Comparison of postoperative morphological changes and retinal displacement in diabetic and idiopathic epiretinal membranes.

PURPOSE: To compare the postoperative retinal displacement by optical coherence tomography (OCT) in idiopathic epiretinal membranes (iERM) and diabetic epiretinal membranes (dERM). METHODS: This retrospective study included 36 iERM and 22 dERM cases. In cross-sectional OCT images (B-scan) the presence of foveal pit, subfoveal fluid, cotton ball sign (CBS), intraretinal cystic changes (ICC), disorganization of retinal inner layers (DRILs) and ectopic inner foveal layer (EIFL) were recorded. Central macular thickness (CMT) and EIFL thicknesses were calculated. Retinal displacement was quantified using infrared image of OCT approach consisting of the fovea to disc margin, interarcade distance and perimacular distances. RESULTS: The presence of subfoveal fluid (p = 0.014) and DRIL (p = 0.02) was significantly higher in the dERM group. CMT decreased significantly in both groups (p˂0.001). The EIFL was significantly thicker in the iERM group compared to the dERM group (p = 0.049), and it decreased significantly in the iERM group postoperatively. In the iERM group, while the fovea-disc margin distance decreased, the interarcade and perimacular distance increased significantly (p˂0.001). In the dERM group, the disc-fovea distance change was not significant (p = 0.082). Significant visual improvement was achieved with vitrectomy in both groups (p˂0.001). In the dERM group, the presence of DRIL was associated with lower pre and post-op visual acuity (VA) (r = 0.596 and p = 0.004 for pre-operative and r = 0.567 and p = 0.007 for post-operative). CONCLUSION: Significant retinal displacement occurs after vitrectomy in both iERM and dERM. The low VA in the dERM group may be related to the presence of DRILs.

The Short-Term Effect of 1% Tropicamide Drop on Pupillary Diameter and Intraocular Pressure Change in Patients With Pseudoexfoliation Material.

PRCIS: In this study, in patients with pseudoexfoliation syndrome (PXS) or glaucoma, changes in intraocular pressure (IOP) and pupil size after 1% tropicamide used for pupil dilation, compared with healthy patients were quantitatively demonstrated up to 4 hours after dilation. PURPOSE: The purpose of this study was to evaluate pharmacological dilatation with one drop of 1% tropicamide on pupillary diameter and IOP changes in patients with PXS and glaucoma (PXG). MATERIALS AND METHODS: Eighty-two patients with PXS, 78 Patients with PXG, and 35 healthy subjects were included in the study. PXG and PXS were diagnosed based on IOP assessment, corneal pachymetry, optic disc examination, visual field testing, and peripapillary retinal nerve fiber analysis. IOP and the diameter of pupil size were measured before dilatation and at postdilatation first, second, and fourth hours. RESULTS: The mean pupillary diameter values at postdilatation second and fourth hours were statistically significantly different between the patients with PXS and PXG ( P <0.001, for each). Also, there were significant differences between the PXS group and the control group in terms of the mean pupillary diameter values at predilatation and postdilatation at the first hour and postdilatation second hour ( P =0.007, <0.001, respectively). The mean pupillary diameter at all times was statistically significantly different between PXG and control groups ( P <0.001 for each). Significant IOP increases were observed in all groups after dilatation. The mean IOP at predilatation and postdilatation fourth hour was statistically significantly different between PXG and PXS groups ( P =0.042, <0.001, respectively). Whereas the mean IOP at predilatation, postdilatation first hour, postdilatation second hour, and postdilatation fourth hour were statistically significantly different between PXG and control group ( P <0.001 for each). CONCLUSIONS: Significant IOP increases have been observed in our study with 1% tropicamide in the PXG and PXS groups, with the peak effect at the second hour in the postdilatation period. Furthermore, the mean pupil diameter was found to be significantly lower in PXG patients compared with the control group.

Evaluation of the lamina cribrosa in different stages of diabetic retinopathy.

