Evaluation of Dry Eye Disease Characteristics of Children With Type 1 and Type 2 Diabetes Mellitus and MODY.

PURPOSE: To assess dry eye disease characteristics of pediatric patients with diabetes. METHODS: Twenty-one patients with type-1 diabetes mellitus (DM), 20 with type-2 DM, 19 with maturity-onset diabetes of the young (MODY), and 20 control participants were included in the study. Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test with anesthesia, and conjunctival impression cytologic analysis were performed. RESULTS: In Group 1, the Schirmer test and TBUT values were lower than the control group. In groups 1 to 3, OSDI scores were higher than the control group. In Groups 1 and 2, the goblet cell density was lower than the control group. CONCLUSIONS: Dry eye parameters of all three diabetic groups were adversely affected in favor of dry eye disease. Children with MODY have increased OSDI scores. Alterations in the conjunctival impression cytology were observed more prominently in patients with type-1 DM.

A Shift of the Pupillary Balance Towards the Parasymphathetic System in Migraine Patients with Aura.

Introduction: To analyze the static and dynamic pupillometrics in migraine patients with aura and compare these parameters to those in age- and sex-matched healthy participants. Methods: This cross-sectional study included 34 patients with migraine and 37 healthy participants as a control group. The static pupillometrics consisted of scotopic pupil diameter (PD), mesopic PD, and low and high photopic PD. The dynamic pupillometrics were as follows: the initial diameter, 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. All participants were evaluated during a headache-free period. An automatic quantitative infrared pupillometry system was used to examine the pupillary characteristics of the eyes. Results: The static and dynamic pupillary parameters except the latency of pupil contraction did not significantly differ between the migraine patients during an attack-free period and the healthy participants. The latency of pupil contraction was significantly statistically lower in migraine group than healthy subjects. Also, the scotopic PD differed significantly in the inter-eye comparison within migraine patients (p<0.05). Conclusion: A significant inter-eye difference in scotopic PD values and the lower latency of pupil contraction in migraine patients with aura in the headache-free period might be attributed to a shift of the pupillary balance towards the parasymphathetic system.

Corneal Biomechanical Properties in Childhood Obesity.

PURPOSE: To investigate corneal biomechanical properties in patients with childhood obesity. METHODS: The study included 47 patients with childhood obesity (study group) and 39 healthy patients (control group). Corneal hysteresis, corneal resistance factor, corneal compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Ocular Response Analyzer (Reichert, Ophthalmic Instruments, Buffalo, NY) in each eye. Central corneal thickness (CCT), anterior chamber angle (ACA), anterior chamber volume (ACV), and anterior chamber depth (ACD) measurements were obtained by the Pentacam rotating Scheimpflug camera (Oculus Optikgeräte GmBh, Wetzlar, Germany). RESULTS: The mean corneal hysteresis was 10.56 ± 1.52 mm Hg in the study group and 11.16 ± 1.92 mm Hg in the control group (P = .022). The mean IOP was 14.9 ± 2.0 mm Hg in the study group and 14.1 ± 1.3 mm Hg in the control group (P = .003). Corneal hysteresis showed a significant, positive correlation with corneal resistance factor (P < .001, r = 0.851), IOPg (P = .044, r = 0.213), CCT (P < .001, r = 0.477), and IOP (P = .005, r = 0.295). Corneal hysteresis showed a significant, negative correlation with IOPcc (P = .001, r = -0.355), ACA (P = .005, r = -0.294), ACV (P = .019, r = -0.246), and ACD (P = .046, r = -0.211). CONCLUSIONS: Patients with childhood obesity have lower corneal hysteresis and higher IOPcc measurements when compared with healthy patients. Corneal tissue changes may occur in early life in childhood obesity, which could lead to ocular disease in the future. [J Pediatr Ophthalmol Strabismus. 2020;57(2):103-107.].

The Efficacy of Single-Dose Intravitreal Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-VEGF Therapy: Real-Life Results.

OBJECTIVES: To investigate the efficacy, safety, and side effect profiles of a single-dose intravitreal dexamethasone implant (IDI, Ozurdex) in patients with diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. METHODS: This study included 101 eyes of 78 diabetic patients with DME that remained persistent despite administering at least six doses of anti-VEGF therapy. The patients were evaluated at baseline and were followed up monthly until the sixth month after the IDI injection. The primary outcomes were central foveal thickness (CFT) and best-corrected visual acuity (BCVA). RESULTS: The mean number of anti-VEGF injection administered to patients was 6.50±0.33. One month after the last injection, the response to treatment was evaluated. IDI injection was performed approximately 1.14±0.08 months after the last anti-VEGF injection. After the IDI injection, BCVA value increased (p<0.001) and CFT value decreased (p<0.001). The peak effect of the IDI was observed in the second month after the injection. CFT values increased and BCVA values decreased from the beginning of the fourth month after the IDI injection. The recurrence rate of CFT elevation in the sixth-month follow-up was 57.4%. Moreover, we observed that high pre-injection CFT values were correlated with a high post-injection recurrence rate of CFT elevation (p<0.001). CONCLUSION: These findings suggest that the IDI injection significantly improves BCVA and CFT values in patients with DME refractory to anti-VEGF therapy. However, recurrence of CFT elevation may occur in >50% patients in the sixth month after the first injection.

