Off-Label Uses of Ranibizumab and Aflibercept for Age-Related Macular Degeneration in Turkey.

Purpose: To evaluate the clinical and demographic aspects of off-label drug use applications for age-related macular degeneration (AMD) in Turkey. Methods: Applications for off-label drug use in the treatment of AMD to the Turkish Medicines and Medical Devices Agency (TITCK) in 2018 were retrospectively analyzed. Demographic characteristics, requested drugs, previous treatment regimens, and reasons for applications were evaluated. Results: The mean age of the patients (n = 209) was 64.9 ± 15.7 years, of which 48.8% were male and 51.2% were female. Ranibizumab (n = 113) comprised 54.1% and aflibercept (n = 96) 45.9% of off-label use applications. No application was made for bevacizumab. The most frequent reasons for application were switchback (49.3%), nonreimbursement of indicated drugs in cases under 50 years of age (24.4%), and failure to complete the loading dose (14.4%). Conclusions: Ranibizumab was the most requested off-label drug for AMD. There was no application for off-label bevacizumab since its use does not require approval from TITCK. In Turkey, new rules were established for the reimbursement of intravitreal drugs for AMD in 2019. Three doses of intravitreal bevacizumab were required initially for aflibercept and ranibizumab to be covered for reimbursement. There is not enough data in the English literature regarding the off-label use of ranibizumab and aflibercept for AMD. This study provides information about drug regulations and the off-label treatment options preferred by physicians for AMD in Turkey.

Altmetric and Bibliographic Analysis of the Most Popular Articles on Vitreoretinal Surgery Between 2010 and 2020.

Purpose Altmetrics is a web-based metrics method that measures the online dissemination of an article and the interactions it receives. We aimed to perform a bibliometric and altmetrics analysis of the 100 most cited articles (T100) on vitreoretinal surgery (VRS) published between 2010 and 2020. Methods A detailed search including terms regarding VRS in the Web of Science database was conducted. Articles were examined for bibliometric data and altmetrics. Results T100 articles had citation numbers ranging from 55 to 368 and altmetrics score (AS) values ranging from 0 to 125, and there was no statistically significant correlation between them. AS was weakly correlated with publication year. A statistically weak negative correlation was also found between AS and percent of citable open access, number of years since publication (NYsP), and average citations per year (ACpY). Conclusion AS values of articles on VRS were found to be low. Apparently, this was because the issue was of a highly specific and technical nature. However, the existence of articles with a zero AS value despite high citation numbers suggests that journals and authors do not yet attach enough importance to altmetrics. Altmetric analysis is not a reliable indicator for evaluating the scientific value of an article, and it cannot be a substitute for traditional metrics but it can provide perspective on the social impact of articles.

Assessment of macular pigment optical density of primary open-angle glaucoma patients under topical medication.

BACKGROUND: Glaucoma is a progressive, sight-threatening disease. In this study, we aimed to compare macular pigment optical density (MPOD) measurements of the primary open-angle glaucoma (POAG) patients under topical therapy with the control group. METHODS: This cross-sectional study included 55 eyes of 30 POAG patients and 42 eyes of 22 age- and sex-matched healthy controls. The data of all participants were analyzed retrospectively. Subsequently, patients with POAG were divided into two groups: Group 1 received therapy including prostaglandin analogue (PGA), and group 2 was using anti-glaucomatous drugs other than PGA. All participants underwent detailed ophthalmologic examination, including fundus photography and spectral-domain optical coherence tomography. In addition, MPOD was measured using the Zeiss Visucam 500 fundus camera. Mann-Whitney U test, Independent samples t-test, and one-way multivariate analysis of variance (MANOVA) tests were used to compare the values between and among groups. RESULTS: There was no significant difference in age and sex between POAG and healthy controls (p = 0.229, p = 0.376, respectively). All MPOD values were higher in the glaucoma group than in the control group. MPOD max, MPOD volume, and MPOD area were significantly higher in the POAG group than in the control group (p<0.05 for all). However, there was no significant difference in the mean MPOD (p = 0.083). In addition, in pairwise comparisons, the PGA therapy group had significantly higher MPOD values than the control group (p<0.05 for all). CONCLUSION: MPOD levels increased in patients receiving PGA treatment. In addition, retinal nerve fiber layer thickness was positively correlated with MPOD levels in POAG patients. Therefore, PGAs may have a neuroprotective effect.