PURPOSE: To evaluate the relationship of the peripapillary retina nerve fiber layer (RNFL) and lamina cribrosa (LC) with diabetic retinopathy (DR) in type 2 diabetes mellitus (DM) cases. STUDY DESIGN: Prospective comparative study. METHODS: This study included 50 non-DR (Group 1), 55 non-proliferative diabetic retinopathy (NPDR) (Group 2), 28 DM cases with proliferative diabetic retinopathy (PDR) (Group 3) and 45 healthy volunteers (Group 4). All participants were evaluated with visual acuity, intraocular pressure (IOP) with Goldman applanation tonometry, anterior segment biomicroscopy, 24 - 2 visual field testing, and dilated fundus examination. Retinal nerve fiber layer (RNFL) thickness, lamina cribrosa thickness (LCT) and anterior lamina cribrosa depth (ALCD) were examined by spectral-domain optical coherence tomography (OCT). RESULTS: There was no difference between the groups in terms of age and gender. Visual acuity (p < 0.001) was significantly different between the groups, while IOP (p = 0.068) was similar. Mean (p = 0.010), superior-temporal (p = 0.024), and superior-nasal (p = 0.011) RNFL thickness decreased significantly in correlation with the stage of DR. LCT decreased significantly as the stage of DR progressed in both vertical and horizontal radial OCT scans (p < 0.001). ALCD was not different between groups (p = 0.954 for horizontal scan, p = 0.867 for vertical scan). CONCLUSION: Peripapillary RNFL and LCT significantly decreases as the DR stage progresses. The biomechanical effects of the LC may also be responsible for diabetes-induced neurodegeneration.

The Effect of an Eyelid Speculum on Intraocular Pressure Measurement in Newborns.

PURPOSE: To evaluate the effect of an eyelid speculum on intraocular pressure (IOP) measurements in newborns. METHODS: A total of 54 eyes of 27 newborns were involved in the study. The IOP measurements were obtained under topical anesthesia with the Icare PRO (Icare Finland Oy) before and after inserting the infant type of Barraquer wire eyelid speculum. A paired t test was used to compare the measurements. RESULTS: The mean IOP without the eyelid speculum was 9.04 ± 2.13 mm Hg (range: 6.00 to 13.20 mm Hg) in the right eye and 9.26 ± 1.59 mm Hg (range: 7.10 to 13.00 mm Hg) in the left eye. With the eyelid speculum in place, the mean IOP was 11.91 ± 2.23 mm Hg (range: 9.10 to 15.80 mm Hg) in the right eye and 11.70 ± 1.89 mm Hg (range: 8.40 to 14.50 mm Hg) in the left eye (P ≤ .001). The mean differences in IOP between measurements with and without the eyelid speculum were 2.87 ± 2.23 mm Hg (range: 0.20 to 5.20 mm Hg) in the right eye and 2.44 ± 1.48 mm Hg (range: 0.00 to 4.90 mm Hg) in the left eye. The mean difference in IOP between measurements with and without the eyelid speculum for all eyes was 2.65 ± 1.89 mm Hg (range: 0.00 to 5.20 mm Hg). There was no correlation between the difference in IOP after the placement of the eyelid speculum and postconceptual age or weight at the examination (r = 0.11, P = .41, r = 0.32, P = .14, respectively). CONCLUSIONS: The Barraquer wire eyelid speculum caused an increase in IOP in newborns under topical anesthesia without a significant difference between postconceptual age and sex in both eyes. The average IOP rise after the eyelid speculum was inserted was 2.65 mm Hg. This effect should be considered when interpreting IOP measurements in newborns. [J Pediatr Ophthalmol Strabismus. 2022;59(1):13-16.].

Evaluation of choroidal thickness in light-coloured eyes.

OBJECTIVE: The aim of this study was to determine whether iris colour is related to the choroidal thickness of healthy individuals. METHODS: Healthy participants were divided into two groups. Group 1 had light-coloured eyes (blue and green), and group 2 had dark-coloured eyes (brown). The main outcome measures were iris thickness, subfoveal choroidal thickness and nasal and temporal choroidal thicknesses 500 µm away from the fovea. RESULTS: Group 1 comprised 31 subjects with light-coloured eyes, and group 2 had 31 subjects with dark eyes. The mean ages of groups 1 and 2 were 26.7 ± 7.5 years and 24.1 ± 5.8 years, respectively (p = 0.14). The choroidal thicknesses of the subfoveal, nasal and temporal regions were 336.3 ± 52.1 µm, 321.9 ± 43.6 µm and 318.4 ± 49.2 µm, respectively, in group 1 and 396.5 ± 76.9 µm, 372 ± 79.3 µm and 379.6 ± 82.4 µm, respectively, in group 2. All the values in group 1 were statistically lower than those in group 2 (p = 0.001, p = 0.001 and p = 0.003, respectively). The iris thickness in group 1 (493.73 ± 95.44 µm) was thinner than in group 2 (524.61 ± 69.74 µm) but not statistically significant (p = 0.141). CONCLUSION: The results showed that a thinner choroid can be seen in disease-free light-coloured eyes. The iris colour should be considered among the factors affecting the choroidal thickness, such as age, sex, race and refractive error.

