Treatment results of diabetic macular edema with different choroidal thickness with intravitreal anti vascular endothelial growth factor.

PURPOSE: To compare the results of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in patients with diabetic macular edema (DME) with different choroidal thicknesses. METHODS: The files of patients diagnosed with DME and treated with intravitreal anti-VEGF were reviewed retrospectively. The best-corrected visual acuity (BCVA), choroidal thickness (CT), and macular thickness (MT) measurements were recorded before and after treatment. All patients included in the study were divided into 3 groups according to the initial subfoveal choroidal thickness (SFCT). Group 1 included 35 patients with SFCT ≤ 220, group 2 included 27 patients with SFCT > 220 ≤ 270, and group 3 included 30 patients with SFCT > 270. The total number of anti-VEGF administered during the follow-up at the last examination, baseline and post-treatment CT, MT, and BCVA measurements were statistically compared in all 3 groups. RESULTS: The mean age of the patients was 61.9 ± 10.2 in group 1, 58.7 ± 8.7 in group 2, and 57.0 ± 6.5 in group 3. The mean anti-VEGF count in group 1 was significantly lower than group 2 and group 3 (p = 0.004, p = 0.006). In Group 1, BCVA improved significantly after treatment compared to baseline (p = 0.001). In Groups 2 and 3, BCVA did not change significantly after treatment compared to baseline (p = 0.320, p = 0.104). After treatment, central macular thickness decreased significantly in group 1 compared to baseline, while central macular thickness did not show a significant change from baseline in group 2 and group 3 after treatment (p = 0.003, p = 0.059, p = 0.590). CONCLUSION: In our study, we observed that the treatment needs of our DME patients with different choroidal thicknesses were different. In patients with DME, the initial choroidal thickness may help determine the need for follow-up and treatment.

Changes in choroidal thickness after anti-vascular endothelial growth factor treatment of diabetic macular edema, real-life data, 2-year results.

PURPOSE: To evaluate the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection on central choroidal thickness (CCT), central macular thickness (CMT) and best-corrected visual acuity (BCVA) in diabetic macular edema (DME). METHODS: Retrospective, cohort analysis of 90 eyes of 90 patients receiving anti-VEGF therapy for DME. In patients' records, measurements of CCT, CMT, and BCVA before treatment and at 2 years after treatment were recorded. Using enhanced-depth imaging optical coherence tomography (EDI-OCT) images, choroidal thickness and macular thickness measurements were recorded in the subfoveal area and 1 mm nasal to 1 mm temporal to the central foveal area. The baseline and final CMT and CCT values measured from all three quadrants were analyzed statistically. RESULTS: Mean age of the patients was 59.60 ± 9.78 (range, 40-77) years. Mean baseline nasal-CT 226.4 ± 52.5 µm, central-CT 243.2 ± 51.1 µm and temporal-CT 224.6 ± 47.9 µm. Mean final nasal-CT 220.0 ± 50.2 µm, central-CT 235.3 ± 53.6 µm, temporal-CT 220.5 ± 48.1 µm (p = 0.122, p = 0.056, p = 0.184, respectively). Mean baseline nasal- MT 385.3 ± 67.7, central-MT 345.5 ± 119.7 µm and temporal-MT 365.0 ± 64.9 µm. Mean final nasal-MT 359.6 ± 59.2 µm, central-MT 306.2 ± 98.4 µm and temporal-MT 353.4 ± 63.3 µm (p = 0.001, p = 0.002, p = 0.234, respectively). The BCVA improved from 0.52 ± 0.44 logMAR at baseline to 0.38 ± 0.33 at final (p = 0.002). CONCLUSION: After treatment of diabetic macular edema with intravitreal anti-VEGF injection, CMT and BCVA improved significantly, but CCT did not decrease significantly.

Efficacy of Hyperbaric Oxygen Therapy on Central Corneal Thickness, Intraocular Pressure, and Nerve Fiber Layer in Patients with Type 2 Diabetes: A Prospective Cohort Study.

