Can objective parameters in optical coherence tomography be useful markers in the treatment and follow-up of type 1 and type 2 macular neovascularizations related to neovascular age-related macular degeneration?

PURPOSE: The aim of this study was to compare the responses of type 1 and type 2 macular neovascularizations (MNV) caused by neovascular type age-related macular degeneration (n-AMD) to intravitreal anti-vascular endothelial growth factor (VEGF) treatments using quantitative parameters determined by optical coherence tomography (OCT). Additionally, it was also intended to assess the connections between these quantitative parameters and changes in best-corrected visual acuity (BCVA) and the number of intravitreal anti-VEGF injections required within a year. MATERIALS AND METHODS: In our retrospective and observational study, the data of 90 eyes of 90 patients diagnosed with n-AMD and treated with intravitreal anti-VEGF with the "Pro re nata" method were evaluated. Subtypes of existing MNVs were distinguished with previously taken optical coherence tomography angiography (OCTA) images. In spectral domain OCT examinations, central macular thickness (CMT) and central macular volume (CMV) values were recorded at baseline and 12th month. The number of intravitreal anti-VEGF injections during the 12 month follow-up period was also recorded for each patient. Obtained data were compared between MNV types. RESULTS: Of the n-AMD cases examined in the study, 56.66% had type 1 MNV and 43.34% had type 2 MNV. The mean baseline BCVA logMAR values in eyes with type 2 MNV (1.15 ± 0.43) were higher than those observed in eyes with type 1 MNV (0.76 ± 0.42) (p = 0.001). Similarly, mean baseline CMT and CMV values in eyes with type 2 MNV were higher than those observed in eyes with type 1 MNV (respectively 424.89 ± 49.46 µm vs. 341.39 ± 37.06 µm; 9.17 ± 0.89 µm3 vs. 8.49 ± 0.53 µm3; p < 0.05). After 12 months of treatment, logMAR values of BCVA (0.86 ± 0.42) in subjects with type 2 MNV were higher than those in subjects with type 1 MNV (0.57 ± 0.37) (p = 0.001). Mean CMT and CMV values at 12th month in subjects with type 2 MNV (379.11 ± 46.36 µm and 8.66 ± 0.79 µm3, respectively) were observed to be higher than those with type 1 MNV (296.95 ± 33.96 µm and 8.01 ± 0.52 mm3, respectively) (p < 0.05). In type 2 MNVs, positive correlations were observed between both baseline and 12th month BCVA logMAR values and baseline CMV (p < 0.05). Similarly, in type 2 MNVs, a positive correlation was observed between 12th month BCVA logMAR values and 12th month CMV (p < 0.05). The total number of intravitreal anti-VEGF injections at 12 months was similar in both groups (p = 0.851). CONCLUSION: In this study, in which we performed a subtype analysis of MNV cases, we observed that the visual function was worse at the beginning and the end of the 12th month, and the CMT and CMV values were higher in the type 2 MNV group compared to the type 1 MNV cases. In addition, we found significant correlations between BCVA logMAR values and CMV values in type 2 MNV cases. In the follow-up of these cases, CMT, which is a more widely used quantitative method, and CMV, which is a newer OCT measurement parameter, may be more useful in patient follow-up and evaluation of treatment efficacy, especially for type 2 MNV cases.

The Efficacy and Safety of Trehalose in Primary Trabeculectomy with Mitomycin C: A Report of Early Findings.

OBJECTIVE: To compare bleb morphology and tear tests of glaucoma patients who used trehalose and those who did not use after primary trabeculectomy with mitomycin C (MMC) during the early post-operative period. METHODS: This retrospective study included two groups: Group 1 using Trehalose + hyaluronic acid (THA) after primary trabeculectomy with MMC (n = 19) and Group 2 undergoing primary trabeculectomy with MMC (n = 16). The preoperative and postoperative intraocular pressure (IOP), the results of Schirmer, and tear break-up time tests were analyzed. Postoperative bleb morphology was also evaluated at the 1st day, and 1st and 2nd weeks, and 1st and 2nd months. RESULTS: There was no statistically significant difference in preoperative IOP, Schirmer test or tear break-up time between groups. The mean horizontal extent of the blebs was significantly wider in Group 1 at the first week (p= 0.02). Bleb vascularization was also found to be lower in Group 1 at the second week (p= 0.001). The mean bleb height and horizontal extent were significantly higher in Group 1 at the first month (p=0.02, p= 0.03, respectively). The mean bleb horizontal extent was significantly higher in Group 1 at the second month (p= 0.03). CONCLUSION: The use of trehalose improved surgical success of primary trabeculectomy with MMC in terms of IOP control, post-operative complications, and bleb morphology during the early postoperative period. Trehalose might contribute to wound healing which led to an ideal bleb.

