Choroidal and macular thickness changes in type 1 diabetes mellitus patients without diabetic retinopathy.

OBJECTIVES: To explore choroidal thickness (ChT) and retinal thickness (RT) changes in patients with type 1 diabetes mellitus (DM). METHODS: Sixty patients with Type 1 DM and 60 age- and sex-matched healthy controls were included in this prospective case-control clinical study. All patients underwent a complete ophthalmological examination. ChT of each participant was measured at the fovea and horizontal nasal and temporal quadrants at 500-µm intervals to 1500 µm from the foveola using spectral-domain optical coherence tomography (SD-OCT). Age, gender, disease duration, serum glycosylated hemoglobin (HbA1c), fasting glucose level, axial length (AL) and refractive error were noted and analyzed. RESULTS: Mean disease duration, mean HbA1c and mean fasting blood glucose in diabetic patients were 6.1±2.8 years, (8.9±0.9)% and 287.5±69.1 mg/dl, respectively. Age, gender, AL, spherical equivalent differences between the patients and subjects were insignificant (p>0.05). Subfoveal ChT, nasal quadrant ChT measurements, temporal 1500 µm and mean nasal ChT were significantly lower in diabetic patients (p<0.05 for all). Temporal 500 µm and 1000 µm ChT measurements, mean temporal ChT, average ChT, central macular thickness and average macular thickness did not differ significantly between the groups (p>0.05 for all). CONCLUSION: This study showed that there is choroidal thinning in young Type 1 diabetic patients with early period of disease duration without diabetic retinopathy nor any other systemic diseases. Choroidal changes in type 1 DM seem to begin at nasal and distal temporal retina. These results need to be verified by larger and longitudinal studies.

Delayed visual loss due to radiation retinopathy.

Radiation retinopathy remains a devastating cause of visual morbidity in patients undergoing radiation for globe, orbit, and head and neck malignancies. A 65-year-old female was admitted with the complaint of low vision in the right eye for two months. Best corrected visual acuity was 20/32 in the right eye and 20/25 in the left eye. Slit lamp examination was normal in both eyes. Fundoscopic examination revealed perifoveolar hard exudates, paramacular microhemorrhages, telangiectasias, and macular degeneration in both eyes. Fundus florescein angiography showed enlargement of the foveal avascular zone, perifoveal capillary telangiectasia, and widespread venous beading bilaterally. Optical coherence tomography revealed bilateral cystoid macular edema. The prediagnosis of diabetic retinopathy was not confirmed because of the absence of diabetes mellitus after endocrinologic evaluation. Detailed medical history explored external beam radiotherapy to the head and neck region for nasopharyngeal cancer 10 years ago. The ultimate diagnosis was radiation retinopathy.

Retinal structural changes in systemic arterial hypertension: an OCT study.

PURPOSE: To assess retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and macular thickness changes in young adults with systemic arterial hypertension. METHODS: This study included 80 young patients (age 23.8 ± 2.8 years) with systemic hypertension (sHT) without any known systemic or ocular disease and 80 age-matched (23.5 ± 2.1 years) healthy controls. Retinal nerve fiber layer thickness, macular thickness, and GCC thickness were measured with spectral-domain optical coherence tomography. RESULTS: Mean disease duration was 3.45 ± 1.48 years (range 2-10). Differences in intraocular pressure, body mass index, axial length, and spherical equivalent between the groups were insignificant (p>0.05). The differences in RNFL thickness did not differ between the groups. Patients with sHT had significantly lower central macular thickness (p = 0.037), inner superior macular thickness (p = 0.045), and outer temporal superior and outer temporal inferior GCC (p<0.001 for both). The RNFL thickness did not differ significantly in all quadrants between the groups (p>0.05). Systolic and diastolic blood pressure were significantly correlated with inner temporal superior and inner temporal inferior GCC thickness in a negative manner (p<0.05 for all). CONCLUSIONS: Ganglion cell complex thickness decrease is possibly a better retinal marker for hypertensive changes with respect to RNFL and macular thickness.

