Pupil responses in patients with COVID-19.

AIM: To compare pupillary responses in patients with Coronavirus disease-2019 (COVID-19) during active infection and at 3rd months post-infection. METHODS: This study included 58 COVID-19 cases (mean age 47.23 ± 1.1 years). The scotopic, mesopic and photopic diameters were noted. Pupil diameters were noted at the 0, 1st, 2nd, 4th, 6th, 8th, and 10th seconds in reflex pupil dilation after the termination of a light. The average dilation speed was calculated at the 1st, 2nd, 4th, 6th, 8th, and 10th seconds. Pupil responses measured during COVID-19 infection and 3 months later were compared. RESULTS: The mean scotopic and mesopic pupil diameter value of during COVID-19 infection was found lower than the 3rd month post-infection. (p = 0.001, p = 0.023; respectively). No statistically significant difference was found in the mean photopic pupil diameter and the mean pupil diameter at 0 s between measurements (p > 0.05, p = 0.734; respectively). The mean pupil diameter was significantly lower during COVID-19 infection at the 1st, 2nd, 4th, 6th, 8th and 10th seconds (p < 0.01, for each). The average dilation speed measurements at every second measured were lower in during COVID-19 infection than the 3rd months later (p = 0.001; p < 0.01 for each). CONCLUSIONS: Pupil responses were found significantly different in COVID-19 cases when compared with the measurements taken three months later.

Corneal endothelial morphology and anterior segment parameters in children with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: To compare the corneal endothelial morphology and anterior segment parameters in type 1 diabetes mellitus children (T1DM) and healthy controls. METHODS: This cross-sectional prospective study included 56 patients with T1DM and 50 eyes of 50 age-matched controls. Endothelial morphology was analyzed with EM-3000 specular microscopy, and anterior parameters were analyzed with Sirius Scheimpflug topography. Endothelial cell density (ECD), coefficient of variation (CV) of cell area, central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), K1 and K2, pupillary diameter (PD), horizontal visible iris diameter (HVID), duration of T1DM, and HbA1c levels were noted. RESULTS: The mean age of the T1DM group was 14.3 ± 3.2 years, compared to 13.2 ± 3.7 years in the healthy group (p = 0.140). The mean duration of diabetes mellitus was 4.5 ± 3.5 years. The mean HbA1c was 9.5 ± 1.9% (minimum 6%, maximum 14%). The mean values of CCT were 556 ± 30 µm and 536 ± 36 µm in T1DM and healthy groups, respectively (p = 0.003). The mean values of ACD were 3.69 ± 0.31 mm and 3.83 ± 0.27 mm in T1DM and healthy groups, respectively (p = 0.02). The mean values of PD were 4.29 ± 1.2 mm and 5.17 ± 1.36 mm in T1DM and healthy groups, respectively (p = 0.001). There was no statistically significant difference between groups in terms of ECD, CV, ICA, K1, K2, and HVID (p > 0.05). CONCLUSION: Type 1 diabetes mellitus children have thicker corneas, shallower anterior chamber depth, and smaller pupillary diameter than healthy subjects.

The Effects of Epiretinal Membranes on the Treatment Outcomes of Dexamethasone Implants in Diabetic Macular Edema: A Real-Life Study.

Purpose: To evaluate the effects of a coexisting epiretinal membrane (ERM) on the treatment outcomes of a dexamethasone implant (DI) in diabetic macular edema (DME) patients. Methods: One hundred five eyes of 78 DME patients (44 F, 34 M; mean age: 65.7) treated with minimum 2 DIs were enrolled into this retrospective study. The study population was divided into the ERM (+) study group and the ERM (-) control group. The best corrected visual acuity (BCVA), intraocular pressure, and central macular thicknesses (CMTs) were evaluated at baseline and months 1, 2, and 3 after each DI treatment. Results: Both groups were comparable in baseline BCVA, CMT, HbA1c levels, and age. In the study group (n: 49), BCVA changed following the first DI from 0.83 to 0.76 and from 0.97 to 0.80 following the second DI. CMT decreased after the first DI from 465 to 377 µ (P < 0.001) and from 477 to 356 µ (P < 0.001) after the second DI. In the control group (n: 56), BCVA changed following the first DI from 0.81 to 0.77 and from 0.86 to 0.83 following the second DI. After the first DI, CMT decreased from 483 to 280 µ (P < 0.001) and from 468 to 301 µ (P < 0.001) after the second DI. The inter-group comparison revealed no significant difference in visual or anatomical gain (P = 0.46, P = 0.05, respectively). Conclusion: The presence of an epiretinal membrane did not change the treatment response to DI therapy.

Evaluation of photoreceptor outer segment length in hydroxychloroquine users.

