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.

The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome.

PURPOSE: The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS). DESIGN: Retrospective cohort, comparative study. METHODS AND MATERIALS: The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit. RESULTS: Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032). CONCLUSION: All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.

Preparation and Characterization Studies of Dorzolamide-Loaded Ophthalmic Implants for Treating Glaucoma.

Objectives: This study constructed dorzolamide (DRZ)-loaded ophthalmic implants for extended drug delivery and increased drug retention. Materials and Methods: Carboxymethyl cellulose (CMC) and chitosan (CHI) were used to describe the ophthalmic implants. The implants were prepared by the solvent casting technique in presence of polyethylene glycol 6000 (PEG 6000) as plasticizer. Physicochemical characterization studies including mechanical characteristics [tensile strength (TS), elongation at break, and Young's modulus], bioadhesion studies, and in vitro and ex vivo drug release studies were conducted. Results: TS of drug-loaded ophthalmic implants was 10.70 and 11.68 MPa, respectively. Elongation at break of CMC and CHI implants was 62.00% and 59.05%, respectively. The in vitro release profiles fit into Higuchi type kinetic model. Ex vivo release study results for both implants were correlated with in vitro release investigations. Conclusion: CMC and CHI-based implants provide extended drug delivery. Implants prepared using CMC provided a significantly slower in vitro release rate, and drug retention on ocular surfaces increased. Thus, it has been concluded that DRZ-loaded CMC implants could provide effective treatment for glaucoma.

The Comparison of Age-related Change in Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses between Glaucoma Suspects and Healthy Individuals.

Aim: The purpose of this study is to investigate the difference of change in the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC) thickness according to age in glaucoma suspect individuals and healthy subjects. Materials and methods: Thicknesses of RNFL and GCC were measured with spectral domain optical coherence tomography (SD-OCT) in glaucoma-suspected individuals and healthy subjects. The differences in age, overall mean, four quadrants, and 12 clock-hour sectors of RNFL and overall mean, superior half, and inferior half GCC thicknesses between glaucoma suspects and healthy participants were analyzed and compared using linear regression analyses. Results: There were 201 glaucoma-suspect individuals and 121 healthy subjects with a mean age of 38.89 and 40.26 years, respectively (p = 0.27). The mean overall RNFL thickness was found to be 97.76 and 97.43 µm in healthy individuals and glaucoma suspects (p = 0.72). The mean overall GCC thickness was found to be 111.30 and 104.67 µm in healthy individuals and glaucoma suspects, respectively (p < 0.001). There was a 0.11 µm decrease per year found in overall GCC thickness in glaucoma suspects and 0.23 µm decreases per year in overall GCC thickness in healthy individuals (p < 0.001). There was a 0.02 µm decrease per year found in overall RNFL thickness in glaucoma suspects and a 0.29 µm decrease per year in overall RNFL thickness in healthy individuals (p < 0.001). However, these per-year decreases in GCC thickness glaucoma suspects and healthy individuals were not found to be statistically significant (p = 0.21); on the other hand, this difference for RNFL thickness was significant (p < 0.001). Conclusion: It was found that the thicknesses of RNFL and GCC were different between glaucoma suspects and healthy individuals. However, age-related decay in the RNFL and GCC thicknesses was not uniform in healthy individuals and glaucoma suspects. Clinical significance: It was found that the RNFL thickness and GCC thickness were lower in glaucoma suspects than in healthy controls eyes. However, an age-related decrease of RNFL and GCC thicknesses were found to be less in glaucoma suspects compared with healthy controls. How to cite this article: Firatli G, Elibol A, Altinbas E, et al. The Comparison of Age-related Change in Retinal Nerve Fiber Layer and Ganglion Cell Complex Thicknesses between Glaucoma Suspects and Healthy Individuals. J Curr Glaucoma Pract 2023;17(1):22-29.

A rare cause of recurrent subconjunctival hemorrhage: ocular vicarious menstruation.