PURPOSE: To evaluate the effect of hyperbaric oxygen therapy (HBOT) on central corneal thickness (CCT), intraocular pressure (IOP), and the retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus. METHODS: This prospective non-randomized cohort study consisted of type 2 diabetes mellitus patients who received 30 sessions of HBOT for diabetic foot ulcer. The CCT, IOP, and RNFL measured at baseline, after the 10th session of HBOT, after the 20th session of HBOT, after the 30th session of HBOT, and after the 3 months of the last session of HBOT. We gained the superior-nasal, superior-temporal, inferior-nasal, inferior-temporal, nasal and temporal quadrant RNFL values with a spectral-domain optical coharence tomography. RESULTS: Forty-six eyes of 46 patients included in the study. During the study period, a statistically significant increase in mean IOP values compared to baseline was observed (p < 0.001). We found no significant changes at CCT and all quadrants of RNFL values during HBOT and after 3 months of the treatment (p > 0.05). During the study period, the IOP levels increased over 21 mmHg (between 22 and 28 mmHg) in seven eyes (15.2%). The mean hemoglobin A1c values of these patients with IOP >21 mmHg were 8.2 ± 0.9 mg/dL, and there was significant differences compared with those of patients with IOP values ≤21 mmHg (7.4 ± 2.8 mg/dL) (p = 0.001). CONCLUSIONS: HBOT increase IOP in type 2 diabetic patients especially in ones with impaired blood glucose regulation. However, it does not cause any changes in CCT and RNFL. As diabetic retinopathy and diabetic foot ulcer are in common pathologies, thus this brief report concludes a need for further studies with longer follow-up periods to explore the potential interaction of HBOT on CCT, IOP, and RNFL.

Voriconazole Treatment for Fungal Chorioretinitis After Obesity Surgery.

Presently described is a case of fungal septicemia diagnosed based on a fundus examination and successfully treated with voriconazole. A 48-year-old woman who had undergone sleeve gastrectomy 20 days prior due to obesity was referred to the ophthalmology clinic for blurred vision in the right eye. The initial examination indicated visual acuity of only light perception in the right eye and 0.00 logMAR in the left eye. Anterior segment examination and light reaction results were normal in both eyes. The vitreous was clear. A central, hemorrhagic, hypopigmented lesion 1/3 optic disc diameter in size, was located in the right fovea, bulging from the retina. There were 3 or 4 small hypopigmented lesions in both peripheral retinas. The examination findings and patient history suggested fungal chorioretinitis. The patient was treated with intravenous voriconazole at a maintenance dose of 200 mg 2 times a day following a loading dose of 6 mg/kg 2 times a day for 48 hours according to the recommendation of the infectious diseases clinic. Multimodal imaging using fundus photography, fluorescein angiography, and spectral domain optical coherence tomography was performed throughout treatment. The patient's daily follow-up revealed no deterioration and improvement was seen on the third day. Endogenous fungal chorioretinitis is a rare infection, but it remains important in ophthalmology due to the high potential to cause severe visual loss and the limited diagnosis and treatment options. Patients who are susceptible to fungemia and have a recurrent fever may be referred to an ophthalmologist. Many clinical tests may have negative results but a careful fundoscopic examination can determine signs of fungemia-related chorioretinitis.

Comparison of Anatomical and Functional Outcomes of Intravitreal Dexamethasone Implant between Phakic and Pseudophakic Eyes with Diabetic Macular Edema.

PURPOSE: To compare the effectiveness of dexamethasone (DEX) intravitreal implants for the treatment of diabetic macular edema between phakic and pseudophakic eyes after a follow-up. METHODS: A total of 79 eyes in 79 patients with diabetic macular edema who were insufficiently responsive to the previous anti-vascular endothelial growth factor treatment and applied intravitreal DEX implant were included in this retrospective study. The patients were divided into two groups according to their type of lenses: pseudophakic (group 1) and phakic (group 2). Best-corrected visual acuity, intraocular pressure (IOP), retinal nerve fiber layer thickness, and central macular thickness changes in the two groups were compared. RESULTS: Group 1 comprised 42 eyes in 42 patients with a mean age of 64.02 ± 3.79 years, while group 2 comprised 37 eyes in 37 patients with a mean age of 64.19 ± 5.08 years. In both groups, best-corrected visual acuity improved significantly with a significant decrease in central macular thickness (p < 0.001). In both lens types, the IOP values decreased significantly on the first day but subsequently increased significantly compared to baseline from one week to six months. Increases in IOP values were significantly higher in group 1 at the first week, 1st month, and 6th month compared with group 2. During follow-up, the inferior quadrant retinal nerve fiber layer showed a significant decrease in both groups. CONCLUSIONS: In both phakic and pseudophakic eyes, intravitreal DEX implantation is an effective treatment method with low-risk complications. In our study, the pseudophakic group experienced a significantly earlier increase in IOP and at higher levels than did the phakic group. In light of these data, we suggest that in patients with pseudophakic eyes, follow-ups for IOP should be stricter and started earlier after intravitreal DEX treatment.