Pattern electroretinography in patients with unilateral acute central serous chorioretinopathy.

BACKGROUND: To evaluate the pattern electroretinography (PERG) in patients with acute central serous chorioretinopathy (CSCR) at baseline and after spontaneous resolution. METHODS: A total of 32 patients (mean ± SD age: 38.8 ± 8.2 years, 71.9 per cent female) with unilateral acute CSCR and spontaneous resolution during follow-up period were included. The unaffected eyes of the study patients comprised the control group. The best-corrected visual acuity, PERG and optical coherence tomography findings were recorded both at baseline and following spontaneous resolution at two to four months. RESULTS: The P50 and N95 amplitudes of the affected eyes were significantly lower than the control group both at baseline and after CSCR resolution (p < 0.001 for each). A significant increase was noted in both P50 and N95 amplitudes of the affected eyes from baseline to post-resolution (p < 0.001 for each). Subfoveal choroidal thickness was significantly higher in the affected eyes as compared with control eyes both at the baseline and after CSCR resolution along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001 for each). The central retinal thickness was higher in the affected eyes as compared with the control eyes at baseline (p = 0.009), along with a significant decrease in the affected eyes from baseline to post-resolution (p < 0.001). Between the baseline P50 amplitude and the visual acuities of the affected eyes, a strong correlation was noted at baseline (r = -0.691, p < 0.001) and a moderate correlation was noted after CSCR resolution (r = -0.422, p = 0.031). CONCLUSIONS: In conclusion, our findings revealed an association of CSCR with impaired P50 and N95 amplitudes and a significant improvement but not a complete recovery in both parameters after CSCR resolution. Our findings emphasise potential utility of PERG in the electrophysiological evaluation of functional impairment in CSCR patients and the likelihood of P50 amplitude to have a prognostic value in CSCR.

Clinical significance of ectopic inner foveal layers in patients with idiopathic epiretinal membranes.

BACKGROUND/OBJECTIVES: To evaluate the relationship between the presence of ectopic inner foveal layers (EIFL), choroidal thickness, and visual acuity (VA) in patients with epiretinal membranes (ERM) staged by spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS: A total of 242 eyes of 121 patients with unilateral idiopathic ERM were prospectively evaluated. ERM stages were defined based on the SD-OCT staging system as stage 1: negligible morphological or anatomical disruption, retinal layers, and foveal pit are identified; stage 2: characteristic stretching of the outer nuclear layer, absence of foveal depression, retinal layers are identified; stage 3: continuous EIFL crossing the central foveal area, absence of foveal depression, retinal layers are identified; and stage 4: anatomical disruption of the fovea, continuous EIFL crossing the entire foveal area, retinal layers are distorted. RESULTS: Of 121 eyes with ERM, 23.1% had stage 1, 26.5% had stage 2, 39.7% had stage 3, and 10.7% had stage 4 disease. VA was better in eyes with stage 1 or 2 ERM than stage 3 or 4 ERM (p < 0.001). VA in logMAR was positively correlated with central foveal thickness (r = 0.557, p < 0.001) and EIFL thickness (r = 0.526, p < 0.001), but not with an outer nuclear layer thickness (r = 0.233, p = 0.123). In multivariate analysis, the presence of EIFL was an independent predictor of VA in eyes with ERM (p < 0.001). The presence and stage of ERM did not have a significant effect on choroidal thickness (p > 0.05). CONCLUSIONS: The SD-OCT staging system according to the presence of EIFL is effective for grading retinal damage and visual loss in eyes with ERM.

The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario.

Purpose: This study evaluated the effect of intravitreal dexamethasone implant (IDI; Ozurdex) injection for treating macular edema in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Methods: This prospective study included 40 eyes of 40 patients with nonischemic BRVO and 31 eyes of 31 patients with nonischemic CRVO who received IDI injection as the first-line treatment for macular edema. The best-corrected visual acuity (BCVA) value before and after the treatment; intraocular pressure; optic coherence tomography findings; and all ocular examination findings, including central foveal thickness (CFT) measurement and fluorescein angiography findings, were evaluated for each patient. Results: After the IDI injection, BCVA value increased (P < 0.001) and CFT value decreased (P < 0.001) in both groups. The recurrence rates of CFT elevation after the first and the second Ozurdex injections were 65.0% and 65.3%, respectively, in patients with BRVO and 70.9% and 68.1%, respectively, in patients with CRVO. A statistically significant correlation was observed between preinjection CFT value and postinjection recurrence of CFT elevation (P = 0.017). Conclusion: Treatment with the IDI injections resulted in significant short-term improvement in CFT and BCVA values in patients with clinically significant RVO-related macular edema. Moreover, we observed that high preinjection CFT value was associated with a risk of postinjection recurrence of CFT elevation.