Change in retinal vessel diameter and choroidal thickness in patients with severe COVID-19: Change In Retinal Parameters In Patients With Severe COVID-19.

PURPOSE: To compare the differences in retinal vascular structure and choroidal thickness between the active disease and post-recovery periods in COVID-19 patients and healthy controls. MATERIAL AND METHODS: This prospective, cross-sectional study included 30 eyes from 30 patients with severe COVID-19 and 30 eyes of 30 sex-matched healthy controls. Central macular thickness (CMT), subfoveal choroidal thickness (CT) and retinal vascular changes of patients were measured after positive polymerase chain reaction (PCR) (where the patient had COVID-19-related symptoms) and then three months after two negative PCRs. Laboratory parameters, including C-reactive protein and d-dimer levels, were also recorded. RESULTS: The mean age of the patients was 47.90 ± 9.06 years in patients group, 49.07 ± 8.41 years in control goups (p = 0.467). In terms of choroidal thicknesses subfoveal, nasal and temporal region were significantly higher in the active disease period than control group (p = 0.019, p = 0.036, p = 0.003, respectively). When the after recovery period was compared with the control group in terms of choroidal thickness, although the choroidal thickness was higher in all regions, this difference was not found statistically significant. There was no statistically significant difference in CMT between groups (p = 0.506).The mean venous and arterial wall thicknesses were significantly higher in the active period than after recovery (p = 0.023, p = 0.013, respectively) but there were no differences between after recovery and control groups in the pairwise comparison (p = 0.851, p = 0.715, respectively). CONCLUSION: In patients with severe COVID-19, there are changes in thickness of the choroid and retinal vessel walls. While vascular wall thickness increases due to inflammation, the absence of lumen changes may be associated with hemodynamic variables.

Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer.

PURPOSE: To compare the topographical tear film break-up time (T-BUT) between individuals recovering from COVID-19 and control subjects using a noninvasive and noncontact technique with a Scheimpflug-Placido disc topographer. METHODS: One-hundred and twenty-two eyes from 61 post-COVID-19 patients and 124 eyes from 62 control subjects were included in this prospective study. All participants underwent detailed ophthalmological examination including best-corrected visual acuity, intraocular pressure measurements, slit lamp examination, and fundoscopy as well as qualitative and quantitative evaluation of the noninvasive first tear film break-up time (NIF-BUT) and noninvasive average tear film break-up time (NIAvg-BUT) with T-BUT measured with a Sirius (CSO - Costruzione Strumenti Oftalmici S. r. l., Italy) corneal topography device. RESULTS: The mean NIF-BUT in post-COVID-19 and control patients was 5.2 ± 3.4 vs. 6.5 ± 3.2 sec, respectively. The mean NIAvg-BUT in the corresponding groups was 7.5 ± 3.5 vs. 8.8 ± 3.0 sec, respectively. Both NIF-BUT and NIAvg-BUT were significantly lower in the post-COVID-19 group than in controls (p = 0.004 vs. 0.020). Topographical tear film break-up at any time during the test (17 sec) was observed qualitatively in 79 eyes (64.8%) in the post-COVID-19 group and 57 eyes (46%) in the control group (p = 0.003). Moreover, temporal quadrant involvement occurred significantly more frequently in the post-COVID-19 group (p = 0.028). CONCLUSION: Tear film stability assessment based on T-BUT showed shorter NIF-BUT and NIAvg-BUT in post-COVID-19 patients as compared to the control group. Our results suggest that post-COVID-19 patients have impaired stability of tear film, and therefore require closer monitoring regarding dry eye. In addition, tear film instability in post-COVID-19 patients can be reliably detected using a noninvasive and noncontact technique that is more comfortable for both patients and physicians.

Severe COVID-19 and Retina: Are There Any Retinal Manifestations?

PURPOSE: To investigate whether there are retinal lesions associated with severe COVID-19. METHODS: We studied 232 symptomatic subjects aged 18 - 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP). RESULTS: The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the examination and imaging. CONCLUSIONS: This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may occur secondary to existing systemic diseases.

