachment after penetrating glaucoma surgery.

PURPOSE: To analyze the risk factors and ocular hypotony characteristics of choroidal detachment (CD) after penetrating glaucoma surgery and to compare between eyes with and without CD. METHODS: This retrospective study enrolled 173 eyes of 168 patients. Patients who underwent trabeculectomy or Ahmed glaucoma valve implantation due to medically uncontrolled glaucoma and who had intraocular pressure (IOP) < 9 mmHg at any time during the first postoperative week were included. RESULTS: The study population consisted of 61 (36.3%) females and 107 (63.7%) males with a mean age of 60.7 ± 14.2 years. The postoperative median follow-up time was 24 months (range, 12-40 months). Postoperatively, CD developed in 47 (27.1%) eyes. Multivariate analyses demonstrated that eyes with high preoperative IOP (> 40 mmHg) were 12.1 times more likely to develop CD (p = 0.000) and that presence of IOP < 9 mmHg on the first day of surgery increased the CD risk 3.8 times (p = 0.002); male gender raised the risk 2.7 times (p = 0.028). The mean preoperative IOP in CD eyes was significantly higher than in non-CD eyes (p = 0.000). The mean IOP change between preoperative and lowest IOP was significantly greater in those with CD than in those without CD (p = 0.000). The mean lowest IOP in the CD eyes was significantly lower than in the non-CD eyes (p = 0.037). For the surgical failure rate, no significant difference was found between the CD and the non-CD groups (p = 0.14). CONCLUSIONS: The present study demonstrated that high preoperative IOP, presence of IOP < 9 mmHg on the first postoperative day, and male gender were significantly associated with CD after penetrating glaucoma surgery. Choroidal detachment accompanied by hypotony did not affect the final outcome negatively.

Diagnostic Performance of Optical Coherence Tomography for Pseudoexfoliation Glaucoma.

PRCIS: Lamina cribrosa (LC) thickness and LC curvature index (LCCI) had comparable diagnostic performances with retinal nerve fiber layer (RNFL) thickness in distinguishing eyes with pseudoexfoliation glaucoma (PXG) from those with pseudoexfoliation syndrome (PXS). Bruch's membrane opening-minimum rim width (BMO-MRW) showed the lowest diagnostic performance among all geometric parameters derived from optical coherence tomography (OCT) scans we evaluated. OBJECTIVE: The aim was to compare the diagnostic performance of different geometric parameters derived from OCT scans (RNFL thickness, LC thickness, LCCI, and BMO-MRW) for distinguishing eyes with PXG from PXS and healthy eyes. MATERIALS AND METHODS: Fifty-five eyes of 55 patients with PXG, 55 eyes of 55 patients with PXS, and 50 healthy subjects were enrolled in this cross-sectional study. The areas under the receiver operating characteristic curves (AUCs) of RNFL thickness, LC thickness, LCCI and BMO-MRW were calculated and compared. RESULTS: In discriminating between eyes with PXG from those with PXS, LC thickness [0.930; 95% confidence interval (CI): 0.883-0.978] and global RNFL thickness (0.974; 95% CI: 0.947-0.992) presented comparable AUCs ( P =0.244). In distinguishing subjects with PXG from healthy controls, both LC thickness (0.972; 95% CI: 0.948-0.997) and LCCI (0.983; 95% CI: 0.968-0.998) had comparable AUCs with global RNFL thickness (0.988; 95% CI: 0.974-1.000) ( P =0.094 and 0.239, respectively). Global BMO-MRW had lower AUCs than RNFL thickness (0.839; 95% CI: 0.759-0.920 and 0.897; 95% CI: 0.836-0.958, respectively) in distinguishing PXG from both PXS and healthy controls ( P =0.001 and 0.002, respectively). BMO-MRW also had significantly lower AUCs than both LC thickness and LCCI in distinguishing PXG from healthy controls ( P =0.034 and 0.001, respectively). CONCLUSION: LC thickness and LCCI had better diagnostic performance than BMO-MRW in distinguishing PXG from PXS and healthy controls, which were comparable to RNFL thickness.