The Use of Autologous Serum Eye Drops after Epithelium-off Corneal Collagen Crosslinking.

SIGNIFICANCE: After epithelium-off crosslinking (CXL), epithelial closure time and post-operative pain are an important issue in terms of possible complications and patient comfort. We report a prospective randomized study about the use of autologous serum eye drops after CXL. PURPOSE: This study aims to evaluate the effect of autologous serum eye drops on epithelial healing and post-operative pain after CXL. METHODS: Sixty patients diagnosed as having progressive keratoconus and treated with accelerated CXL (9 mW/cm for 10 minutes) randomly received 20% autologous serum eye drops (autologous serum group, n = 30) or artificial tears (control group, n = 30). Patients were evaluated every day after the surgery, and the day of epithelial closure was recorded. All patients were asked to report the maximum pain level using the Wong-Baker FACES Pain Rating Scale at the end of each day until the epithelial closure was completed. The change in topographic parameters and haze were recorded at 6 months. RESULTS: The mean epithelial closure time was significantly lower in the autologous serum group than in the control group (2.37 ± 0.49 and 2.67 ± 0.47 days, respectively; P = .02). There was a statistically significant difference between the pain scores in the first and second days of surgery between the two groups (first-day autologous serum autologous serum group: 2.80 ± 0.66 and control group: 3.50 ± 0.82, P = .01; second-day autologous serum group: 1.73 ± 0.69 and control group: 2.20 ± 0.76, P = .02). Pre-operative and post-operative topographic parameters and haze at 6 months were similar between the two groups (P > .05 for all). CONCLUSIONS: Use of autologous serum eye drops after CXL accelerates epithelial healing and reduces post-operative pain. Shortening the duration of epithelial closure would be beneficial in reducing possible complications and increasing patient comfort.

Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Normal Tension Glaucoma.

Normal tension glaucoma (NTG) is a subtype of glaucoma that occurs at relatively low intraocular pressure levels and results in progressive optic neuropathy. Previous studies display some abnormal immune activity against the optic nerve. Neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) are novel markers for inflammation. Here we evaluated the NLR, PLR, Creactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels in NTG. NLR and PLR were resulted by dividing neutrophil and platelet counts to lymphocyte count respectively. Patients with a history of diabetes mellitus, chronic renal failure, rheumatologic disease, anemia, cancer, cigarette smoking, myocardial infarction and a febrile illness within one month of sampling were excluded from the investigation. In total, the blood samples of 28 NTG and 27control patients were analyzed for the study. There were 11 female (40.7%) and 16 male patients (59.3%) in the control group. The NTG group contained 15 (53.6%) female and 13 (46.4%) male patients. All of the NLR, PLR, ESR and CRP, values of NTG patients were not statistically different from the control group (P = 0.07, P = 0.64, P = 0.17, and P = 0.44 respectively). Although previous studies have shown significant differences in NLR and PLR levels in other types of glaucoma, we did not find any significant difference in NTG subjects. Our early report may give insight into the differential diagnosis of NTG.

A Comparison Study of Ranibizumab and Aflibercept in Patients with Naive Diabetic Macular Edema in Presence of Serous Retinal Detachment.