Purpose: Vicarious menstruation is cyclical bleeding in extra-uterine locations that occurs during menstruation or within 48 h of its onset. We aim to present a 43-year-old female with ocular vicarious menstruation, its treatment, and a review of other published cases of ocular vicarious menstruation. Case description: A 43-year-old Caucasian female presented with a 15-year history of recurrent monthly unilateral subconjunctival hemorrhage. The episodes were cyclical and coincided with the onset of menses, lasting for approximately 10 to 14 days. Slit-lamp examination of the right eye showed nasally located subconjunctival hemorrhage. Detailed laboratory findings, including parameters for various hematological disorders, were normal. A follow-up examination 2 weeks later showed that the subconjunctival hemorrhage in the right eye was completely resolved. The patient was prescribed the oral contraceptive levonorgestrel/ethinyl estradiol and marked improvement at the recurrences of subconjunctival hemorrhage was noted during subsequent menses. Conclusion: Ocular vicarious menstruation is among the rarest causes of recurrent subconjunctival hemorrhage. A therapeutic trial of oral contraceptive should be considered in patients that present with ocular vicarious menstruation.

Artificial intelligence based detection of age-related macular degeneration using optical coherence tomography with unique image preprocessing.

PURPOSE: The aim of the study is to improve the accuracy of age related macular degeneration (AMD) disease in its earlier phases with proposed Capsule Network (CapsNet) architecture trained on speckle noise reduced spectral domain optical coherence tomography (SD-OCT) images based on an optimized Bayesian non-local mean (OBNLM) filter augmentation techniques. METHODS: A total of 726 local SD-OCT images were collected and labelled as 159 drusen, 145 dry AMD, 156 wet AMD and 266 normal. Region of interest (ROI) was identified. Speckle noise in SD-OCT images were reduced based on OBNLM filter. The processed images were fed to proposed CapsNet architecture to clasify SD-OCT images. Accuracy rates were calculated in both public and local dataset. RESULTS: Accuracy rate of local SD-OCT image dataset classification was achieved to a value of 96.39% after performing data augmentation and speckle noise reduction with OBNLM. The performance of proposed CapsNet was also evaluated on the public Kaggle dataset under the same processing procedures and the accuracy rate was calculated as 98.07%. The sensitivity and specificity rates were 96.72% and 99.98%, respectively. CONCLUSIONS: The classification success of proposed CapsNet may be improved with robust pre-processing steps like; determination of ROI and denoised SD-OCT images based on OBNLM. These impactful image preprocessing steps yielded higher accuracy rates for determining different types of AMD including its precursor lesion on the both local and public dataset with proposed CapsNet architecture.

Assessment of risk factors on eye dryness in young adults using visual display device in both contact lens wearers and non-wearers.

PURPOSE: Researchers are interested in examining the impact of visual display devices (VDDs) on the development of dry eye illness because their use is becoming more common among college students. The goal of this study was to see if there was a link between certain risk factors and the development of eye dryness in VDDs using young adults who wore contact lenses and those who did not. METHODS: The self-administrated survey was hosted in Google Forms, sent via e-mail to the participants. It consisted of two parts of assessing different risk factors (i.e., environmental conditions, angle of gaze, and years of VDD use) with contact lens use and Ocular Surface Disease Index (OSDI) questionnaire. The OSDI scores of the entire sample who suffer from dry eye and the subgroup using contact lenses were calculated. The relationship between different risk factors with the OSDI scores was also assessed. RESULTS: A total of 274 young adults from college students and academic staff (216 female, 58 male) were suffering from eye dryness. Eighty-eight of the 274 participants wore contact lenses. The mean OSDI scores of the 274 young adults were 32.92. Mean OSDI scores in contact lens wearers and non-wearers were 34.36 and 32.24, respectively (p < 0.01). There was a statistically significant relationship between OSDI score and indoor environmental conditions in computer using VDD group. Using a computer in a dark environment and above the line of sight resulted in a higher OSDI scores. Females who wore contact lenses while using a computer for more than three years had significantly higher OSDI scores than non-wearer females. Tablet type VDD use increased the mean ODSI scores of the contact lens wearers significantly. CONCLUSIONS: Dry eye symptoms were shown to be increased in the contact lens wearer group with the increased duration of computer VDD use, decreased indoor environmental brightness conditions, and above the line of sight.

Autoimmune Disease-Related Dry Eye Diseases and Their Placement Under the Revised Classification Systems: An Update.