Evaluation of off-label anti-vascular endothelial growth factor and steroid implant medication uses in macular edema due to retinal vein occlusion in Turkey.

WHAT IS KNOWN AND OBJECTIVE: Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs, ranibizumab and aflibercept, and corticosteroid implants are approved treatment options for RVO-related macular edema (ME) in Turkey. To the best of our knowledge, there is no data regarding the off-label use of these drugs for RVO in English literature. We aimed to evaluate the clinical and demographic characteristics of off-label drug use applications in Turkey for RVO. METHODS: Applications made to the Turkish Medicines and Medical Devices Agency between January 1 and December 31, 2018, for the use of off-label drugs (ranibizumab, aflibercept, dexamethasone implant) for the diagnosis of RVO from hospitals across Turkey were retrospectively analysed. Data of the applications, such as demographic characteristics, previous treatment regimens, reasons for applications, applicant hospitals and their regions, were recorded. RESULTS: There were 291 approved applications for RVO. The mean age of the patients was 64.88 ± 10.78 years, 48.8% were male, and 51.2% were female. Of these applications, 44.7% were for aflibercept, 35.7% for ranibizumab and 19.6% for dexamethasone implant. No application was made for bevacizumab since it could be used without needing for an application. The most common reasons for applications were due to dose limitations, failure to complete loading doses, and glaucoma, respectively. In terms of the distribution of the applicant hospitals, public university hospitals ranked first with 72.5%, training and research hospitals ranked second with 14.7% and foundation university hospitals ranked third with 13.1% rates. WHAT IS NEW AND CONCLUSION: The practice of drug use in RVO in Turkey has changed as of the beginning of 2019. Stepwise therapy has been accepted by the drug regulatory agency Turkish Medicines and Medical Devices Agency. Utilization of licensed drugs, aflibercept, ranibizumab and dexamethasone has been allowed only after administration of 3 doses of intravitreal bevacizumab. After 3 doses of bevacizumab, the physician may continue either with bevacizumab again or a dexamethasone implant. If there is a reason such as the presence of glaucoma, the physician may skip dexamethasone and switch to aflibercept and ranibizumab, but in this case, dexamethasone cannot be administered to the patient for life. The evaluation of the off-label treatments of RVO, which is one of the most frequently followed diseases in retina clinics, not only contributes to the literature but also provides information regarding the most frequently applied treatments and the physicians' off-label drug preferences for RVO.

The Effect of COVID-19 Pandemic on Eye-Related Emergency Department Visits: A Comparison of 2-Year Results.

Objectives: The aim of this study was to examine the clinical and demographic impact of the COVID-19 pandemic on emergency department admissions to a tertiary eye care hospital. Methods: Records of admissions to the ophthalmology emergency department during the pre-pandemic period (Group 1) and pandemic period (Group 2) were retrospectively reviewed to cover the period between March 15, 2019, and March 15, 2021. Application numbers, demographic characteristics of patients were recorded. The cases were grouped by age, sex and diagnoses, and the findings were compared within and between the groups. Results: A total of 161, 941 patients (Group 1: 103, 178 and Group 2: 58, 763) were admitted to the emergency department of our hospital within 2 years. All admission diagnoses were significantly lower in the pandemic period than in the pre-pandemic period (p=0.001). However, the rate of sight-threatening cases or cases requiring urgent treatment (retinal diseases, uveitis, etc.) was significantly higher in the pandemic period than in the pre-pandemic period (p=0.001). The most common admission diagnoses were ocular infectious/inflammatory diseases while the foreign body on the ocular surface/ocular trauma group was second. Admissions for allergic and infectious diseases were significantly less during the pandemic period (p=0.001 and p=0.002, respectively). In both periods, the number of admissions of male patients was significantly higher than that of females. The most frequent applicant age group was the 17-40 years age group. Conclusion: This observational study reveals the changes caused by the COVID-19 pandemic in ocular emergency admissions. The data from our study may be helpful in planning healthcare delivery during and after the pandemic period.