Aim of the study: The aim of this study is to compare the efficacy of intravitreal injection of Aflibercept and Ranibizumab in the treatment of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this prospective, non-randomized-cohort study, 60 eyes with DME with SRD were divided into 2 groups: group 1 consisted of 30 eyes treated with intravitreal injection of 0.5 mg/0.1 mL Ranibizumab (IVR) and group 2 consisted of 30 eyes treated with intravitreal injection of 2 mg/0.05 mL Aflibercept (IVA). After three sequential injections with 30-40-day interval as a loading dose, all patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central macular thickness (CMT), SRD's height (SRDH) and the number of reinjections of the drugs were compared. Results: The groups were similar in terms of age and sex (p > 0.05). There was no difference between groups in terms of the baseline BCVA, CMT and SRDH (p > 0.05). There was no significant difference between groups with regard to BCVA and CMT values for 12 months (p > 0.05). SRDH decreased significantly in both groups; however, the reduction of SRDH was considerably higher in group 2 for 12 months (p < 0.05). The mean number of reinjection was 4.40 ± 0.85 in group 1 and 3.16 ± 0.75 in group 2 and it was noticeably lower in group 2 (p < 0.001). The number of cases with persistent SRD at the end of the study was 14 (46.6%) in group 1 and 5 (16.6%) in group 2 (p < 0.001). Conclusions: Aflibercept may treat SRD more efficiently in patients with DME compared to Ranibizumab with fewer injections.

The effect of hyperbaric oxygen therapy on retinal thickness and progression of retinopathy in patients with Type 2 diabetes: a prospective cohort study.

Purpose: Evaluation of the effect of hyperbaric oxygen therapy (HBOT) on the progression of retinopathy, choroidal and retinal thickness in patients with type 2 diabetes mellitus (DM). Materials and methods: This prospective non-randomized cohort study consisted of 60 eyes of 30 patients who received 30 sessions of HBOT for a diabetic foot ulcer (DFU). The participants were divided into three groups; group 1: mild-moderate non-proliferative diabetic retinopathy (DRP) (n = 14), group 2: severe non-proliferative DRP (n = 20) and group 3: DRP without active proliferative findings with the applied laser for at least 2 years (n = 26). The cases were examined on base-line (measurement-1), after the 10th session of HBOT (Measurement-2), after the 20th session of HBOT (Measurement-3), after the 30th session of HBOT (Measurement-4), and after 10 days of the last session of HBOT (Measurement-5). The changes in central macular thickness (CMT; subfoveal point [CMT-SF], nasal point [CMT-N] and temporal point [CMT-T]), central choroidal thickness (CCT; subfoveal point [CCT-SF], nasal point [CCT-N] and temporal point [CCT-T]), and the stage of DRP were compared. Results: There was no significant difference between groups in terms of change ratio (CR%) in CMT-SF and CMT-N values. However, in Measurement-3, CR% in CMT-T was significantly higher in group 1 (p = 0.019). A significant increase in CMT-N and CMT-T parameters over time was observed in Group 1 (p < 0.05). There was a significant decrease in CCT-SF, CCT-N, and CCT-T values with time in each of the three groups (p < 0.05). At the end of HBOT, there was no progression or regression in the stage of DRP in any group. Conclusions: HBOT has both a thinning effect on the choroid layer in all three groups and a thickening effect on the macula in the mild-moderate non-proliferative diabetic eyes.

Corneal biomechanical properties in patients with Hashimoto's thyroiditis.

BACKGROUND: Hashimoto's thyroiditis (HT) is an autoimmune endocrine disorder that results from a dysregulation of the immune system leading to an immune attack on the thyroid gland. It has potential effects on different organs and tissues. OBJECTIVES: The aim of the study was to investigate the effect of HT on corneal biomechanical properties using the ocular response analyzer (ORA). MATERIAL AND METHODS: A total of 48 patients with HT and 49 healthy subjects were enrolled in the study. The mean age of the patients and healthy subjects was 42.33 ±11.96 and 40.20 ±12.60 years, respectively (p = 0.39). All of the subjects underwent a full ophthalmological examination, including visual acuity, corneal pachymetry with topography, biomicroscopy, and funduscopy. Corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal compensated IOP (IOPcc) were measured with the ORA. RESULTS: Central corneal thickness (CCT) in the patient group and the control group were not significantly different (p = 0.65). Corneal hysteresis of the HT patients was significantly lower than that of the control group (p = 0.005). There were no statistically significant differences in CRF between the 2 groups (p = 0.53). Goldmann-correlated IOP and IOPcc were higher in the HT patients, but only IOPcc showed a statistically significant difference (p = 0.001). CONCLUSIONS: In conclusion, our data shows that HT affects corneal biomechanical properties by decreasing CH. Thus, IOPcc measured with the ORA should be taken into account when determining accurate IOP values in patients with HT.

