Optical coherence tomography angiography findings in a case with acute posterior multifocal placoid pigment epitheliopathy.

Twenty-six-year-old male patient admitted to the outpatient clinic with a complaint of decreased vision in both eyes. Visual acuity was 2/10 in the right and 7/10 in the left eye. Fundus examination revealed bilateral yellow-white subretinal lesions involving the macula. Fluorescein angiography showed hypofluorescent lesions in early and hyperflourescent lesions in the late phase. Optical coherence tomography angiography performed in the acute phase showed bilateral hypofluorescency at the choriocapillary level. A diagnosis of acute posterior multifocal placoid pigment epitheliopathy was given. After steroid treatment, visual acuity was improved to 10/10 and earlier lesions in optical coherence tomography angiography were found to be reduced. In conclusion, optical coherence tomography angiography is a noninvasive imaging technique that can be used in the diagnosis and follow-up of acute posterior multifocal placoid pigment epitheliopathy.

Automated quantification of foveal avascular zone and vascular density in Behçet's disease.

PURPOSE: To measure the vascular density (VD) and foveal avascular zone (FAZ) area in patients with Behçet's disease (BD) obtained by optical coherence tomography angiography (OCTA). METHODS: VD and FAZ area in the deep and superficial retinal vascular networks were measured in all eyes. RESULTS: Thirty BD and 31 control subjects were included in the study. The mean overall VD measured in the entire scan was lower in BD compared with control group in both the superficial (49.52 ± 6.54 vs 53.57 ± 2.87%, respectively; p = 0.003) and deep (53.44 ± 7.44 vs 58.41 ± 3.01%, respectively; p = 0.002) areas. The FAZ in the BD group was significantly increased at the level of the superficial (0.52 ± 0.67 vs 0.28 ± 0.1 mm2, respectively; p = 0.05) and deep (0.91 ± 1.25 vs 0.39 ± 0.14 mm2, respectively; p = 0.024) areas compared with those of the control group. The deep and the superficial FAZ areas were positively correlated with disease duration and negatively with VA. CONCLUSION: In the patients with BD, OCTA showed decreased VD in both the superficial and deep retinal vascular networks. Besides, the VA was correlated with the VD and FAZ.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal vein occlusion.

BACKGROUND: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and the development of retinal vein occlusion. METHODS: One hundred and eleven patients and 88 control subjects were enrolled. Retinal vein occlusion diagnosis was clinically made with fundus examination. NLR and PLR values were compared between groups. RESULTS: Neutrophil levels were found to be comparable between the two groups (p = 0.47). Lymphocyte levels were lower in retinal vein occlusion patients (p = 0.001). NLR was significantly higher in retinal vein occlusion patients (p = 0.001). Platelet counts were found to be comparable in the two groups (p = 0.75). PLR was significantly higher in retinal vein occlusion patients (p = 0.001). According to the receiver operating characteristic curve analysis, the optimal cut-off values of NLR and PLR to predict retinal vein occlusion were > 1.63 and > 98.50, respectively. CONCLUSIONS: The present study showed that higher NLR and PLR were associated with the development of retinal vein occlusion. Also, NLR and PLR may be used as predictive tools for identifying risk for retinal vein occlusion.

YouTube as a source of information in retinopathy of prematurity.

AIM: We aimed to evaluate the quality of information available on YouTube regarding the basic information, examination, diagnosis, and the treatment of retinopathy of prematurity (ROP). METHODS: A YouTube search was performed on https://www.youtube.com / for videos pertaining to "retinopathy of prematurity" and "ROP." The first 100 relevant videos were included in the study. Two ophthalmologist reviewers independently evaluated and classified the videos as useful or misleading. The videos were accepted as "useful," if they provide scientifically correct information about any aspect of ROP: cause, pathogenesis, symptoms, findings, treatments, procedure details of the treatment, epidemiology, and prognosis. The videos contain scientifically unproven information are defined as "misleading." Videos were also classified according to the source: surgeon/practitioner, independent user, hospital/free clinic, social media/TV, medical site, university, and advertisement. RESULTS: The mean duration, the mean days on YouTube, the mean comments per videos, and the mean dislikes per video were similar in useful and misleading videos. However, the mean likes per day, mean view per video, and mean view per day were significantly higher in useful videos than those of misleading videos (p = 0.004, p = 0.022, and p = 0.011, respectively). Most of the useful videos were uploaded by healthcare professionals including source from university, hospital/free clinic, and surgeon/practitioner (48/64). The videos uploaded by healthcare professionals were more useful compared to those of non-healthcare professionals (p = 0.029). CONCLUSION: YouTube could be used as an important tool for patient information in ROP. However, one third of the YouTube videos regarding ROP are misleading and may present a risk of harmful consequences. In this aspect, authoritative videos by healthcare professionals should be uploaded for dissemination of reliable information on ROP.