Investigation of the Relationship Between Ocular Demodex Colonization and the Conjunctival Flora

Objective: This study aimed to determine whether ocular Demodex colonization leads to changes in the conjunctival flora in healthy middle-aged individuals. Methods: This study included 70 patients who applied to an ophthalmology clinic with a complaints of presbyopia. Two eyelash specimens from the lower eyelids of both eyes were obtained from each individual. In eyelash specimens were examined for Demodex spp. by direct wet smearing under microscopy. Conjunctival culture samples were cultivated on blood agar, eosin methylene blue and chocolate agar. Results: In the 38.5% of the individuals, Demodex spp. mites were found in the eyelashes, out of which 11.4% were Demodex brevis and 27.1% Demodex folliculorum. Bacterial growth was observed in 82.9% of the samples examined. The most frequently detected bacterium was Staphylococcus epidermidis (57%). Conclusion: Although Demodex spp. infestation has been shown to be related to diseases on ocular surface of eyes such as pterygium, xerophthalmia and chalazion, we did not observe that it induces changes in ocular surface flora in healthy adults.

Hydroxychloroquine treatment alters retinal layers and choroid without apparent toxicity in optical coherence tomography.

Background To investigate whether single retinal layer, choroidal and peripapillary retinal fiber layer thicknesses were affected in patients under hydroxychloroquine treatment without retinal toxicity Methods Forty-nine patients under hydroxychloroquine treatment (HCQ group) and 39 healthy volunteers, a total of 88 individuals, were included in the study. Patients with HCQ treatment were further divided into two groups as less than 5 years of HCQ use (group 1, 29 patients) and 5 years or more of HCQ use (group 2, 20 patients). All participants underwent full ophthalmologic examination and optical coherence tomography (OCT) imaging as OCT is a recommended tool for screening toxicity by the American Association of Ophthalmology. The automatic segmentation of retinal layers included retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retina pigment epithelium (RPE), inner retinal layers (IRL), outer retinal layers (ORL) and total retina thickness (TRT). Choroidal thickness (ChT), choroidal vascularity index and peripapillary RNFL were also measured. Results Both inferior and nasal parafoveal RNFL, temporal parafoveal GCL, and IPL layer thicknesses were decreased, while temporal parafoveal RPE layer thicknesses were increased in hydroxychloroquine users. Subfoveal ChTs were significantly reduced in both groups 1 and 2 compared to the control group(p = 0.042 and p = 0.009, respectively) and temporal ChT thicknesses were statistically decreased in group 2 compared to the control group(p = 0.018), but not for nasal ChT. Conclusions Hydroxychloroquine use may cause parafoveal retinal layer thickness alterations and also subfoveal and parafoveal ChT alterations even without evident retinal toxicity in OCT.

Off-label uses of Aflibercept, Ranibizumab and Dexamethasone implant for diabetic retinopathy in Turkey.