Evaluation of pupil responses and anterior chamber parameters in overactive bladder syndrome before and after antimuscarinic treatment.

PURPOSE: To evaluate the static and dynamic pupillometric responses and anterior chamber parameters in overactive bladder (OAB) patients before and after solifenacin succinate treatment and to compare these results with those of healthy control subjects. MATERIALS AND METHODS: Forty OAB patients who were planned to be treated with solifenacin succinate and 40 control subjects without any systemic or ocular diseases were included in the study. Following detailed ophthalmological examination, Pentacam imaging in order to detect anterior chamber angle, depth and volume; and static and dynamic pupillometry measurement in order to detect high-photopic (100 cd/m2), low-photopic (10 cd/m2), mesopic (1 cd/m2) and scotopic (0.1 cd/m2) pupil diameters, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation and velocity of pupil dilation were performed at baseline and at the first month of treatment. Data from the right eyes of the participants were used for statistical analysis. RESULTS: Baseline low- and high-photopic pupil diameters, duration of pupil contraction, latency of pupil dilatation and velocity of pupil dilatation values were significantly higher; and velocity of pupil contraction and duration of pupil dilation values were lower in the OAB group compared to the control group (P < 0.05 for all). One-month treatment with oral solifenacin succinate revealed higher scotopic and mesopic pupil diameters (P = 0.042, P = 0.031, respectively). Also, latency of pupil contraction was found to be increased and velocity of pupil dilatation was found to be decreased compared to pretreatment (P = 0.003, P < 0.001, respectively). We did not find any significant change in anterior chamber angle, depth and volume measured with Pentacam HR compared to pretreatment. CONCLUSIONS: Patients with OAB also have pupil abnormalities which probably reflect an underlying autonomic disorder that affects the bladder and pupils. One-month treatment of solifenacin succinate may lead to enlargement of pupil diameters under low illumination conditions and may lead to changes in dynamic pupillometric responses compatible with antimuscarinic treatment. Systemic antimuscarinic therapy has no effect on anterior chamber depth and intraocular pressure.

Is choroidal vascularity index a useful marker in different stages of idiopathic epiretinal membranes?

BACKGROUND: This study aims to evaluate the choroidal vascularity index in patients with idiopathic epiretinal membrane at different stages. METHODS: This prospective study included 125 eyes of 125 patients with idiopathic epiretinal membrane and 62 eyes of 62 healthy control subjects. In this study, epiretinal membrane stages were defined based on the spectral-domain optical coherence tomography staging system. The choroidal vascularity index was measured as the ratio of the luminal area to the stromal area in the central 1500 µm after binarization on enhanced depth imaging optical coherence tomography images. Data on epiretinal membrane stages, choroidal vascularity index, and best-corrected visual acuity were noted. RESULTS: Of 125 eyes with epiretinal membrane, 38 (30.4 %) had stage 1, 32 (25.6 %) had stage 2, and 55 (44 %) had stage 3 disease. Visual acuity was better in eyes with stage 1 or 2 epiretinal membrane than those with stage 3 epiretinal membrane (p < 0.001). The mean choroidal vascularity index was 2.29 ± 1.02 in the control, 2.23 ± 0.98 in the stage 1 epiretinal membrane, 2.22 ± 0.91 in the stage 2 epiretinal membrane, and 2.23 ± 1.11 in the stage 3 epiretinal membrane group. There was no significant difference between epiretinal membrane subgroups and the control group regarding the choroidal vascularity index (p = 0.81). CONCLUSION: From the results obtained in the present study, the choroidal vascularity index was not effected by either the development or the progression of idiopathic epiretinal membrane.