Peripapillary retinal nerve fiber layer and macular ganglion cell complex thickness in patients with chronic phase of nonarteritic anterior ischemic optic neuropathy.

Objective: We aimed to investigate the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (mGCC) thickness in patients with chronic phase of nonarteritic anterior ischemic optic neuropathy (crNAION) analyzed by spectral domain optical coherence tomography (SD-OCT). Methods: Patients with crNAION, and healthy control subjects were enrolled in the study. All participants underwent SD-OCT for measurement of pRNFL, mGCC, and central macular thickness (CMT). The measurements of the eyes of the patients with crNAION were compared with those of the control subjects and unaffected fellow eyes. Results: A total of 25 patients with crNAION were eligible for the study. The control group consisted of 50 healthy subjects. The pRNFL and mGCC thickness in eyes with crNAION were found to be significantly thinner in all quadrants when compared to those of healthy control subjects and unaffected fellow eyes. The CMT of the eyes with crNAION was similar to that of the healthy control subjects. Conclusions: We demonstrated that mGCC and pRNFL thickness measurement by SD-OCT are capable of detecting axonal damage in eyes with crNAION. Furthermore, this study used SD-OCT and found that mGCC and pRNFL had the ability to detect GC loss in the eyes of the patients with crNAION.

Early detection of macular and peripapillary changes with spectralis optical coherence tomography in patients with prediabetes.

PURPOSE: To compare the retina ganglion cell complex (GCC) layer and peripapillary nerve fibre layer thickness (pRNFL) in patients with prediabetes and healthy subjects analysed by spectral domain optical coherence tomography (SD-OCT). METHODS: This cross-sectional and comparative study included prediabetic patients and healthy subjects. All participants underwent SD-OCT measurement of pRNFL thickness, and GCC thickness. RESULTS: A total of 30 eyes of the 30 patients with prediabetes and 30 eyes of 30 controls were included. The overall calculated pRNFL thicknesses were similar between the prediabetic and control subjects. The GCC thickness was significantly lower in all quadrants of the inner macula, and outer nasal quadrant in the prediabetes group when compared to the control group. CONCLUSION: Our study demonstrated that inner macular GCC thickness was significantly thinner in prediabetic subjects. As a result neurodegeneration may play role in the thinning of GCC.

Laryngohyoid Fractures in Fatal Nonhomicidal Falls From a Height.

In cases of fall from a height, the presence of laryngohyoid fracture or bleeding at autopsy constitutes a suspicion of strangulation before trauma in these types of cases. This study has aimed to investigate the incidence of laryngohyoid fractures in nonhomicidal fall from height cases, and their relationship with age, sex, height of fall, body mass index, and other injuries.A total of 170 cases proven to be nonhomicidal falls from height with certain witnesses and evidences in 4683 autopsy cases in 2013 were included in this study.The mean age of the patients included in the study was 39.96 ± 22.25, and 70.6% of the cases were men. It was found that 118 (69.4%) of the deaths were accidental and 52 (30.6%) were suicidal. Laryngohyoid fracture was determined in 9.4% of the cases. In the multivariate logistic regression analyses, it was found that as the height increased, the incidence of hyoid bone fracture increased, and as the age increased, the incidence of thyroid cartilage fracture increased significantly. Furthermore, in cases with cervical spine fractures, the incidence of hyoid bone fracture, and in cases with clavicle or cervical spine fractures, the incidence of thyroid cartilage fracture were observed to be significantly higher.When there is a suspicion in falls from height with laryngohyoid fractures, the height of fall, the age of case, and the injury in the adjacent bones contribute to the determination of the cause and manner of death.

OCTA Imaging of Choroidal Neovascular Membrane Secondary to Toxoplasma Retinochoroiditis.

Two patients (a 37-year-old man and a 28-year-old woman) who had choroidal neovascular membrane (CNVM) secondary to inactive toxoplasma retinochoroiditis scarring were evaluated. Multimodal imaging including fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA) was used. CNVM secondary to inactive toxoplasma retinochoroiditis scarring was detected. Representative images of CNVM were demonstrated in the outer retinal layer and choriocapillary layer on OCTA. OCTA, a relatively new technique, is useful in the diagnosis of the CNVMs secondary to retinochoroiditis. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:509-511.].