Objective: Diabetic retinopathy (DRP) is the most common retinal vascular disease leading to blindness. There is limited data about the off-label drug use for DRP and diabetic macular edema (DME) in literature. The aim of the article was to evaluate the applications for off-label drug use in patients with DME and DRP in Turkey in terms of demographic and clinical characteristics. Methods: Applications for off-label drug use from hospitals across Turkey to the Turkish Medicines and Medical Devices Agency for DRP in 2018 were reviewed retrospectively. Results: 112 approved applications for 167 eyes were included in our study. The mean age of the cases was 61.24 ± 10.23 years, of them 57.1% were males and 42.9% were females. Of these applications, 41.1% were for aflibercept (n:46), 33.9% for ranibizumab (n:38), and 25% for dexamethasone implant (n:28). There was no application for bevacizumab. In terms of referring hospitals, public university hospitals were in the first place with a rate of 70.5%. The most common reasons for applications were drug switchback request and failure to complete loading dose, respectively. Discussions: DRP treatment can sometimes be challenging. The effectiveness of the intravitreal drugs may decrease over time and drug switching may be necessary. In Turkey, intravitreal drugs are only approved and reimbursed for DRP patients in case of macular edema. Off-label drug use may be preferred in non-approved indications and for reasons such as the need for additional drug doses to the determined limits. However, permission must be obtained from TMMDA for off-label drug use in Turkey. Conclusion: Anti-vascular endothelial growth factor drugs are the first-line treatment options for DME. TMMDA currently approves stepwise therapy for diabetic macular edema, initiated with bevacizumab. Bevacizumab administration does not require approval for off-label application. Additionally, ranibizumab, aflibercept, and dexamethasone implant are reimbursed only in case of failure to respond to 3 doses of bevacizumab injection. Our report provides information about off-label drug preferences and drug use regulations in DRP treatment in Turkey. Abbreviations:DME = diabetic macular edema, DRP = Diabetic retinopathy, FFA = fundus fluorescein angiography, TMMDA = Turkish Medicines and Medical Devices Agency, VEGF = vascular endothelial growth factor.

Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population.

PURPOSE: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. METHODS: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. RESULTS: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. CONCLUSIONS: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

Choroidal vascularity index and choroidal thickness changes in patients with allergic asthma.

BACKGROUND: This study aimed to investigate whether the choroidal vascularity index (CVI), choroidal thickness (ChT), and retinal nerve fiber thickness (RNFL) of patients with allergic asthma change compared to the healthy control group. METHODS: This cross-sectional, observational study comprised 59 eyes of 59 patients with allergic asthma (Group 1) and 50 eyes of 50 age and sex-matched healthy volunteers as a control group (Group 2). CVI was measured by binarization of images obtained from choroidal enhanced depth imaging (EDI) mode optic coherence tomography. CVI was defined as the ratio of the choroidal luminal area to the total circumscribed choroidal area. ChT was measured manually at 3 points, subfoveal and 1000 microns nasal and temporal to the fovea (SFCT, N1000, and T1000 respectively). RNFL measurements were subdivided as global, nasal, temporal, superonasal, superotemporal, inferonasal, and inferotemporal quadrants. RESULTS: Subfoveal CVI and ChT were significantly lower in asthma patients (p:0,043 and p: 0.034, respectively). N1000 and T1000 ChT and RNFL thicknesses were lower in asthma patients compared to the control group, though no significant difference was found between them (p> 0.05). CONCLUSION: Our findings suggest that asthma patients have choroidal structural changes. In the literature, there are not enough studies regarding the effects of asthma on ocular parameters.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammation markers in patients with papilledema due to idiopathic intracranial hypertension.

Purpose: The aim of this study was to investigate the role of inflammation in the pathogenesis of idiopathic intracranial hypertension (IIH) using the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as inflammation markers. Methods: The files of 33 IIH patients and 33 controls were screened for this retrospective study. For each patient, the NLR and PLR values were calculated using a single fasting blood sample. For both eyes, papilledema (PE) grades, best-corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) measurements were recorded along with the demographic data, including body mass index (BMI), and complete neurological and ophthalmological findings. Comparisons between the two groups and between the IIH patients with and without PE were made. The associations of NLR and PLR with all other parameters were analyzed independently from age, gender, and BMI. Results: NLR and PLR were higher in patients with IIH than controls (P < 0.05). They were also higher in patients with PE (P < 0.05) in the IIH group. NLR and PLR were found to be associated with BCVA (P < 0.001 and P = 0.023, respectively), global RNFLT (P = 0.004 and 0.012, respectively), RNFLT of the temporal quadrant (P < 0.001 and P = 0.042, respectively) and PE grade (P < 0.001 and P = 0.035, respectively). Conclusion: The NLR and PLR values and their associations with BCVA, RNFLT, and PE support the hypothesis that inflammation is a very important component of the pathogenesis of IIH.