The Role of Ocular Response Analyzer in Differentiation of Forme Fruste Keratoconus From Corneal Astigmatism.

PURPOSE: To determine the diagnostic accuracy of corneal biomechanical factors in differentiating patients with forme fruste keratoconus (FFKC) from astigmatic and normal cases. METHODS: A total of 50 eyes with FFKC, 50 with astigmatism and 50 normal eyes, were included in this study. All patients had a detailed ophthalmologic examination including slit-lamp evaluation, Goldmann tonometry, indirect fundoscopy, topography by Scheimpflug imaging biomicroscopic anterior and posterior segment examination, and corneal biomechanical and intraocular pressure evaluation with ocular response analyzer (ORA). RESULTS: All topographic findings were statistically significant among the three groups (P>0.05). Although there was no statistically significant difference in the corneal-compensated intraocular pressure (IOPcc) among the three groups, the Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were statistically significantly lower in the FFKC group, compared with the other groups (P<0.001). There were no statistically significant difference in the IOPg, CH, and CRF between astigmatism and control groups (P=0.99, 0.79, and 0.86, respectively). The area under the receiver operating characteristic (AUROC) curve was greater than 0.85 for IOPg (0.80), CH (0.85), and CRF (0.90) for discriminating between FFKC and controls; whereas the AUROC was greater than 0.85 for IOPg (0.80), CH (0.79), and CRF (0.85) for discriminating between FFKC and astigmatism groups. CONCLUSION: Based on our study results, in differentiation of patients with FFKC from normal control cases or astigmatic patients, corneal biomechanical parameters play a role particularly in patients with suspicious results. We suggest using ORA in combination with corneal topography for better and more accurate diagnosis of FFKC.

Alterations in Corneal Biomechanical and Topographic Features After Accelerated Crosslinking: 1-Year Results.

OBJECTIVES: To determine the biomechanical and topographic alterations within the first year after accelerated crosslinking (CXL) treatment in patients with keratoconus. METHODS: In this prospective study, 52 eyes of 52 patients with progressive keratoconus underwent accelerated CXL were included. All patients had a detailed preoperative ophthalmologic examination, including slit-lamp evaluation, Goldmann tonometry, fundoscopy, topography by Scheimpflug imaging (Sirius), and corneal biomechanical evaluation with a biomechanical waveform analysis device (ORA). Alterations in visual acuity and topographic findings were evaluated before the treatment and at 12 months follow-up. Corneal biomechanical features were obtained before the treatment, and at 1st, 3rd, 6th and 12th months. RESULTS: Uncorrected-visual acuity and best-corrected visual acuity both statistically significantly improved at 12th month (p=0.001). There were no statistically significant differences in keratometry values, whereas maximum K (AKfront) and symmetry index front (SIfront) decreased significantly (p=0.015 and p=0.009, respectively). Corneal thinnest point and volume also decreased significantly at 12th month (p=0.001 for both). Goldmann-correlated intraocular pressure (IOPg) and corneal compensated IOP (IOPcc) values transiently increased in the first three months, while corneal hysteresis (CH) and the corneal resistance factor (CRF) transiently decreased, with the difference not statistically significant (p>0.05). However, central corneal thickness significantly decreased at the end of the 12th month (p=0.001). CONCLUSION: Accelerated CXL seems to be effective in stopping the progression of keratoconus. Our findings showed transient alterations in biomechanical features, which will end with the preoperative values at the end of the 12th month. Further studies are needed to demonstrate the changes in corneal biomechanics in vivo.

Treatment of Corneal Alkali Burn with Chestnut Honey, Royal Jelly, and Chestnut Honey-Royal Jelly Mixture.