Early Neurodegeneration of the Inner Retinal Layers in Type 1 Diabetes Mellitus.

PURPOSE: This study explores retinal structural changes in type 1 diabetes without clinically diagnosed diabetic retinopathy (DR). METHODS: Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, and macular thickness (MT) were measured in 90 type 1 diabetic patients by using spectral domain optical coherence tomography. The values were compared with 100 sex- and age-matched healthy controls. The independent t test was used to assess differences in the mean age, mean diabetic and ocular parameters, and the thickness values between the diabetic and control groups. Multiple linear regression analysis was performed to investigate the correlation between the thickness values and diabetic and ocular parameters. RESULTS: Whole-RNFL, the superior and inferior quadrants, and the superior half of the peripapillary RNFL thicknesses were significantly thinner in diabetic patients compared with controls (p < 0.05). GCC thicknesses in the average macular, outer temporal superior and outer temporal inferior sectors were significantly thinner in diabetic patients (p < 0.05). Central and average MTs were similar in both groups (p > 0.05). There were significant negative correlations of the duration of type 1 diabetes with the inner nasal MT, inner temporal superior GCC thickness, inner nasal inferior GCC thickness, and outer nasal superior GCC thickness (p < 0.05). Similarly, there were significant negative correlations of the level of HbA1c with the whole-RNFL thickness, superior-half-RNFL thickness, and superior-quadrant-RNFL thickness (p < 0.05). CONCLUSIONS: Type 1 diabetic patients without clinically diagnosed DR had neurodegeneration in the inner retinal layers compared with healthy controls.

Choroidal Thickness Changes in the Acute Attack Period in Patients with Familial Mediterranean Fever.

PURPOSE: The aim of this study was to evaluate choroidal thickness changes during acute attacks of familial Mediterranean fever (FMF). METHODS: Fifty patients with FMF and 50 healthy controls were included. Choroidal thickness of each participant was measured at the foveola and horizontal nasal and temporal quadrants at 500-µm intervals to 1,500 µm from the foveola using spectral-domain optical coherence tomography. White blood cell count, erythrocyte sedimentation rate (ESR) and serum levels of fibrinogen and C-reactive protein (CRP) were evaluated. The clinical findings (peritonitis, arthritis and pleuritis) were noted. RESULTS: Choroidal thickness was significantly thicker at all measurement points in FMF patients compared to healthy controls during an acute attack (p < 0.05). There were positive correlations between the choroidal thickness and ESR, fibrinogen and, particularly, CRP levels. Clinical findings did not change the choroidal thickness significantly (p > 0.05). CONCLUSIONS: Increased choroidal thickness in the acute phase of FMF is possibly related to the inflammatory edematous changes in the choroid.

Choroidal thickness in systemic arterial hypertension.

PURPOSE: To assess choroidal thickness changes in young adults with systemic arterial hypertension. METHODS: This prospective study comprised 80 hypertensive patients and 80 healthy control subjects. Choroidal thickness was measured with spectral-domain optical coherence tomography (SD-OCT) (RS-3000, Nidek). Choroidal thickness was obtained at the subfovea, 500 µm, 1000 µm, and 1500 µm nasal to the fovea (N500, N1000, N1500) and 500 µm, 1000 µm, and 1500 µm temporal to the fovea (T500, T1000, T1500). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured with a mercury sphygmomanometer. Only the right eye values were used for statistical comparisons between the groups. RESULTS: Mean age was 23.8 ± 2.8 years in hypertensive subjects and 23.5 ± 2.1 years in the control group (p = 0.945). All choroidal thickness measurements (mean choroidal thickness, subfoveal choroidal thickness, all nasal and all temporal choroidal thicknesses) were significantly lower in hypertensive subjects (p<0.001 for subfoveal, N500, T500, T1000, T1500; p = 0.001 for N1000; and p = 0.012 for N1500). The correlations between choroidal thickness measurements and blood pressure (SBP, DBP, MAP) were insignificant (p>0.05 for all correlations). Choroidal thickness measurements were also insignificantly correlated with disease duration (p>0.05 for all correlations). CONCLUSIONS: The results of this study demonstrated that choroidal thickness decreases in patients with systemic arterial hypertension. This may be caused by arteriolar sclerosis and vascular contraction caused by high intravascular pressure in the choroid.