Variations in the Vascular Anatomy of the Right Colon and Implications for Right-Sided Colon Surgery.

BACKGROUND: Knowledge of the normal pattern and variations of the blood supply of the right colon is crucial for better outcomes after colon surgery. OBJECTIVE: The purpose of this study was to describe the precise vascular anatomy of the right colon according to surgical perspective. DESIGN: Adult fresh cadavers were dissected between January 2013 and October 2015, focusing on the venous and arterial anatomy of the right side of the colon. SETTINGS: Macroscopic anatomical dissections were performed on 111 adult fresh cadavers with emphasis on the vascular anatomy of the right colon. The colic tributaries of the superior mesenteric artery and vein were documented in writing. Furthermore, the dissections were recorded with a video camera. RESULTS: The incidence of colic arteries arising from the superior mesenteric artery included ileocolic artery, 100%; right colic artery, 33.3%; middle colic artery, 100%; and accessory middle colic artery, 11,7%. All 111 cadavers had a single ileocolic vein, which drained into the superior mesenteric vein in 103 cases (92.8%), into the gastro-pancreatico-colic trunk in 7 cases (6.3%), and into the jejunal trunk in 1 case (0.9%). The drainage site of the ileocolic vein to the superior mesenteric vein varied, and in 9% of cases the ileocolic vein did not accompany the ileocolic artery. The gastro-pancreatico-colic trunk was detected in 87 cases (78.4%); with several forms of the origin of the respective branches, the gastropancreatic trunk was detected in 24 cases (21.6), and the classic gastrocolic trunk of Henle was not detected. Variations were found in the formation and drainage routes of other venous colic tributaries of the superior mesenteric vein. LIMITATIONS: This study is limited by its use of cadavers in that it is impossible to trace each vessel to its origin in live surgery. CONCLUSIONS: Surgeons must watch, observe, and bear in mind that vascular variations can occur. Awareness of these complex variations may improve the quality of surgery and may prevent devastating complications during right-sided colon resections.

Evaluation of the Anterior Segment Parameters of the Patients with Scleroderma.

PURPOSE: To evaluate corneal parameters of scleroderma (SC) patients by Pentacam-HR. METHODS: Twenty-two eyes of 22 SC patients and 33 eyes of 33 control subjects were enrolled. All participants underwent Pentacam (Pentacam-HR, Oculus, Germany) evaluation. Both SC and control groups were divided into two subgroups as dry eye (DE) (Schirmer test with topical anesthesia (STA) ˂5 mm) and without DE (STA ˃5 mm). RESULTS: Pachymetric measurements and mean corneal volume (CV) were significantly lower in the SC group than in the control group (p<0.001). Pachymetric measurements and CV of SC patients with DE were significantly lower than all the other subgroups. Control subgroups with or without DE were similar in pachymetric measurements and CV. CONCLUSIONS: The results suggest that SC patients have thinner corneas compared with control subjects. Additionally, coexistence of DE seems to have an additional impact in the thinning of cornea in SC patients.

Retina ganglion cell/inner plexiform layer and peripapillary nerve fiber layer thickness in patients with acromegaly.

Increased secretion of growth hormone and insulin-like growth factor-1 in acromegaly has various effects on multiple organs. However, the ocular effects of acromegaly have yet to be investigated in detail. The aim of the present study was to compare retina ganglion cell/inner plexiform layer (GCIPL) and peripapillary nerve fiber layer thickness (pRNFL) between patients with acromegaly and healthy control subjects using spectral domain optical coherence tomography (SD-OCT). This cross-sectional, comparative study included 18 patients with acromegaly and 20 control subjects. All participants underwent SD-OCT to measure pRNFL (in the seven peripapillary areas), GCIPL (in the nine ETDRS areas), and central macular thickness (CMT). Visual field (VF) examinations were performed using a Humphrey field analyzer in acromegalic patients. Measurements were compared between patients with acromegaly and control subjects. A total of 33 eyes of 18 patients with acromegaly and 40 eyes of 20 control subjects met the inclusion criteria of the present study. The overall calculated average pRNFL thickness was significantly lower in patients with acromegaly than in control subjects (P = 0.01), with pRNFL thickness significantly lower in the temporal superior and temporal inferior quadrants. Contrary to our expectations, pRNFL thickness in the nasal quadrant was similar between acromegalic and control subjects. The mean overall pRNFL thickness and superonasal, nasal, inferonasal, and inferotemporal quadrant pRNFL thicknesses were found to correlate with the mean deviation (MD) according to Spearman's correlation. However, other quadrants were not correlated with VF sensitivity. No significant difference in CMT values was observed (P = 0.6). GCIPL thickness was significantly lower in all quadrants of the inner and outer macula, except for central and inferior outer quadrants, in the acromegaly group than that in the control group (P < 0.05). GCIPL thicknesses of the inferior inner and outer macula quadrants were found to correlate with MD, whereas no correlation was observed between other quadrants and VF sensitivity. We demonstrated that GCIPL thickness decreased in patients with acromegaly compared with that in control subjects. However, the nasal quadrant pRNFL thickness was similar in acromegaly, in contrast to our expectations. SD-OCT may have utility in the assessment of the effects of acromegaly on retinal structures.