Accommodative amplitudes and high-order aberrations in patients with multiple sclerosis with optic nerve ınvolvement / Amplitudes de acomodação e aberrações de alta ordem em pacientes com esclerose múltipla com envolvimento do nervo óptico

ABSTRACT Purpose: This study aimed to investigate and compare the changes in corneal aberrations and accommodative amplitudes between patients with multiple sclerosis and normal individuals. Methods: We included 20 patients who were previously diagnosed with multiple sclerosis with optic nerve involvement (multiple sclerosis group) and 20 healthy sex- and age-matched individuals (control group). We only selected those who were under 40 years old because accommodation in individuals over 40 years old significantly deteriorates. We measured the accommodative amplitude in diopters by minus lens test and evaluated the higher-order aberrations by using the iDesign aberrometer. Then, we compared the accommodative amplitude and the root mean square of higher-order aberrations between the groups. Results: The mean age of the multiple sclerosis and control groups were 35.25 ± 4.52 and 32.28 ± 6.83 years, respectively (p=0.170). The accommodative amplitude was 4.05 ± 1.25 D in the multiple sclerosis group and 6.00 ± 1.03 D in the control group, with a statistically significant difference (p<0.001). Meanwhile, the root mean square of higher-order aberrations was not significantly different between the groups (multiple sclerosis group, 0.44 ± 0.22; control group, 0.43 ± 0.10, p<0.824). Moreover, aberration changes had no statistically significant differences between the two groups at baseline and at 5 D stimulus. Conclusions: The accommodative amplitude was decreased in patients with multiple sclerosis, suggesting the possible cause of transient visual impairments in these patients. However, this accommodative amplitude did not demonstrate a significant difference in terms of higher-order aberration change during accommodation between such patients and the controls.

RESUMO Objetivo: Investigar se as aberrações da córnea e as amplitudes de acomodação alteram mais em pacientes com esclerose múltipla do que em populações normais. Métodos: Vinte pacientes previamente diagnosticados com esclerose múltipla com envolvimento do nervo óptico (grupo com eslerose múltipla) e 20 indivíduos saudáveis pareados por sexo e idade (grupo controle) foram incluídos no estudo. Pacientes com menos de 40 anos de idade foram incluídos em ambos os grupos devido à deterioração significativa de acomodação em pacientes com mais de 40 anos de idade. Para cada participante, a amplitude de acomodação foi medida em dioptrias pelo teste de lentes negativas e as aberrações de alta ordem foram avaliadas com o aberrômetro iDesign. Em seguida, a amplitude de acomodação e a média da raiz quadrada de aberrações de alta ordem foram comparadas entre os grupos. Resultados: As médias da idade dos grupos com esclerose múltipla e controle foram 35,25 ± 4,52 anos e 32,28 ± 6,83 anos, respectivamente (p=0,170). A amplitude de acomodação foi de 4,05 ± 1,25 D no grupo com esclerose múltipla e 6,00 ± 1,03 D no grupo controle. A diferença entre os com esclerose múltipla e o grupo controle foi estatisticamente significativa (p<0, 001). A média da raiz quadrada das aberrações de alta ordem não foi significativamente diferente entre os grupos (com esclerose múltipla, 0,44 ± 0,22; controle, 0,43 ± 0,10, p<0,824). Não houve diferenças estatisticamente significativas entre os grupos em termos de alterações de aberrações entre a linha de base e o estímulo 5 D. Conclusões: Este estudo mostra que a amplitude de acomodação diminuiu em pacientes com esclerose múltipla. Portanto, esses resultados podem causar possíveis razões de deficiências visuais transitórias em pacientes com esclerose múltipla. No entanto, esta diferença de amplitude de acomodação não fez uma diferença significativa entre os grupos quanto à alteração das aberrações de alta ordem durante a acomodação.

Accommodative amplitudes and high-order aberrations in patients with multiple sclerosis with optic nerve involvement.