Long-term Choroidal Thickness Changes After Acute Solar Retinopathy.

BACKGROUND AND OBJECTIVE: To identify long-term changes in choroidal thickness after solar retinopathy. PATIENTS AND METHODS: The study included 25 eyes of 25 men with acute solar retinopathy. Ocular examination, best corrected visual acuity (BCVA), and retinal and choroidal thickness measurements obtained using spectral-domain optical coherence tomography were evaluated. RESULTS: The mean follow-up was 6.1 ± 0.4 months. The initial BCVA decreased in the affected eyes (P < .001). The mean BCVA (logMAR) improved significantly from 0.16 ± 0.06 to 0.03 ± 0.05 at 6 months (P < .001). There were no significant differences in the initial retinal and choroidal thicknesses between the affected and other eyes, while there was a significant decrease in the mean macular thickness and mean macular volume at 1 month and the mean choroidal thickness increased (P < .001). CONCLUSION: Significant retinal and choroidal thickness changes occurred after solar retinopathy. The changes in choroidal thickness suggest that the effects of solar retinopathy might not be limited to the retina.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results.

PURPOSE: The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR). METHODS: Seventy patients (70 eyes) who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. RESULTS: At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05). CONCLUSIONS: This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results.

Diode laser-assisted transcanalicular dacryocystorhinostomy: the effect of age on the results / Dacriocistorrinostomia transcanalicular auxiliada por laser de diodo: o efeito da idade sobre os resultados

ABSTRACT Purpose: The aim of this study was to explore the effect of age on the success of transcanalicular diode laser-assisted dacryocystorhinostomy (TCDCR). Methods: Seventy patients (70 eyes) who underwent transcanalicular diode laser-assisted dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction as a primary surgery were included in this retrospective, nonrandomized study. The patients were divided into two groups according to age. Mean ages were 21.3 ± 3.3 in group 1 and 60.3 ± 7.3 in group 2. The records of the 3-, 6-, and 12-month follow-up examinations were evaluated, and the anatomical and functional outcomes were noted. Functional success was defined as the absence of epiphora as indicated by the patient. Anatomical success was determined as patency of the neo-ostium with irrigation. Results: At the 3-month follow-up, 67% cases in group 1 showed anatomical success and 52% showed functional success; in group 2, the rates were 100% and 92%, respectively. Functional and anatomical success rates were the same for both the 6- and 12-month visits; 46% in group 1 and 76% in group 2. The results in group 2 were significantly better at all three follow-up visits (p<0.05). Conclusions: This study clearly showed that the older patients experienced better transcanalicular diode laser-assisted dacryocystorhinostomy results than the younger patients. The diminished inflammatory response in the older population may be a possible contributing factor to these results. .