Effect of bariatric surgery on macular and peripapillary choroidal structures in young patients with morbid obesity.

OBJECTIVE: To examine the effect of bariatric surgery on the macular and peripapillary choroid in the late postoperative period in young patients with morbid obesity and compare them with a healthy control group. METHODS: This prospective controlled study included 50 eyes of 25 young patients with morbid obesity and 50 eyes of 25 age and sex-matched healthy controls. Sleeve gastrectomy was performed on all patients with obesity. Preoperative and 6-month postoperative macular and peripapillary choroidal thickness, total choroidal area (TCA), luminal area (LA), and choroidal vascularity index (CVI) were performed. Results were compared with healthy controls by using enhanced depth imaging optical coherence tomography. RESULTS: Choroidal thickness and CVI values were smaller in patients with obesity in both macular and peripapillary areas compared with the healthy control group (both p < 0.001). There was a statistically significant increase in the macular and peripapillary choroidal thickness of patients with obesity when the preoperative and the postoperative 6-month values after bariatric surgery were compared (both p < 0.001). Also, it was found that bariatric surgery increased TCA and LA values in the macular and all sectors of peripapillary areas (all p < 0.001), and CVI values in the temporal and nasal peripapillary sectors (p = 0.007, p = 0.012, respectively). CONCLUSIONS: Bariatric surgery was found to increase the macular and peripapillary choroidal thickness and the nasal and temporal peripapillary CVI values in young patients with morbid obesity in the late period. To the best of our knowledge, the current study has shown for the first time that bariatric surgery affects peripapillary choroid and CVI values.

Comparison of Choroidal Vascularity Index in Patients with Pseudoexfoliation Glaucoma, Pseudoexfoliation Syndrome, and Healthy Controls.

PURPOSE: To compare peripapillary choroidal vascularity index (CVI) parameters in pseudoexfoliation glaucoma (PEG), pseudoexfoliation (PEX) syndrome, and healthy controls. METHODS: A total of 240 eyes of 240 patients were included in this cross-sectional prospective study, and the three groups consisted of (i) 80 eyes of 80 patients with PEG, (ii) 80 eyes of 80 patients with PEX syndrome, and (iii) 80 healthy control eyes. Peripapillary enhanced depth imaging optical coherence tomography images were binarized via standard protocols with the ImageJ software. CVI was analyzed in all sectors of the peripapillary region. RESULTS: Peripapillary CVI was found to be significantly lower in the PEG group (61.6 ± 2.32) compared with the PEX group (64.7 ± 3.15) and the control group (67.5 ± 2.44) (p < .001), and patients with PEX also had significantly lower values compared to controls (p < .001). Peripapillary CVI values were significantly lower in the temporal, nasal, superotemporal, superonasal, inferotemporal and inferonasal sectors of the PEG group compared to both the PEX group and controls (p < .001). Peripapillary CVI was also found to be lower in all sectors in the PEX group compared to controls (p < .001). Global peripapillary choroidal thickness was significantly thinner in the PEG group than the PEX and control groups (133.37 ± 39.16, 154.36 ± 33.28 and 157.82 ± 36.77 µm, respectively, p < .001). CONCLUSIONS: In the current study, it was shown that the presence of PEX caused a decrease in CVI value and this decrease was highest in patients with PEG. CVI may be a useful parameter to show vascular dysfunction in PEG and PEX syndrome.

Efficacy of the Müller Muscle-Conjunctival Resection for the Correction of Unilateral Ptosis following External Levator Operations in Patients with Bilateral Involutional Ptosis.