Dry eye disease (DED) is a chronic and progressive disorder involving the ocular surface, characterized by disturbances in tear film composition, instability of the tear film, and inflammation of the ocular surface. There are two forms of DED: aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE). Autoimmune diseases are systemic disorders involving multiple organs, including the eyes, and have a significant impact on DED. There have been multiple studies demonstrating the relation between autoimmune diseases and DED. This article reviews the current knowledge regarding the epidemiological characteristics, pathogenesis, and treatments of autoimmune disease-related DED.

Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide.

PURPOSE: To evaluate the efficacy and safety of topical dexamethasone (DEX) eye drops in combination with a single perioperative subtenon triamcinolone acetonide (sTA) injection versus conventional topical DEX eye drops in the prevention of ocular inflammation and cystoid macular edema following cataract surgery. MATERIALS AND METHODS: Medical records of 245 eyes of 245 patients who underwent uncomplicated cataract surgery were analyzed in this retrospective controlled clinical study. Topical DEX eye drops were administered to 128 eyes routinely postoperatively, and 117 eyes were given a single dose of sTA (40 mg/ml) together with topical DEX eye drops for postoperative care. Postoperative topical antibiotic prophylaxis was applied to all eyes. The primary outcomes were anterior chamber (AC) cells and flare, central macular thickness (CMT), best corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements on day 7, day 30, day 90, and day 180 following surgery. RESULTS: Although CMT increased in the DEX group, no increment was observed in the DEX + sTA treated group for all follow-up periods (on day 7 (+1.3 ± 18.6 and -8.7 ± 21.9 µm, p = 0.038), on day 30 (+20.5 ± 58.4 and -4.1 ± 25.2 µm, p = 0.009), on day 90 (+7.2 ± 19.9 and -5.7 ± 30.6 µm, p = 0.029), and on day 180 (+8.2 ± 22.6 and -6.4 ± 32.9 µm, p = 0.032)). There was no significant difference in terms of AC cells and flare between the two groups during the entire follow-up period (p > 0.05). Significant improvement in BCVA was observed in the DEX + sTA group at day 30 (p = 0.008). IOP differences were comparable, and both groups had high ocular tolerance. There were no severe adverse effects recorded. CONCLUSIONS: Topical DEX eye drops in combination with single dose perioperative injection of sTA have robust efficacy in preventing ocular inflammation and the development of cystoid macular edema following uncomplicated cataract surgery.

Long term results of three anti-vascular endothelial growth factor agents in pachychoroid neovasculopathy.

PURPOSE: To assess morphological changes and visual results in eyes with pachychoroid neovasculopathy (PNV) that underwent different intravitreal anti-vascular endothelial growth factor (VEGF) agents. MATERIALS AND METHODS: This is a retrospective, observational, comparative study that included 76 PNV eyes in 76 patients that were allocated to three groups according to the monotherapy injection procedure, as follows: the intravitreal bevacizumab (IVB) group, intravitreal ranibizumab (IVR) group, and intravitreal aflibercept (IVA) group. Central macular thickness (CMT), best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) were measured at baseline, after treatment 1st month, 3rd month, 6th month, and 12th month, and at the final post-treatment examination. RESULTS: Mean age of the patients was 57.31 ± 5.91 years (range: 34-67 years). The mean duration of follow-up was 31.50 ± 12.91 months (range: 13-60 months). The IVB group included 30 eyes, the IVR group included 22 eyes, and the IVA group included 24 eyes. There weren't any significant differences in BCVA changes between the groups at any post-baseline measurement time point. Although CMT did not change significantly in the IVB group from baseline to the final follow-up visit (baseline: 376.33 ± 86.31 µm; final visit: 340.80 ± 122.70 µm) (p = 0.172), CMT did change significantly in the IVA group (baseline: 383.41 ± 131.83 µm; final visit: 297.33 ± 103.81 µm) (p = 0.029) and IVR group (baseline: 379.18 ± 97.93 µm; final visit: 335.72 ± 111.45 µm) (p = 0.041). SFCT decreased significantly in the IVR and IVA groups (p = 0.015 and p < 0.001, respectively). The mean number of injections was 12.06 ± 4.72 (range: 6-20) in the IVB group, 11.81 ± 3.31(range: 7-17) in the IVR group, and 7.16 ± 3.15 (range: 4-13) in the IVA group (p = 0.004). CONCLUSION: All three anti-VEGFs were effective in terms of visual results in patients with PNV. Patients treated with IVA required fewer injections than those treated with IVB or IVR. Furthermore, IVR and IVA treatment significantly decreased SFCT, whereas IVB did not.