RESUMO Objetivo: O objetivo deste estudo foi explorar o efeito da idade sobre o sucesso de dacriocistorrinostomia transcanalicular auxiliada por laser de diodo (TCDCR). Método: Setenta olhos de setenta pacientes submetidos dacriocistorrinostomia transcanalicular auxiliada por laser de diodo para o tratamento da obstrução nasolacrimal como cirurgia primária foram incluídos neste estudo retrospectivo, não randomizado. Os pacientes foram divididos em dois grupos segundo a idade. As idades médias foram 21,3 ± 3,3 no grupo 1 e 60,3 ± 7,3 no grupo 2. Os registros do acompanhamento pós-operatório aos três, seis e 12 meses, foram avaliados, observando resultados anatômicos e funcionais. Sucesso funcional foi definido como a ausência de lacrimejamento, conforme informado pelo paciente. Sucesso anatômico foi determinado como a permeabilidade do novo óstio à irrigação. Resultados: Nos três meses de acompanhamento, 67% dos casos no grupo 1 apresentou sucesso anatômico, e 52% mostraram sucesso funcional. No grupo 2, as taxas foram de 100% e 92%, respectivamente. Taxas de sucesso funcionais e anatômicas foram as mesmas para ambos os seis e 12 meses de visitas: 46% no grupo 1 e 76% no grupo 2. Os resultados do grupo 2 foram significativamente melhores em todas as três visitas pós-operatorias (p<0,05). Conclusões: Este estudo mostra claramente que os pacientes mais idosos apresentam melhores resultados à dacriocistorrinostomia transcanalicular auxiliada por laser de diodo comparados aos mais jovens. A resposta inflamatória diminuída na população mais velha é um possível fator que contribuiu para estes resultados. .

Corneal pathology in microphthalmia with linear skin defects syndrome.

PURPOSE: To describe the histopathology of the cornea in microphthalmia with linear streaks (MLS) syndrome. METHODS: Two patients with MLS syndrome underwent penetrating keratoplasty. This study describes the histopathology and investigates immunophenotype of the corneal extracellular matrix by using keratan sulfate and collagen type III antibodies. RESULTS: Clinical examination revealed bilateral sclerocornea and characteristic skin changes. By light microscopy, central corneal stroma in both patients showed vascularization and irregular thick collagen lamellae typical of sclerocornea. In addition, corneal thinning, anterior synechiae, and the absence of the Descemet membrane were noted, which was suggestive of Peters anomaly. Diffuse and intense anti-keratan sulfate staining and minimal anti-collagen type III stromal staining were seen in both corneal buttons. CONCLUSIONS: The cornea in MLS may clinically resemble sclerocornea. Histologic features resemble those previously described in sclerocornea and also seen in anterior segment dysgeneses. Keratan sulfate and collagen type III labeling suggests that the corneal extracellular matrix resembled cornea and not sclera.

Bimatoprost-induced periocular skin hyperpigmentation: histopathological study.

OBJECTIVE: To investigate light microscopic and ultrastructural changes in bimatoprost-induced skin hyperpigmentation. METHODS: Eyelid biopsy specimens from bimatoprost-treated patients and matched controls were examined by light microscopy and transmission electron microscopy. Using an image analyzer, melanin granules were counted on Fontana-Masson-stained sections, and melanosomes were counted on electron micrographs. Immunohistochemical analysis was performed with antibodies against S100 and CD3. Positively labeled cells were counted. RESULTS: By light microscopy, a marked increase in the number of melanin granules was noted in the bimatoprost-treated specimens. Electron microscopy demonstrated dermal melanocytes with prominent rough endoplasmic reticulum and abundant normal-sized melanosomes in different stages of maturation as compared with control specimens. Furthermore, the keratinocytes of the bimatoprost-treated specimens showed abundant mature melanosomes when compared with controls. Also of note, atypical melanocytes were absent in both specimens. The S100-positive melanocytes were comparable in bimatoprost-treated and control specimens. Few CD3- and CD68-positive cells in the bimatoprost-treated specimens were noted in both groups. CONCLUSION: Bimatoprost-induced periocular hyperpigmentation is caused by increased melanogenesis. There was no evidence of melanocyte proliferation or prostaglandin-induced inflammation in the specimens that were examined.

Femtosecond laser photodisruption of human trabecular meshwork: an in vitro study.