PURPOSE: This study aimed to investigate and compare the changes in corneal aberrations and accommodative amplitudes between patients with multiple sclerosis and normal individuals. METHODS: We included 20 patients who were previously diagnosed with multiple sclerosis with optic nerve involvement (multiple sclerosis group) and 20 healthy sex- and age-matched individuals (control group). We only selected those who were under 40 years old because accommodation in individuals over 40 years old significantly deteriorates. We measured the accommodative amplitude in diopters by minus lens test and evaluated the higher-order aberrations by using the iDesign aberrometer. Then, we compared the accommodative amplitude and the root mean square of higher-order aberrations between the groups. RESULTS: The mean age of the multiple sclerosis and control groups were 35.25 ± 4.52 and 32.28 ± 6.83 years, respectively (p=0.170). The accommodative amplitude was 4.05 ± 1.25 D in the multiple sclerosis group and 6.00 ± 1.03 D in the control group, with a statistically significant difference (p<0.001). Meanwhile, the root mean square of higher-order aberrations was not significantly different between the groups (multiple sclerosis group, 0.44 ± 0.22; control group, 0.43 ± 0.10, p<0.824). Moreover, aberration changes had no statistically significant differences between the two groups at baseline and at 5 D stimulus. CONCLUSIONS: The accommodative amplitude was decreased in patients with multiple sclerosis, suggesting the possible cause of transient visual impairments in these patients. However, this accommodative amplitude did not demonstrate a significant difference in terms of higher-order aberration change during accommodation between such patients and the controls.

Systemic oxidative stress biomarkers in patients with vitreomacular traction syndrome.

PURPOSE: To evaluate whether the systemic oxidative stress biomarkers increased in patients with vitreomacular traction syndrome (VMT). METHODS: This study compared 25 patients diagnosed with VMT with 20 healthy controls. As a biomarker of systemic oxidative stress, malondialdehyde (MDA) was measured. Total oxidant status (TOS) and total antioxidant status (TAS) were measured to evaluate the systemic oxidant status. RESULTS: Serum MDA values were significantly higher among the patients (p < 0.001). The ideal cut-off value for MDA was determined to be 22.1 µmol/L, with 80% sensitivity and 75% specificity. The between-group differences were not statistically significant for TOS or TAS (p = 0.326 and p = 0.698, respectively). CONCLUSION: Increased MDA levels suggest that systemic oxidative stress may play a role in VMT.

Assessment of Inflammation Biomarkers in Diabetic Macular Edema Treated with Intravitreal Dexamethasone Implant.

Purpose: To evaluate inflammation biomarkers in diabetic macular edema (DME) treated with intravitreal dexamethasone implant (Ozurdex®). Methods: This retrospective single-center study investigated 64 eyes of 64 patients with DME who were nonresponsive to prior antivascular endothelial growth factor and treated with intravitreal Ozurdex. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio were calculated. Visual acuity and optical coherence tomography markers, including hyper-reflective dots and subretinal fluid (SRF), were determined, and central retinal thickness was also evaluated monthly for 3 months. Results: The average age was 64.06 ± 7.81 (48-84) years. The baseline NLR and MLR were significantly higher in patients with better visual outcomes (P = 0.029 and P = 0.048, respectively). Better anatomical outcomes were observed in the presence of SRF (P = 0.027). No significant differences were observed in the rates of the presence of SRF and hyper-reflective points about the better functional outcome (P > 0.05). Conclusions: SRF as an imaging biomarker, and NLR and MLR as blood biomarkers, stand out as markers of inflammation and were found to be associated with better response to Ozurdex implantation in DME.

Macular vessel density in patients recovered from COVID 19.

PURPOSE: The purpose is to evaluate macular vascular densities (VDs) using optical coherence tomography angiography (OCTA) in patients effected by coronavirus disease-2019 (COVID-19). METHODS: The superficial (SF) and deep macular VD of 50 patients with SARS CoV2 pneumonia who had positive polymerase chain reaction (PCR) tests and who recovered after receiving treatment and 55 healthy age- and gender-matched controls were compared using OCTA. Blood inflammation parameters were also recorded. RESULTS: There was no statistically significant difference between the two groups in terms of age and gender (p = 0.147 and p = 0.504, respectively). Nor was there a difference with respect to smokers between the two groups (p = 0.231). In COVID-19 patients, the VDs in superior hemi quadrant, superior quadrant and inferior quadrant, were significantly lower (p = 0.033, p = 0.029 and p = 0.042, respectively) in superficial plexus. It was also significantly lower in parafovea, superior hemi and superior quadrants (p = 0.026, p < 0.001 and p = 0.004, respectively) in deep plexus. In addition, white blood cell and neutrophil counts were significantly negatively correlated with the VD of the deep parafovea, deep superior quadrant and deep superior hemi quadrant (p < 0.05). There was no difference between the patient and control groups in both superficial and deep foveal avascular zone (FAZ) (p = 0.101 and p = 0.691 respectively). CONCLUSION: In COVID-19 disease, VD is low in some sectors in both SF and deep layers, but no change in FAZ. The effect of COVID 19 disease on the retina and whether it makes the retina sensitive to damage can only be understood with long-term follow-up.