SUMMARY: Patients with aponeurotic blepharoptosis who are treated with external levator advancement may experience complications such as upper eyelid height asymmetry and often require revision surgery. The authors assessed the efficacy of Müller muscle-conjunctival resection in cases with upper eyelid height asymmetry following bilateral external levator advancement. The authors used retrospective analysis of 11 cases between September of 2016 and October of 2018 with eyelid asymmetry following bilateral external levator advancement. Following a positive phenylephrine test, these patients underwent unilateral Müller muscle-conjunctival resection revision surgery to treat the undercorrected eyelid. Preoperative and postoperative marginal reflex distance 1, symmetry outcomes, and clinical outcomes of patients were evaluated after the Müller muscle-conjunctival resection. The average patient age was 54.81 ± 3.95 years (range, 37 to 69 years; median, 56 years); seven patients (63.6 percent) were women. Hering dependency was seen in all patients before the external levator advancement. A total of three patients underwent bilateral external levator advancement simultaneously, and eight patients underwent bilateral external levator advancement sequentially. The phenylephrine test was positive in all patients before the Müller muscle-conjunctival resection. Symmetry outcomes were assessed after the revision surgery as perfect (<0.5 mm), good (≥0.5 to <1 mm), or fair (≥1 mm) in four patients, six patients, and one patient, respectively. An optimal correction was noted in 13 of the 22 eyelids after the revision surgery, whereas eight of the 22 eyelids had minimal undercorrection, and one eyelid had minimal overcorrection. Müller muscle-conjunctival resection revision surgery for treatment of the ptotic eyelid following bilateral external levator advancement is viable and may represent a new alternative among the limited revision techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

In vivo analysis of choroidal vascularity index changes in eyes with Fuchs uveitis syndrome.

BACKGROUND: This study aimed to investigate changes in the choroidal vascularity index (CVI) in eyes with Fuchs uveitis syndrome (FUS) and determine the effect of heterochromia on choroidal vascularity using binarisation of enhanced-depth imaging (EDI)-optical coherence tomography (OCT) images. METHODS: The study included the affected eyes (FEs) and unaffected fellow eyes (NFEs) of 24 patients with unilateral FUS and the eyes of 30 healthy controls (HCs). The subfoveal total choroidal area (TCA) and the luminal area (LA) were determined by binarised EDI-OCT images using Image J software (National Institutes of Health, Bethesda, MD). The CVI value was calculated by dividing the LA value by the TCA value. RESULTS: The CVI values were significantly lower in FEs (58.8 ± 3.7 %) compared to NFEs (62.3 ± 3.9 %, p = 0.002) and HCs (61.1 ± 3.7 %, p = 0.008). The mean LA was significantly narrower in FEs than in NFEs (p = 0.047) and HCs (p = 0.001). Additionally, the mean CVI values were significantly lower in eyes with heterochromia compared to those without heterochromia (p = 0.024) in the affected eyes of patients with FUS. CONCLUSION: This study shows that there are significant quantitative structural changes, especially in the luminal part of the subfoveal choroid, in eyes with FUS. The choroid seems to be more affected in the presence of heterochromia. These findings might support posterior involvement and the chronicity of the disease.

Evaluation of the Quality, Reliability, and Educational Content of YouTube Videos as an Information Source for Soft Contact Lenses.

OBJECTIVES: To evaluate the quality, reliability, and educational content of YouTube videos related to soft contact lenses (CL). METHODS: An online YouTube search was performed for the terms contact lens and other common CL-related terms contact lens insertion and removal, contact lens wearing, and contact lens care. The first 50 videos were evaluated for each term. Videos were evaluated using three checklists (the modified DISCERN criteria, the Journal of the American Medical Association [JAMA] criteria, and Global Quality Score [GQS]). Video popularity was also evaluated using the video power index (VPI). Videos were classified into three groups according to the source of the upload; group 1: universities/occupational organizations, group 2: medical ad/profit-oriented companies, and group 3: independent users. RESULTS: From among the 200 videos analyzed, 79 were included. The mean mDISCERN score of the videos was 2.34±1.39, the mean JAMA score was 1.20±0.99, and the mean GQS value was 3.47±1.28. There were positive correlations between the three checklists (P<0.001). Video power index was not correlated with each score. The videos in group 1 (13.9%) had the highest scores whereas videos in group 3 (41.8%) had the lowest scores. There was no significant difference between the video sources according to the VPI. CONCLUSION: Although some YouTube videos contain useful information for CL wearers, most videos have poor quality and reliability and contain insufficient information. Eye care providers should be aware of these sources and steer CL users to information sources that provide accurate and reliable information and do not contain misleading information.