The goal of this in vitro study was to test the feasibility of using femtosecond (fsec) laser pulses to fistulize the human trabecular meshwork (TM), and to determine the minimum exposure time and energy dosage needed to create an ablation channel. Corneo-scleral rims were obtained from tissue used for penetrating keratoplasty. Four millimeter tissue strips hydrated in Optisol-GS were used to create partial thickness fistulas in the human TM by focusing a Ti:Sapphire laser beam (45 fsec, 1 kHz, 800 nm) with various pulse energies (7.2 and 14.4 microJ) and exposure times (0.25, 0.5, 1, and 2 sec) on the inner surface of the TM. Two-photon images of the lesions were obtained with a multiphoton microscope, using an ultrafast Ti:Sapphire light source. In addition, sections of fixed tissue were examined by light microscopy. Diameters and lengths of the lesions were determined from the hematoxylin and eosin (H&E) stained sections, and the collagen structure surrounding the lesion was evaluated from the two-photon images. All selected time points (except for 0.25 sec) and energies achieved the desired photodisruption of the TM. Incisions created with 0.5 sec/14.4 microJ irradiation appeared to be the most suitable because they were able to achieve consistent full thickness trabecular ablation. Incisions created at 1 sec /14.4 microJ/pulse and 2 sec/14.4 microJ/pulse were deeper than those at shorter time points with the same pulse energy. Longer exposure times and higher pulse energies were usually more variable and associated with deeper and larger incisions and slight collateral damage. Our results indicate that, with appropriate exposure time and pulse energy, fsec photodisruption can be employed to create lesions in the human TM without damaging the surrounding tissues. This study demonstrates that fsec laser treatments may have future potential for the surgical treatment of glaucoma.

The efficacy of hyperbaric oxygen for the treatment of experimental uveitis induced in rabbits.

OBJECTIVE: The aim of the present study was to examine the efficacy of hyperbaric oxygen (HBO) therapy in the treatment of experimental uveitis induced in rabbits. It was hypothesized that HBO therapy improves the regression of experimental uveitis induced in rabbits. RESEARCH DESIGN AND METHODS: An experimental animal study was conducted on 48 rabbits (48 right eyes of these rabbits) to evaluate the effects of HBO therapy on endotoxin-induced acute anterior uveitis in rabbits. To induce acute anterior uveitis, Salmonella typhimurium lipopolysaccharide endotoxin (LPS) was intravitreally injected into the right eyes of the rabbits. The animals were randomly assigned to five groups. No treatment was given to the rabbits in Group A. Prednisolone acetate was topically administered to the rabbits in Group B. Methylprednisolone acetate was administered by anterior subtenon injection to the rabbits in Group C four hours after LPS application. HBO therapy was administered to the rabbits in Group D. Both HBO therapy and anterior subtenon injection of methylprednisolone therapy were administered to the rabbits in Group E. To compare the effects of the different therapies on the progression of endotoxin-induced uveitis, examinations including clinical scoring of anterior uveitis, microscopic examination of aspirated aqueous humor for inflammatory responses, and aqueous protein level assessment were performed once a day after LPS injection. RESULTS: There was a statistically significant difference between the control group (Group A) and other groups (Groups B-E) with respect to the number of inflammatory cells and protein levels in the aqueous one and three days after LPS injection (p < 0.05), indicating that the treatments resulted in less inflammation in Groups B-E compared to Group A. Moreover, there was no statistically significant difference between Groups B and C, Groups B and D, Groups B and E, Groups C and D, and Groups C and E with regard to the number of inflammatory cells in the aqueous at Day 1 after LPS injection (p > 0.05). In addition, Groups B and C and Groups B and D were comparable with regard to cell counts at Day 3 (p > 0.05), showing that HBO was comparable to corticosteroids in reducing inflammation. The differences between Groups B and E and Groups C and E were significant with regard to aqueous cell counts at Day 3 (p < 0.05), showing that HBO plus steroid was more effective than steroids alone. CONCLUSION: The intensity of ocular inflammation in the group receiving HBO therapy combined with anterior subtenon injection of methylprednisolone therapy was lower than in the other groups. We also demonstrated that HBO therapy was an effective therapeutic modality for the treatment of experimental uveitis induced in rabbits with an efficacy comparable to that of corticosteroids. Moreover, HBO plus steroid was superior to steroids alone in reducing inflammation.