Evaluation of macular, retinal nerve fiber layer and choroidal thickness by optical coherence tomography in children and adolescents with vitamin B12 deficiency.

PURPOSE: To investigate macular, Retinal Nerve Fiber Layer (RNFL) and choroidal thickness in children and adolescents with vitamin B12 deficiency and no neurological examination finding. METHODS: The study group includes of thirty-three children aged 8-17 years who were brought to the Pediatric outpatient clinic with the symptoms of fatigue and forgetfulness and whose Vitamin B12 levels were detected < 200 pg/ml. The control group was the 30 children and adolescents applied to the same policlinic with various symptoms and whose Vitamin B12 levels were found normal. Children and adolescents with chronic systemic/ocular disease history and myopia or hyperopia more than 4 diopters were not included in both groups. Spectral Domain-Optical Coherence Tomography (SD-OCT) was used for measurements. RESULTS: Mean Macular thickness value was 261.2 ± 17.6 in the Vitamin B12 deficiency group and 267.7 ± 17.4 in the control group. Mean value of Retinal Nerve Fiber Layer (RNFL) thickness was 103.5 ± 7.5 in the Vitamin B12 deficiency group and 104.3 ± 8.9 in the control group. The mean values of Choroidal thickness were 360.1 ± 59.8 and 316.9 ± 95.4 in Vitamin B12 deficiency and control groups, respectively. There was a statistically significant increase in choroidal thickness in Vitamin B12 deficiency group compared to controls. CONCLUSION: Statistically significant increase in the Choroidal thicknesses of children and adolescents with Vitamin B12 deficiency is important in terms of shedding light on studies that will contribute to a better understanding of the relationship between vitamin B12 and inflammation. CLINICAL TRIAL REGISTRATION: This study is an observational study.

Correlation of Corneal Endothelial Cell Density with Corneal Tomographic Parameters in Eyes with Keratoconus.

OBJECTIVES: To examine changes in corneal endothelial cell density (ECD) in different stages of keratoconus and evaluate its correlation with corneal tomographic parameters. MATERIALS AND METHODS: Two hundred six patients with keratoconus were enrolled in the study. Corneal topography was performed by Sirius (CSO, Italy), which has a rotating Scheimpflug camera and a Placido disc topographer. Automatic endothelial analysis was done with the non-contact endothelial microscope (20x probe) of Confoscan-4 (NIDEK, Japan). The eyes were classified into stages based on steepest keratometric value as follows: mild <45 D; moderate 45-52 D; severe >52 D and according to thinnest cornea thickness (TCT) as <400 µm, 400-450 µm, and >450 µm. Tomographic and endothelial cell parameters were compared among the groups using Kruskal-Wallis test and the correlations between them were analyzed using Spearman correlation. RESULTS: The study included 391 eyes of 100 male (24.29±7.7 years, range 11-47 years) and 106 female (26.26±7.5 years, range 13-45 years) patients (p=0.07). Mean ECD values were 2628±262 cells/mm2, 2541.9±260.4 cells/mm2, and 2414.6±384.3 cells/mm2 in mild, moderate, and severe keratoconus, respectively (p<0.001) and 2592.3±277 cells/mm2, 2502±307 cells/mm2 and 2348±296 cells/mm2 in corneas with TCT values >450 µm, 400-450 µm, and <400 µm, respectively (p<0.001). ECD showed significant negative correlation with keratometric and elevation parameters and positive correlation with pachymetric parameters (p<0.05). CONCLUSION: As endothelial cell numbers seem to decrease with the progression of keratoconus, specular/confocal microscopy screening should be carried out, especially in eyes with advanced stages and corneas with TCT <400 µm.

Posterior Corneal Steepening in Posterior Polymorphous Corneal Dystrophy.