OBJECTIVE: This study aims to evaluate the photoreceptor outer segment (PROS) length in patients who use hydroxychloroquine (HCQ) prior to the development of retinopathy. METHODS: In this prospective, single-centre, comparative study, 44 patients using HCQ for ≥5 years, 30 patients using HCQ <5 years, and 45 age- and sex-matched healthy controls were enrolled. The participants underwent a detailed ophthalmologic examination, spectral-domain optical coherence tomography (SD-OCT) imaging, and 10-2 automated visual field testing. The PROS length was defined as the distance between the inner surface of the ellipsoid zone and the inner surface of the retina pigment epithelium. The measurements were performed subfoveally and at 500-1000-1500 µm temporally and nasally to the foveola. RESULTS: The mean PROS length of long-term users (≥5 years) was statistically greater than the controls at all measurement points (p < 0.001 at all points). Although the subfoveal PROS length was comparable between the long-term and short-term users (p = 0.148), the parafoveal PROS length measurements (nasal 1500 µm, nasal 1000 µm, nasal 500 µm, temporal 1000 µm, and temporal 1500 µm) of the long-term users were significantly greater than those of the short-term users (p < 0.001, p = 0.002, p = 0.027, p = 0.018, p = 0.001, respectively). No significant difference was found between the short-term users and the controls (p = 0.815, p = 0.395, p = 0.093, p = 0.079, p = 0.133, p = 0.686, p = 0.341, respectively). CONCLUSION: The PROS length was greater in patients who used HCQ ≥5 years. Possible retinal pigment epithelium toxicity may have caused this finding.

Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema.

PURPOSE: This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME). METHODS: Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment. RESULTS: After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6 LogMAR and 478.2 ± 107.8 µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4 LogMAR (p = 0.005) and 313.8 ± 62.7 µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5 LogMAR and 298.4 ± 71.5 µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively). CONCLUSION: Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.

A Real-Life Study: Intravitreal Aflibercept, Ranibizumab and Dexamethasone for Macular Edema Secondary to Branch Retinal Vein Occlusion.

OBJECTIVES: This study aims to compare the efficacy of intravitreal injection of aflibercept (IVA), ranibizumab (IVR) and dexamethasone implant (DEX IMP) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: In this retrospective and comparative study, 57 eyes of 57 patients with ME after BRVO were studied. Patients were diveded into three groups according to treatment regimen as follows: 2 mg IVA (group 1, n=18), 0,5 mg IVR (group 2, n=20) and 0,7 mg Dex imp (group 3, n=19). Group 1 and group 2 were treated with three monthly anti-VEGF treatment followed by pro re nata (PRN) regimen, and group 3 was treated with 0,7 mg dexamethasone dose followed by another injection based on patients' data. Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) measurements were noted at baseline, 1, 2, 3 and 6 months. RESULTS: All groups were similar concerning age, gender, duration of symptoms, initial CMT and BCVA (p>0.05). Mean number of injections were 3,85±0.74 in group 1, 3,85±0,87 in group 2 and 1,75±0,44 in group 3. All the groups decreased CMT and increased BCVA for six months. There was not a statistically significant difference between groups. Concerning side effects, one person in group 1 and 2, four people in group 3 increased IOP, but all of them controlled IOP with anti-glaucomatous drugs. One patient in group 1, two in group 2, four in group three patients had cataract progression. CONCLUSION: All three drugs have similar results in patients with ME secondary to BRVO at a six-month follow-up. Compared to anti-VEGF drugs, dex imp has side effects as increased IOP and cataract progression, but it has higher BCVA at all months in the treatment of ME after BRVO.

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion.

AIM: To compare three initial monthly intravitreal ranibizumab (IVR) injections followed by pro re nata (PRN) dosing with one initial monthly IVR injections followed by PRN dosing for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection (1+PRN group) and 24 eyes received 3 monthly IVR injections (3+PRN). At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography (SD-OCT) was performed. Central macular thickness (CMT), the integrity of the external limiting membrane (ELM), the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment (IS/OS) defect were determined. RESULTS: At baseline the mean CMT was 521.3±153.2 µm in the 3+PRN group while it was 438.1±162.4 µm in 1+PRN group. At the final visit, mean CMT was 278.3±87.8 µm in the 3+PRN group and 285.2±74.2 µm in the 1+PRN group (P=0.079). The changes in CMT over the entire study period were also comparable in both groups (243±160 µm in the 3+PRN group, and 152.9±175.3 µm in the 1+PRN group; P=0.090). At baseline, best-corrected visual acuity (BCVA) was 0.92±0.60 logarithm of the minimal angle of resolution (logMAR) in the 3+PRN group, while it was 0.72±0.46 logMAR in the 1+PRN group. Final BCVA was 0.42±0.55 logMAR in the 3+PRN group and 0.38±0.50 logMAR in the 1+PRN group (P=0.979). Additionally, the BCVA changes from baseline to final visit were not significantly different (-0.50±0.45 logMAR in the 3+PRN group, and -0.33±0.39 logMAR in the 1+PRN group; P=0.255). CONCLUSION: No significant differences in the anatomical or functional results are found between 3+PRN and 1+PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.