Subthreshold Photocoagulation, Laser Endpoint Management Based on Optical Coherence Tomography Angiography in Cases of Diabetic Macular Edema Refractory to Anti-VEGF.

PURPOSE: This study aimed to determine the changes that occur in the vasculature, as based on optical coherence tomography angiography (OCTA) after non-damaging endpoint management (EpM), using a continuous wave yellow laser. The study was on eyes with diabetic macular edema (DME) that were resistant to anti-vascular endothelial growth factors (anti-VEGFs). MATERIALS AND METHODS: This was a retrospective analysis of OCTA images of 44 eyes in 44 patients with DME refractory to anti-VEGF. The eyes were treated with a PASCAL Streamline yellow laser (577 nm wavelength, 200 mm spot size). Treatment was administered to the DME area and utilized 10% continuous wave laser energy and 0.50 µm beam diameter spot spacing. Best-corrected visual acuity (BCVA) and enhanced in-depth imaging with optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) images were recorded at baseline, and 3 and 6 months posttreatment. Total choroidal area (TCA), luminal area (LA), stromal area (SA), and the choroidal vascularity index (CVI) were calculated using Image J software. The macula was divided into five quadrants in accordance with the mapping system in the Early Treatment Diabetic Retinopathy Study (ETDRS). RESULTS: All patients (mean age: 58.90 ± 9.55 years) were diagnosed with diabetes mellitus type 2. Mean BCVA at baseline was 0.30 ± 0.11 logarithm of the minimum angle of resolution (logMAR) versus 0.23 ± 0.10 logMAR at 3 months (p = 0.032) and 0.17 ± 0.10 logMAR at 6 months (p = 0.013). The foveal avascular zone area (FAZ) decreased in the deep capillary plexus (DCP) from baseline to 6 months (p = 0.028). Vessel densities (VDs) of the superficial capillary plexus (SCP), DCP, and choriocapillaris decreased significantly in the fovea at 3 and 6 months compared to baseline (p < 0.05 for both follow-up time points). There were significant decreases in SCP and DCP in the superior quadrant at the end of month 6 (p = 0.001 and p = 0.038, respectively). There was a significant decrease in the nasal quadrant of the DCP and choriocapillaris at the end of month 6 (p = 0.024 and p = 0.049, respectively). Although there was a significant decrease in central macular thickness (CMT) (p < 0.001), subfoveal choroidal thickness (SFCT) (p < 0.001), and LA (p = 0.034) at months 3 and 6, there was no significant change in the CVI (p = 0.19). According to the DME recovery rate, 36 eyes (81%) were irradiated once, whereas 8 eyes (19%) were irradiated twice. CONCLUSIONS: Non-damaging EpM therapy using a continuous wave yellow laser in eyes with DME that are resistant to anti-VEGFs induces significant changes in the SCP, choriocapillaris, and, most commonly, the DCP, which caused a significant decrease in VDs during 6 months of follow-up.

The efficacy of different anti-vascular endothelial growth factor agents and prognostic biomarkers in monitoring of the treatment for myopic choroidal neovascularization.