OBJECTIVES: The alkaline burn of the cornea usually results in a decreased vision with opacification. In this study, we investigated the potential role of endemic chestnut honey (CH) and royal jelly on corneal healing after an alkaline burn. METHODS: We created an alkaline burn on the center of the corneas of four groups of Wistar rats by applying round filter paper soaked with 1 N NaOH for 30 seconds. The animals were treated with RJ, CH, RJ-CH combination and Na-Hyaluronate (Na-HA) eye drops. We performed a serial evaluation with anterior segment photography on the first, 7th, and 14th days of the experiment. Pathologic examination conducted with hematoxylin and eosin stains and immunostaining for SMA and α4ß1 integrin. We evaluated the corneal healing process with a scoring system, which was estimating the degree of corneal edema, the size of the corneal ulcer, and limbal hyperemia. RESULTS: There was no statistically significant difference between groups on the first, 7th, and 14th days concerning the healing scores (p=0.88, p=0.06, p=0.80, respectively). However, there were significantly better scores in the repeated measures of CH (p=0.012) and RJ-CH (p=0.00) groups. The RJ group and Na-HA group did not show a significant difference in repeated measures (p=0.19 and p=0.10, respectively). The α4ß1 integrin levels on immunostaining showed a significant difference among groups on the 14th day (p=0.002). CONCLUSION: We found better corneal healing after treatment with the RJ-CH containing eye drops concerning corneal healing sore and α4ß1 integrin staining.

Complication of micro-bypass stenting: the anterior chamber displacement of a Xen implant / Complicação de stent micro-bypass: o deslocamento da câmara anterior de um implante de Xen

ABSTRACT Although minimally invasive glaucoma surgery using different types of implants is a promising strategy for treating glaucoma, potential long-term complications require further evaluation. Here, we report a case of the anterior chamber displacement of a Xen implant due to a maneuver aimed at correcting a dysfunctional and bent subconjunctival implant.

RESUMO Embora a cirurgia de glaucoma minimamente in vasiva, que usa diferentes tipos de implantes, seja uma estratégia promissora para o tratamento do glaucoma, as possíveis complicações a longo prazo exigem uma avaliação mais aprofundada. Aqui, relatamos um caso de deslocamento da câmara anterior de um implante Xen devido a uma manobra que visa corrigir um implante subconjuntival disfuncional e dobrado.

Comparison of outcomes of conventional transcanalicular laser dacryocystorhinostomy and modified transcanalicular laser dacryocystorhinostomy.

INTRODUCTION: Transcanalicular laser DCR (TL-DCR) approaches have been developed for the formation of a fistula between the nasal cavity and the lacrimal sac to ensure the continuity of the lacrimal drainage system over the years. However, the success rate of TL-DCR has varied widely. AIM: To evaluate and compare the success rates of conventional transcanalicular multidiode laser dacryocystorhinostomy and modified transcanalicular multidiode laser dacryocystorhinostomy. MATERIAL AND METHODS: Ninety-one eyes of 91 adult patients admitted with epiphora and diagnosed with chronic dacryocystitis were included in the study. The participants were divided into two groups. Group 1 consisted of 55 patients who were treated with conventional transcanalicular laser dacryocystorhinostomy. Group 2 consisted of 36 patients to whom the same surgical procedure was applied with the difference of nasal mucosa excision prior to laser osteotomy. The groups' intraoperative surgical ostium size, perioperative and postoperative complications, operative times and success rates were compared. RESULTS: The mean follow-up periods for each group were 8.88 ±2.99 months and 10.28 ±4.47 months, respectively (p = 0.077). Intraoperative mean surgical ostium sizes were 31.85 ±14.98 mm2 and 42.25 ±18.09 mm2, respectively (p = 0.004). The mean operation time in group 1 was significantly shorter compared to group 2 (18.55 ±4.05 min and 24.44 ±3.18 min, respectively, p = 0.0001). The overall success rate was 65.45% in group 1 and 75.00% in group 2 (p = 0.335). CONCLUSIONS: Although the surgical ostium area was significantly greater in group 2, there was no significant difference in surgical success and patient satisfaction rates between the two groups.

Complication of micro-bypass stenting: the anterior chamber displacement of a Xen implant.

Although minimally invasive glaucoma surgery using different types of implants is a promising strategy for treating glaucoma, potential long-term complications require further evaluation. Here, we report a case of the anterior chamber displacement of a Xen implant due to a maneuver aimed at correcting a dysfunctional and bent subconjunctival implant.