The effects of delivery type and gender on intraocular pressure and central corneal thickness in newborns.

PURPOSE: To analyze intraocular pressure (IOP) and central corneal thickness (CCT) in newborns during the first 12 h of life. METHODS: Forty-three newborns born by vaginal delivery (VD) and 30 newborns born by cesarean section (CS) were evaluated. IOP and CCT were measured using Tono-Pen and handheld pachymeter, respectively, at both the 5th minute after delivery and at the 12th h of life. RESULTS: The mean IOP for the VD group was significantly higher than that of the CS group at both the 5th minute and 12th h (p =0.042 and p =0.018, respectively). In both groups, the IOP decreased by the 12th h, but the decrease was only significant for the CS group (p =0.020). The decrease in CCT over the 12 h was significant for both groups (p <0.001). In the VD and CS groups, the IOP values of the males were significantly higher than those of the females at the fifth minute only (p =0.024 and p =0.043, respectively). No other values were significantly different between the genders. CONCLUSIONS: Newborn IOP is affected by the mode of delivery and gender. A higher IOP was found in vaginally delivered newborns than in CS newborns for at least 12 h postpartum. CCT showed a significant decline within 12 h. Male newborns have significantly higher IOP values in the first minutes of life.

Mean Platelet Volume in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy.

Objective. We aimed to investigate the mean platelet volume (MPV) of the patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods. The medical records of 46 patients with the diagnosis of NAION and 90 control subjects were retrospectively evaluated. All participants underwent complete ocular examination including intraocular pressure (IOP) measurement. Hematocrit, MPV, hemoglobin, and platelet levels of the patients with NAION were compared with those of control subjects. Results. There was no significant difference between the groups in platelet counts (p = 0.76). NAION group had significantly higher MPV values (8.25 ± 1.26 fL) than that of control subjects (7.64 ± 1.01 fL) (p < 0.001). Multivariate logistic regression analysis showed that MPV is an independent predictor of NAION (odds ratio = 1.61; 95% confidence interval (CI) = 1.13-2.28; p = 0.007). The mean IOP was significantly higher in NAION group (p < 0.001). IOP was also found as an independent predictor of NAION according to the regression analysis (OR = 1.27; 95% CI = 1.08-1.48; p = 0.003). Conclusion. Our results demonstrated that the MPV values were significantly higher in NAION patients, suggesting that larger platelets may contribute to the pathogenesis of the NAION.

Mean platelet volume in patients with retinal artery occlusion.

PURPOSE: The aim of this study was to investigate the mean platelet volume (MPV) of patients with retinal artery occlusion (RAO). METHODS: Thirty-seven patients diagnosed with RAO and 32 control subjects were included in this retrospective study. Retinal artery occlusion was diagnosed on the basis of clinical examination and fundus fluorescein angiography. All participants underwent complete ocular examination, and MPV, hematocrit, hemoglobin, and platelet counts were recorded. RAO patient data were compared with those of the control subjects. RESULTS: Patients with RAO had significantly higher MPV values (7.96 ± 1.2 fL) compared with control subjects (7.33 ± 0.7 fL, p<0.001). No significant difference was found with regard to platelet count between the RAO group and the control group (262 ± 70.1 × 109/L and 251 ± 56.6 × 109/L, respectively, p=0.50). MPV was an independent predictor of RAO [odds ratio (OR)=0.50; 95% confidence interval (CI)=0.28-0.89; p=0.019). CONCLUSIONS: Our results demonstrated that MPV values were significantly higher in patients with RAO, suggesting that larger platelets may contribute to the pathogenesis of the RAOs.