PURPOSE: To evaluate anatomical and visual results of eyes with naive myopic choroidal neovascularization (mCNV) in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapies. MATERIAL AND METHODS: This is a retrospective, non-randomized, comperative, intervetional study. One hundred fourteen eyes of 114 patients with mCNV who underwent intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) monotherapy injections were enrolled into the study. The best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were compared among the groups during the follow-up periods at the beginning, months 1, 3, 6, 12, and the final visit. RESULTS: The mean age of the patients was 47.76 ± 10.57 years (range, 33-72 years) and the mean follow-up period was 23.34 ± 6.81 months (range, 13-38 months). The mean BCVA denoted a significantly improve at each group (p < 0.05). In terms of an inter-group analysis of all 3 groups, at months 1, 6, and 12 and final visit, the BCVA were statistically significantly better in the IVA group when compared to both IVB and IVR groups (p = 0.021, p = 0.032, p = 0.024, p = 0.012). There was a significant decrease in CMT following IVB (236.49 ± 40.91 µm-190.74 ± 50.12 µm), IVA (232.91 ± 46.29 µm-193.73 ± 46.81 µm) and IVR (234.78 ± 45.37 µm-192.21 ± 37.27 µm) between baseline and final visit (p = 0.018, p = 0.002, p < 0.001, respectively). There was a statistically significant decrease in SFCT values between baseline and final examination only in the IVA group (p < 0.001). The mean number of injections were 9.18 ± 3.18 (range; 3 to 13) in IVB, 6.46 ± 2.93 (range; 3-11) in IVR and 4.45 ± 1.42 (range; 2-7) in IVA (p = 0.028). CONCLUSION: All three anti-VEGFs were found to be effective in terms of visual results in patients with mCNV. However, we demonstrated that IVA reduces the need for anti-VEGF when compared to patients who received both IVB and IVR. Furthermore, IVA induced a prominent reduction in SFCT, whereas IVR and IVB did not have a significant action on SFCT.

Comparison of Retinochoroidal Vascular and Structural Changes after Half-Dose Photodynamic Therapy versus Half-Fluence Photodynamic Therapy Based on Optical Coherence Tomography Angiography in Eyes with Chronic Central Serous Chorioretinopathy.

PURPOSE: The aim of this study is to compare the efficacy of half-fluence photodynamic therapy (PDT) and half-dose PDT on the choroidal structure via perfusion of the retinal plexus and choriocapillaris in eyes with chronic central serous chorioretinopathy (cCSCR). MATERIALS AND METHODS: This retrospective study included 43 eyes in 43 patients with cCSCR. Patients in group 1 received half-fluence (verteporfin 6 mg m-2) PDT and those in group 2 received half-dose (verteporfin 3 mg m-2) PDT. Enhanced depth imaging optical coherence tomography and optical coherence tomography angiography (OCTA) images were recorded 1 day before and 3 months after PDT. Total choroidal area (TCA), luminal area (LA), and stromal area (SA) were calculated using Image J software. RESULTS: From baseline to 3 months post PDT TCA decreased from 2.43 ± 0.47 mm2 to 2.08 ± 0.59 mm2 (p < 0.001), LA decreased from 1.78 ± 0.11 mm2 to 1.54 ± 0.26 mm2 (p < 0.001), and SA decreased from 0.76 ± 0.33 mm2 to 0.53 ± 0.37 mm2 (p < 0.001) in group 1. Choriocapillaris vascular density measured via OCTA increased from 37.82 ± 10.99 at the initial visit to 44.96 ± 15.34 at month 3 after half-fluence PDT administered to the fovea (p < 0.001). Deep capillary plexus vessel density was 32.49 ± 11.36 at baseline and increased to 43.27 ± 11.40 at month 3 after half-fluence PDT administered to the fovea (p < 0.001) in group 1. TCA decreased to 2.00 mm2 ± 0.51 mm2 from 2.39 mm2 ± 0.43 mm2 (p < 0.001), LA decreased to 1.53 ± 0.29 mm2 from 1.74 ± 0.16 mm2 (p = 0.019). Although SA decreased from 0.76 ± 0.33 mm2 to 0.53 ± 0.37 mm2 in group 2, the difference was not significant (p = 0.07). Based on OCTA, choriocapillaris vascular density increased from 43.68 ± 10.38 mm2 at baseline to 47.46 ± 6.42 mm2 at 3 months after half-dose PDT onto the fovea (p = 0.049). Deep capillary plexus vessel density increased from 34.37 ± 9.36 mm2 at the initial visit to 38.17 ± 8.81 mm2 3 months after half-dose PDT onto the fovea (p = 0.046) in group 2. At 3 months, post-PDT subretinal fluid (SRF) was significantly higher resolution in group 1 than in group 2 (p = 0.021). CONCLUSIONS: OCTA shows there is a significant increase in deep capillary plexus and choriocapillaris perfusion 3 months after both half-fluence PDT and half-dose PDT. Although there was a significant decrease in LA in both groups, based on OCTA there was a significant decrease in SA, a significant increase in choriocapillaris and deep capillary perfusion in group 1; therefore, the level of SRF resolution at month 3 post PDT might explain its higher incidence in group 1.