Alterations in biomechanical properties of the cornea among patients with polycystic kidney disease.

PURPOSE: The aim of this study was to evaluate the corneal biomechanical features in polycystic kidney disease (PKD) patients and compare them with the healthy individuals. METHODS: Totally 81 patients with a mean age of 48.46 ± 14.51 years and 60 control cases with a mean age of 44.68 ± 12.69 years were included in the study. All of the subjects underwent a complete ophthalmological examination, including visual acuity testing, biomicroscopic anterior and posterior segment examinations. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were evaluated with the ocular response analyzer, and the central corneal thickness was evaluated with Sirius® corneal topography. RESULTS: PKD patients had significantly increased CH values, without any alterations in IOP or CCT values, compared with the control cases (p:0.001). Among PKD patients, 23 were having liver cysts accompanying renal cysts. There was not any statistically significant difference between PKD patients with or without liver cysts regarding biomechanical properties of the cornea. However, both patient groups had statistically significantly increased CH values compared with the control cases. CONCLUSION: Patients with PKD present with higher CH values than age-matched controls. Larger studies are warranted to elucidate the alterations in corneal biomechanical properties and their clinical relevance in PKD patients.

INTRAVITREAL DEXAMETHASONE IMPLANTATION IN PATIENTS WITH DIFFERENT MORPHOLOGICAL DIABETIC MACULAR EDEMA HAVING INSUFFICIENT RESPONSE TO RANIBIZUMAB.

PURPOSE: To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types. METHODS: In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12). Primary outcome measures were best corrected visual acuity, and central macular thickness. RESULTS: The three subgroups were similar in terms of age and gender (P > 0.05). Total duration of diabetes was significantly less in the serous retinal detachment subgroup (P = 0.01). There were no differences in the best corrected visual acuity between the three subgroups until the sixth month. However, the best corrected visual acuity was significantly better in the diffuse retinal thickness subgroup at the sixth month (P = 0.008). Regarding the central macular thickness values, it was statistically better in serous retinal detachment than in diffuse retinal thickening and cystoid macular edema subgroups till the sixth month (P = 0.001). However, at the sixth month, there was not any statistical difference between subgroups regarding central macular thickness values. Antiglaucomatous agents were required in 4 (11.4%) patients throughout the study. CONCLUSION: Treatment algorithms should differ according to the morphology of diabetic macular edema; however, more data is needed to give specific recommendations.

Corneal biomechanical features in patients with ankylosing spondylitis.

PURPOSE: To evaluate the corneal biomechanical features and central corneal thickness in ankylosing spondylitis patients and to evaluate correlations of these parameters with disease activity. METHODS: The study included 51 patients diagnosed with ankylosing spondylitis (mean age, 40.80 ± 13.15 years; range, 18-72 years) and 34 age- and sex-matched healthy controls (mean age, 42.00 ± 12.32 years; range, 18-60 years). All underwent a complete ophthalmological and physical examination, including visual acuity testing and biomicroscopic anterior and posterior segment examinations. Corneal hysteresis, corneal resistance factor, Goldmann-correlated intraocular pressure, and corneal compensated intraocular pressure were evaluated with an ocular response analyzer, and the central corneal thickness was measured with Sirius® corneal tomography. The Bath Ankylosing Spondylitis Disease Activity Index, Functional Index, and Metrology Index scores were recorded. RESULTS: In the ankylosing spondylitis patients, the mean disease duration was 7.73 ± 6.05 (range, 1-30) years. There was no statistically significant difference between the patients and controls in the corneal biomechanical features. The Goldmann-correlated intraocular pressure and corneal compensated intraocular pressure both showed positive correlations with age (p=0.003 and p=0.001, res-pectively). There was a negative correlation between corneal hysteresis and disease duration (p=0.002), and between central corneal thickness and the Bath Ankylosing Spondylitis Metrology Index score (p=0.003). CONCLUSION: This study demonstrated a significant negative correlation between corneal hysteresis and disease duration in ankylosing spondylitis patients. Furthermore, the central corneal thickness value decreased with an increase in Bath Ankylosing Spondylitis Metrology Index score, which may result in an underestimate of intraocular pressure readings and thus an inaccurate risk assessment of glaucoma.