The effect of optic neuritis attacks on choroidal vascularity index in patients with multiple sclerosis.

PURPOSE: To investigate the changes in the choroidal vascularity index (CVI) of patients with multiple sclerosis (MS) using binarization on enhanced depth imaging optical coherence tomography (EDI-OCT) images and to evaluate the effect of optic neuritis (ON) attacks on these measurements. METHOD: Three groups were created by including forty eyes of 20 patients diagnosed with relapsing-remitting MS and had a unilateral history of ON attack and the randomly selected eyes of 30 healthy age- and sex-matched control subjects. Group 1 (n = 20) consisted of the ON-affected eyes of the MS patients (MSON); group 2 (n = 20) included their fellow healthy eyes (MSNON); group 3 (n = 30) included the eyes of healthy controls. RESULTS: The mean age was 33.3 ± 9.4 years in the MS group and 33.4 ± 11.1 years in the healthy control group. Mean choroidal vascularity index (CVI) was significantly lower in the MSON group than the MSNON group (59.6 ± 3.72 % vs 61.7 ± 3.16 %, p = 0.007). The CVI values of both the MSON and MSNON groups were significantly lower when compared to the controls (63.9 ± 2.76) (p < 0.001, p = 0.030). Compared to controls, the subfoveal total choroidal area and luminal area values were significantly greater in the MSON (p = 0.009, p = 0.009, respectively) and MSNON groups (p = 0.031, p = 0.013, respectively). CONCLUSION: The presented study demonstrates that, compared to healthy subjects, CVI values are lower in the affected and unaffected eyes of patients who had a history of ON in relation with their MS diagnosis. The presence of significant anatomical changes, especially in the luminal area, may suggest that ON causes vascular disorganization which contributes to MS pathophysiology.

Effects of Ab Interno XEN Gel Implantation on Postural Intraocular Pressure Elevations.

Purpose: The aim of this study was to analyze the postural intraocular pressure (IOP) changes in open-angle glaucoma after ab interno XEN gel implant surgery and to compare them with the changes observed with trabeculectomy and medical treatment.Patients and Methods: The study sample included 18 patients with XEN gel implants, 30 patients who had trabeculectomy, and 30 medically managed glaucoma patients. All patients in XEN gel implant and trabeculectomy groups had at least 11 months of follow-up and had successful surgeries that resulted in medication-free control of IOP. A rebound tonometer (Icare, Finland Oy, Helsinki, Finland) was used to measure the IOP levels at the sitting, supine, and dependent lateral decubitus (DLDP) positions after a 5-minute rest at each position.Results: In all the groups, the mean IOP values in the DLDP and supine positions were significantly higher than the sitting position. The IOP elevation after moving from sitting to supine position was significantly reduced in XEN gel implant and trabeculectomy groups compared to medical treatment group (p = .001 and p = .002, respectively). The IOP elevation after a moving from sitting to DLDP was also significantly reduced in XEN gel implant and trabeculectomy groups compared to the medical treatment group (p = .003 and p = .01, respectively). However, there was no significant difference in IOP change after moving from sitting to supine or DLDP positions between XEN gel implant and trabeculectomy groups (p = .74 and p = .98, respectively).Conclusion: This study demonstrated that XEN gel implant could reduce postural elevations in IOP to the same degree as trabeculectomy and provide significantly better postural IOP control than medical treatment. This surgery can be an effective minimally invasive alternative for patients with significant positional IOP elevations.

Retinal and choroidal vascularity changes in healthcare professionals wearing FFP3 respirators.