Predictive value of ectopic inner foveal layer without internal limiting membrane peeling for idiopathic epiretinal membrane surgery.

PURPOSE: To investigate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) in patients diagnosed with idiopathic epiretinal membrane (iERM) and had pars plana vitrectomy (PPV) with solely ERM peeling. MATERIALS AND METHODS: Patients diagnosed with iERMs who had undergone PPV including only ERM peeling were enrolled in the study, and follow-up findings were recorded at baseline, and at 3, 6, 12 months and final examinations. EIFL was categorized into four grades, from mild to severe. Pre- and postoperative anatomical changes were measured using spectral domain optical coherence tomography (SD-OCT) imaging. The association between EIFL and other SD-OCT parameters with best-corrected visual acuity (BCVA) was assessed before and after PPV surgery. RESULTS: One-hundred thirty-eight eyes of 106 patients with mild to severe EIFL were included in the study. Higher EIFL thickness was significantly correlated with lower baseline (r = 0.575, p = 0.020) and final BCVA (r = 0.748, p = 0.001). Although EIFLs continued in advanced-stage cases (stage 3 and 4) (64 eyes [82%]) at the final visit, it was observed in 8 eyes (23%) in the early stage (stage 2) of iERMs. A strong positive correlation was found between EIFL thickness and recurrence rate of ERM (r = 0.876, p < 0.001). Recurrence of ERM was detected in 27 eyes; 2 (7%) at stage 1, 3 (9%) at stage 2, 10 (23%) in stage 3, and 12 (33%) in stage 4 (p < 0.001). CONCLUSION: A negative association was found between the severity of EIFL and postoperative anatomical and visual recovery. In terms of surgical timing, early stages (stages 1 and 2) may be preferred for providing good anatomical and visual recovery and a low recurrence rate following surgery.

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.

Clinical Performance of Samfilcon A Contact Lenses in Intensive Digital Device Users: A Multicenter, Prospective Clinical Study.

INTRODUCTION: To evaluate patient satisfaction with samfilcon A contact lenses (CLs) in intensive digital device users with myopia and to compare patient satisfaction with samfilcon A lenses to prior experience with senofilcon A or lotrafilcon B CLs. METHODS: This was a comparative, prospective, national study conducted at 14 centers in Turkey. Subjects were adults aged 18 and 45 years with myopia (range -0.25 D to -6.00 D) who spend a minimum of 3 hours viewing digital devices (e.g., computer, smartphone). A subgroup of patients were habitual lens wearers (senofilcon A or lotrafilcon B lens wear for at least 6 months prior to enrollment). The primary assessment was patient satisfaction with samfilcon A lenses (0-100 Likert scale). Secondary assessments included patient satisfaction with samfilcon A lenses compared to patients' habitual lenses, investigator satisfaction with samfilcon A lenses and investigator-evaluated slit lamp examination findings. RESULTS: Samfilcon A lenses were given high overall ratings from both patients and investigators, with a low incidence of ocular symptoms. Overall, patients were highly satisfied with samfilcon A lenses for comfort, vision and overall performance, and stated that they would consider wearing these lenses in the future. Among habitual senofilcon A or lotrafilcon B lens wearers, samfilcon A lenses were rated significantly better than the habitual lenses in regard to comfort, vision and overall performance. Investigator assessments were also highly favorable, both at initial fit and after 4 weeks of follow-up, with no significant findings noted on slit lamp examination. CONCLUSION: Samfilcon A lenses were rated highly by investigators in regard to fit, handling and slit lamp findings, and by novice and habitual lens wearers in regard to comfort, vision and overall performance. These results support the use of samfilcon A lenses among digital device users who seek day-long comfort and good visual acuity.

Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives.