Corneal biomechanical features in patients with ankylosing spondylitis / Características biomecânicas da córnea entre pacientes com espondilite anquilosante

ABSTRACT Purpose: To evaluate the corneal biomechanical features and central corneal thickness in ankylosing spondylitis patients and to evaluate correlations of these parameters with disease activity. Methods: The study included 51 patients diagnosed with ankylosing spondylitis (mean age, 40.80 ± 13.15 years; range, 18-72 years) and 34 age- and sex-matched healthy controls (mean age, 42.00 ± 12.32 years; range, 18-60 years). All underwent a complete ophthalmological and physical examination, including visual acuity testing and biomicroscopic anterior and posterior segment examinations. Corneal hysteresis, corneal resistance factor, Goldmann-correlated intraocular pressure, and corneal compensated intraocular pressure were evaluated with an ocular response analyzer, and the central corneal thickness was measured with Sirius® corneal tomography. The Bath Ankylosing Spondylitis Disease Activity Index, Functional Index, and Metrology Index scores were recorded. Results: In the ankylosing spondylitis patients, the mean disease duration was 7.73 ± 6.05 (range, 1-30) years. There was no statistically significant difference between the patients and controls in the corneal biomechanical features. The Goldmann-correlated intraocular pressure and corneal compensated intraocular pressure both showed positive correlations with age (p=0.003 and p=0.001, res­pectively). There was a negative correlation between corneal hysteresis and disease duration (p=0.002), and between central corneal thickness and the Bath Ankylosing Spondylitis Metrology Index score (p=0.003). Conclusion: This study demonstrated a significant negative correlation between corneal hysteresis and disease duration in ankylosing spondylitis patients. Furthermore, the central corneal thickness value decreased with an increase in Bath Ankylosing Spondylitis Metrology Index score, which may result in an underestimate of intraocular pressure readings and thus an inaccurate risk assessment of glaucoma.

RESUMO Objetivo: Avaliar as características biomecânicas da córnea e espessura central da córnea em pacientes com espondilite anquilosante e analisar a correlação destes parâmetros no grupo de estudo com a atividade da doença. Métodos: Foram incluídos no estudo 51 pacientes com diagnóstico de espondilite anquilosante e 34 controles saudáveis com idade e sexo. Todos os sujeitos foram submetidos a um exame oftalmológico e físico completo, incluindo exames de acuidade visual, exames de segmento anterior e posterior biomicroscópicos. Foram avaliados o coeficiente de resistência da córnea, a pressão intraocular correlacionada com Goldmann e a pressão intraocular compensada da córnea com o analisador de resposta ocular, a espessura corneana central com a tomografia corneana pelo Sirius®. Se o índice de atividade da doença de espondilite anquilosante de banho, o índice funcional de espondilite anquilosante de banho, o índice de metrologia de espondilite anquilosante de banho. Resultados: Foram incluídos no estudo 51 pacientes com idade média de 40,80 ± 13,15 (intervalo: 18-72) anos e 34 casos de controle com idade média de 42,00 ± 12,32 (intervalo: 18-60) anos. No grupo espondilite anquilosante a duração média da doença foi de 7,73 ± 6,05 (1,00-30,00) anos. Não houve diferença estatisticamente significante entre dois grupos quanto às características biomecânicas da córnea. Na análise de correlação, no grupo de estudo; pressão intraocular correlacionada com Goldmann e pressão intraocular compensada da córnea estavam positivamente correlacionados com a idade (p=0,003, p=0,001, respectivamente). Houve uma correlação negativa entre a duração da doença e CH (p=0,002), e entre índice de metrologia de espondilite anquilosante de banho e espessura corneana central (p=0,003). Conclusão: Este estudo demonstrou correlação negativa significativa entre a duração da doença e a histerese corneal em pacientes com espondilite anquilosante. Além disso, com um aumento na pontuação de índice de metrologia de espondilite anquilosante de banho, o valor de espessura corneana central também estava di­minuindo o que pode causar uma diminuição nas leituras de pressão intraocular artificialmente e resultar em avaliação de risco imprecisa de glaucoma.