Relationship of Obesity and Related Disorders with Ocular Parameters in Children and Adolescent.

PURPOSE: To evaluate the effect of obesity and obesity-related high blood pressure (BP) on the retinal nerve fiber layer (RNFL) and macula in children and adolescents. MATERIALS AND METHODS: Thirty-two obese patients followed up in the pediatrics endocrinology clinic between 2018 and 2019 were evaluated in the ophthalmology clinic. The results were compared with 25 healthy subjects, matched for age and sex. Anthropometric measurements, and systolic and diastolic BP were measured. The study consisted of three groups: Group 1, patients with obesity; Group 2, those with obesity and associated hypertension (obesity-related HT); and Group 3, healthy controls. A complete ophthalmologic examination was performed. Macular and RNFL thicknesses were determined using spectral domain optical coherence tomography (SD-OCT). RESULTS: There were no statistically significant differences between the groups in terms of gender, age, and intraocular pressure (p > .05). The inferior RNFL thickness and central foveal thickness were statistically thinner in the obesity-related HT group (p < .001 and p = .040). The systolic and diastolic BP and fasting glucose values were significantly higher in the obesity-related HT group than the other groups (p < .001; p < .001; p = .026, respectively). In linear regression modeling in obese and obesity-related HT groups, a significant assocation was found between diastolic BP and temporal RNFL thickness (p = .027) as well as between the systolic BP and triglyceride values and the nasal RNFL thickness values (p = .016 and p = .025, respectively). CONCLUSIONS: Inferior RNFL thickness and central foveal thickness were significantly thinner in patients with obesity-related HT. The effects of obesity-related HT on the retina should be evaluated using SD OCT, since no signs were found in a routine ocular examination.

The Impacts of Face Mask Use on Standard Automated Perimetry Results in Glaucoma Patients.

PURPOSE: The coronavirus disease 2019 (COVID-19) spread rapidly worldwide, causing a severe outbreak. Because the disease is easily transmitted, face masks are a vital tool to slow the spread. The aim of this study is to investigate the impacts of face mask use on standard automated perimetry (SAP) results in glaucoma patients. MATERIALS AND METHODS: All follow-up glaucoma patients who underwent SAP between May and October 2020 were enrolled in this study. In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients' face masks. RESULTS: A total of 127 patients (59 female and 68 male) with a mean age of 59.8±10.3 years were included in the study. While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks. Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in 3 patients (2.4%). The main effects of poorly fitting face masks on SAP reliability were increased fixation losses and false-positive errors (for both, P=0.001). Low SAP reliability was significantly higher in patients wearing cloth face masks than in those wearing surgical face masks (47.8% vs. 9.9%; P=0.0001). The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability (odds ratio: 27, 95% confidence interval: 5.48-132.92, P=0.0001). In all repeated SAPs, the patients' reliability parameters improved, and inferior visual field artifacts disappeared. CONCLUSIONS: Unsuitable face masks can cause either visual field artifacts, which may be interpreted as glaucoma progression or low test reliability. Taping the face masks' upper edges is an effective technique to prevent visual field artifacts and obtain good test reliability.

Peripapillary choroidal thickness in patients with vitamin D deficiency.