PURPOSE: The aim was to evaluate the anterior and posterior corneal topographic characteristics of three patients with posterior polymorphous corneal dystrophy (PPCD) using a rotating Scheimpflug camera combined with a Placido disc system (Sirius, CSO, Italy). CASE REPORTS: Two children with unilateral PPCD and a 53-year-old woman with bilateral PPCD were diagnosed by the presence of vesicles and railroad track lesions at the level of the Descemet membrane with slitlamp biomicroscopy and in vivo confocal microscopy. Anisometropic and/or meridional amblyopia was detected in both children. In the 16-year-old child, there was unilateral anterior corneal steepening with high astigmatism (plano -7.00 x 170) in the eye with PPCD. The 5-year-old boy had unilateral axial myopia and against-the-rule corneal astigmatism (-12.00 -2.00 x 90). Corneal topography of the woman revealed with-the-rule astigmatism and thin corneas (464 µm OD and 445 µm OS) in both eyes. Posterior corneal steepening greater than 25 µm either in a vertical or in a horizontal pattern changing with the orientation of the railroad track band lesions was detected in all subjects. CONCLUSIONS: Besides anterior corneal changes, PPCD seems to cause posterior corneal elevation, which necessitates corneal tomographic evaluation. In unilateral or highly asymmetric cases, children with PPCD should be screened for amblyopia.

Comparison of the effect of unilateral intravitreal bevacizumab and ranibizumab injection on diabetic macular edema of the fellow eye.

PURPOSE: To find out whether intravitreally administered bevacizumab and ranibizumab affect the contralateral, untreated, eyes of patients with bilateral diabetic macular edema (DME). METHODS: A retrospective review of patients with bilateral DME, who were treated with intravitreal bevacizumab or ranibizumab, was performed. All enrolled patients received intravitreal 1.25 mg bevacizumab or 0.5 mg ranibizumab in the eye with more severe macular edema. As outcome measures, best-corrected visual acuity (BCVA) was assessed with the Early Treatment Diabetic Retinopathy Study chart and central foveal thickness (CFT) measurement was obtained using optical coherence tomography-3 before and at 2 and 4 weeks after injections. RESULTS: The study included 55 eyes of 55 patients who received bevacizumab (group 1) and 32 eyes of 32 patients who received ranibizumab (group 2). The mean age of the 55 patients [35 female (63.6%), 20 male (36.4%)] in group 1 was 54.31±12.67 years, and the mean age of the 32 patients [20 female (62.5%), 12 male (37.5%)] in group 2 was 56.01±13.29 years. The median BCVA in the uninjected eye showed no statistically significant change at any visit after either bevacizumab or ranibizumab injection (P=0.302, P=0.582, respectively). In group 1, the median CFT in the uninjected eye was 417 µm at baseline; this was reduced to 401 µm at 2 weeks and 372 µm at 4 weeks. The change in CFT was found to be statistically significant (P=0.009). No statistically significant change was found in the median CFT of uninjected eyes of patients treated with ranibizumab (399, 403, and 407 µm before and at 2 and 4 weeks after treatment, respectively). CONCLUSIONS: Compared with ranibizumab, intravitreal administration of bevacizumab resulted in a greater decrease in macular thickness in the untreated eye, in patients with bilateral DME.

Quantitative assessment of anterior chamber inflammation in patients with retained presumed intraocular cotton fiber after phacoemulsification.

PURPOSE: To evaluate anterior chamber inflammation in eyes with retained presumed intraocular cotton fibers after small-incision cataract surgery. METHODS: Fourteen patients with retained presumed intraocular cotton fibers after phacoemulsification were evaluated for anterior chamber inflammation. The control group consisted of 15 patients with no postoperative intraocular cotton fibers. An aqueous flare meter was used to evaluate anterior chamber reaction 1 day, 1 week, and 1 month postoperatively. RESULTS: Retained cotton fibers were detected in the anterior chamber in 6 cases, and in the corneal incision site, extending into the anterior chamber, in 8 cases. The mean flare values at each postoperative visit were statistically similar between two groups. CONCLUSIONS: Following cataract surgery, retained presumed intraocular cotton fibers did not cause any additional inflammation in the eye within the short term. In contrast to other intraocular foreign bodies, which may cause severe inflammation, retained intraocular cotton fibers seem to be well tolerated following cataract surgery.