PURPOSE: To evaluate short-term retinal and choroidal vascularity changes in the healthcare professionals after four hours of use filtering facepiece respirators (FFR). MATERIALS AND METHODS: This prospective study included 20 healthcare professionals. Oxygen saturation, pulse rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and spectral domain optical coherence tomography (OCT) imaging were evaluated at baseline and after four hours wearing of FFP3 FFRs without an exhalation valve. Superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), and inferior temporal vein (ITV) diameter were measured from OCT images. The total subfoveal choroidal area (TCA), luminal area (LA), stromal area (SA) choroidal vascularity index [(CVI), the ratio of LA to TCA] were determined after binarization of enhanced depth imaging OCT (EDI-OCT) images of the choroid. RESULTS: The mean age of the participants was 27.35 ± 2.80 years (range, 25-34). Eight of them were female and 12 were male. After wearing the FFR for four hours, a significant decrease was observed in the mean DBP (p = 0.018), MAP (p = 0.016), and MOPP (p = 0.007) when compared to base-line values. STV diameter (p = 0.019) and ITV diameter (p = 0.046) measurements were found significantly higher than baseline measurements. A significant increase in the choroidal vascularity was observed in the LA (p = 0.004) and TCA values (p = 0.043) after wearing the FFR for four hours. CONCLUSION: The current study shows that after four hours usage of FFR, in addition to systemic changes, retinal and choroidal vascularity might be affected significantly. With further studies, long-term effects and clinical significance of these short-term changes should be investigated on healthcare professionals.

Analysis of the quality, reliability, and popularity of information on strabismus on YouTube.

To evaluate the quality, reliability, and popularity of YouTube videos addressing strabismus. This is a retrospective, cross-sectional, register-based study. A search was performed using the keywords "strabismus," "squint," "eye squint," and "crossed eye" on YouTube, and the first 50 videos for each keyword were analyzed. The video duration, time since upload, number of total views, view ratio were recorded. Video popularity was recorded using the video power index (VPI). Video educational quality and reliability were measured using the DISCERN questionnaire, Journal of the American Medical Association (JAMA) score, and Global Quality Score (GQS). All videos were also assigned publishers and categories. Among the 200 videos analyzed, 84 were included. The mean duration was 6.2 min, and the mean number of total views was 227,226. The mean VPI score was 189.6 ± 1093.5 (range, 0-11631). The mean DISCERN score, JAMA score, and GQS were 42.2 ± 15.3, 1.9 ± 1.2, and 2.7 ± 1.1, respectively. While the main video publishers were patients (32.1%) and ophthalmologists (28.5%), the main video categories were patient experience (35.7%) and patient information (26.1%). While the most popular videos were uploaded by a TV show/YouTube channel, the videos with the highest educational quality and reliability scores were uploaded by academic institutions. Although some videos contained sufficient information, most of the videos were rated as fair. YouTube users mostly preferred videos that were of low quality. Patients may be receiving biased information, and physicians should be aware of the type of information patients may be accessing on YouTube.

Optic Nerve Head Changes in Patients with Optic Neuritis Secondary to Multiple Sclerosis: A Comparison of the Affected and Fellow Healthy Eyes.

OBJECTIVE: To evaluate the thickness of lamina cribrosa (LC) in patients with multiple sclerosis (MS) using optical coherence tomography (OCT) and the effect of optic neuritis (ON) attack on these measurements during the remission period. METHODS: The study included 20 cases diagnosed with relapsing-remitting MS with a history of ON attacks affecting one eye and in remission of MS and ON attacks for at least three months, and 28 randomly selected eyes of age- and sex-matched healthy controls. In the MS group, the eyes affected by ON attack were assigned as Group 1 (MS+ON), their fellow unaffected eyes as Group 2 (MS-ON), and healthy control eyes as Group 3. The LC, peripapillary retinal nerve fiber layer (ppRNFL), and subfoveal choroidal thickness measurements were made by using OCT in all cases, and results were compared between the groups. RESULTS: The mean LC thickness in MS+ON and MS-ON groups was significantly lower than the control group (p<0.001). There was no significant difference between MS+ON and MS-ON groups in terms of mean LC thickness (p=0.073). The mean ppRNFL in the MS+ON and MS-ON groups was statistically significantly lower than the control group (p=0.003, p=0.035, respectively). CONCLUSIONS: It is noteworthy that LC is significantly affected in eyes with MS who have not had a history of ON attack. Evaluation of the LC measurements can be important for early detection of optic nerve damage in patients with MS.