AIM: To investigate the effects of vitamin D deficiency on peripapillary choroidal thickness and retinal nerve fiber layer thickness. MATERIALS AND METHODS: Patients diagnosed with vitamin D deficiency but not yet treated for it (Group 1) and patients with normal vitamin D levels (Group 2) were included in this study. Subjects with any kind of eye disease and/or systemic disease were excluded from this study. Demographic characteristics of the patients were collected, and the subfoveal choroidal thickness, central foveal thickness, retinal nerve fiber layer thickness, and peripapillary choroidal thickness were measured using optical coherence tomography. RESULTS: The mean ages in Groups 1 and 2 were 30.5 ± 6.7 and 28 ± 5.78 years (p = 0.12), respectively, and female to male ratios were 19/11 and 17/13, respectively (p = 0.59). The mean vitamin D levels were 8.2 ± 2.5 and 28 ± 4.9 ng/mL in Groups 1 and 2, respectively (p <0.001). In Group 1, subfoveal choroidal thickness and nasal and inferior peripapillary choroidal thicknesses at 500 µm were 327.5 ± 81.4, 142.9 ± 40, and 140.66 ± 38.74 µm, respectively. For Group 2, these values were 407.1 ± 85.5, 189.3 0 ± 57.18, and 195.93 ± 67.58 µm, respectively (p <0.001, p = 0.001, and p <0.001, respectively). In addition, a positive correlation was found between vitamin D levels and the subfoveal choroidal thickness and nasal and inferior peripapillary choroidal thicknesses in all patients (r = 0.365, p = 0.005; r = 0.341, p = 0.008; and r = 0.370, p = 0.004, respectively). CONCLUSION: Subfoveal choroidal thickness and inferior and nasal peripapillary choroidal thicknesses decreased in patients with vitamin D deficiency.

The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus.

PURPOSE: To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). METHODS: The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. RESULTS: The mean age was 41.25 ± 6.89 years in group 1 and 41.81 ± 5.78 years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184 cells/mm2 in group 1 and 2649 ± 315 cells/mm2 in group 2 (p = 0.843). The percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) CONCLUSION: Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality.

Apelin-13: A Promising Biomarker for Age-Related Macular Degeneration?

PURPOSE: To investigate the value of serum apelin-13 levels in patients with age-related macular degeneration (AMD). METHODS: Patients with dry-type AMD, patients with treatment-naïve neovascular-type AMD, and healthy controls were included in this study. Diagnoses were confirmed on detailed fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Central foveal thickness and subfoveal choroidal thickness were evaluated. Both serum apelin-13 and vascular endothelial growth factor (VEGF) levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) principle. RESULTS: A total of 84 subjects, i.e., 24 in the dry-type AMD group (group 1), 27 in the neovascular-type AMD group (group 2), and 33 in the control group (group 3) were included in the study. Mean best-corrected visual acuity (BCVA) was 76 ± 4.5, 48.4 ± 16.3, and 83.4 ± 3.09 ETDRS letters in group 1, 2, and 3, respectively. The level of serum VEGF was 44.11 ± 26.14, 56.53 ± 53.77, and 61.47 ± 41.62 pg/mL in groups 1, 2, and 3, respectively (p = 0.553, p = 0.286, and p = 0.896, respectively). The level of serum apelin-13 was 586.47 ± 167.56, 622.18 ± 324.52, and 379.31 ± 171.96 pg/mL in groups 1, 2, and 3, respectively (p = 0.847, p = 0.04, and p ≤ 0.001, respectively). There was a negative correlation between the level of serum apelin and visual acuity (VA) and choroidal thickness. CONCLUSION: Serum apelin-13 levels were higher in both dry-type and neovascular-type AMD patients than in controls. Further studies demonstrating the relationship of the level of serum apelin-13 and AMD are needed.

Determination of Neurodegeneration in Polycystic Ovary Syndrome with Retinal Segmentation Analysis.

Purpose: To compare the thickness of each retinal layer in patients with polycystic ovary syndrome (PCOS) versus healthy, age-matched controls by using retinal segmentation analysis.Methods: In our cross-sectional study, 37 patients with PCOS (i.e., patient group) and 35 healthy individuals (i.e., control group) underwent spectral-domain optical coherence tomography imaging. Using built-in automatic retinal segmentation software to analyze the images collected, we compared the thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer, outer plexiform layer, outer nuclear layer, photoreceptor layer (PRL), retinal pigment epithelium (RPE), inner retinal layers, and outer retinal layers between the groups. To analyze the measurements, we used a traditional Early Treatment Diabetic Retinopathy Study (ETDRS) grid.Results: In ETDRS subfields, 6-mm nasal RNFL thickness; 3- and 6-mm nasal GCL thickness; 3-mm superior and 6-mm nasal IPL thickness; 1-mm central, 3-mm nasal, superior, and inferior, and 6-mm nasal and inferior PRL thickness; and 6-mm inferior RPE thickness were significantly thinner in patients with PCOS than that of healthy controls.Conclusion: The results of our retinal segmentation analysis indicate that patients with PCOS tend to have thinner GCL, IPL, and PRL than healthy, age-matched controls due to neurodegeneration likely caused by insulin resistance, or subclinical retinal inflammation.