The central retinal artery occlusion (CRAO) is a rare ophthalmological emergency that can occur in the eye. CRAO can affect persons of any age, however it is most common in people over the age of 60. CRAO is associated with a number of risk factors, including giant cell arteritis, carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and thromboembolic disease. The chance of each of these etiologies being present is assessed during the course of the investigation. Hyperbaric oxygen treatment (HBOT) is classified by the American Heart Association for CRAO at level IIb. In accordance with that, HBOT might be considered for the treatment of such a severe condition. HBOT can maintain retinal oxygenation during ischemic events by allowing oxygen to diffuse through choroidal capillaries that have been exposed to elevated partial pressures of oxygen. As a result, ischemia-related damage is reversed if applied within proper time frame. The amount of time that has passed prior to initiation of HBOT is considered to be the most critical factor in determining the best visual prognosis. According to the Undersea and Hyperbaric Medical Society, patients who are identified with CRAO after the onset of symptoms should be evaluated for HBOT within 24 hours. HBOT has the advantage of having a low risk profile, and it can be utilized to improve visual outcomes in proper patients.

The effect of topical ocular moxifloxacin on conjunctival and nasal mucosal flora.

To determine the short-term effect of topically administered ocular moxifloxacin on conjunctival and nasal bacterial mucosal flora. The study included 20 patients with newly diagnosed age-related macular degeneration. Each patient's diseased eye was selected as the treatment eye and the fellow eye was selected as the control eye. All treatment eyes constituted the treatment group and all controls eyes constituted the control group. All patients received intravitreal injection of ranibizumab. Cultures were obtained from the inferior conjunctival fornix and the nostrils in all patients. Patients were instructed to administer moxifloxacin eye drops to the treatment eye 4 times daily for 1 week. The patients were instructed to come for a follow-up exam 1 week post intravitreal injection. The bacterial culture positivity rate and the bacteria isolated from the conjunctiva and nostrils were recorded in the 2 groups before and after use of topical ocular moxifloxacin. Mean age of the patients (12 female and 8 male) was 64.9 years. Before use of topical ocular moxifloxacin the conjunctival and nasal culture positivity rates in the treatment group were both 100%, versus 90% and 95%, respectively, in the control group. At the follow-up exam the conjunctival and nasal mucosa culture positivity rates in the treatment group decreased to 20% (4/20) and 30% (6/20), respectively (P < 0.001), versus 85% (17/20) and 80% (16/20), respectively, in the control group (P = 0.68 and P = 0.72 for conjunctival and nasal). This is the first study to show that moxifloxacin applied to the ocular surface topically has a significant effect on nasal flora. Daily administration of topical ocular moxifloxacin for 1 week significantly reduces the nasal bacterial flora in addition to conjunctival flora.

Choroidal vascularity index: an enhanced depth optical coherence tomography-based parameter to determine vascular status in patients with proliferative and non-proliferative macular telangiectasia.

KEY MESSAGES: The pathogenesis of subretinal neovascularization (SRNV) due to macular telengiectasia (MacTel 2) has not fully elucidated. This optical coherence tomography (OCT)-based method can provide better understanding of the pathogenesis of SRNV due to MacTel 2. PURPOSE: To evaluate the choroidal vascular index (CVI) through optical coherence tomography (OCT) on eyes with proliferative macular telangiectasia type 2 (MacTel 2) or non-proliferative MacTel 2, and in healthy individuals. METHODS: Macular enhanced depth imaging OCT scans on 42 eyes of 21 patients with non-proliferative MacTel 2, on 32 eyes of 20 patients with proliferative MacTel 2, and on 38 eyes of 32 control patients were analyzed by adjusting for age-gender-axial length. Proliferative MacTel 2 was diagnosed when subretinal neovascularization (SRNV) was simultaneously observed in the non-proliferative phase. Binarization methods of ImageJ software were used to analyze images, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were obtained. CVI was characterized as the ratio of LA to TCA. RESULTS: The mean TCA and SA were significantly higher in group 1 and group 2 when compared with group 3 (3.36 ± 0.29 mm2 vs. 3.27 ± 0.76 mm2 vs. 2.49 ± 0.24 mm2, p < 0.001; 1.15 ± 0.31 mm2 vs. 1.10 ± 0.69 mm2 vs. 0.35 ± 0.23 mm2, respectively; p < 0.001). Although LA was relatively higher in group 1 and group 2 than group 3, no statistically significant difference was observed (2.22 ± 0.14 mm2 vs. 2.17 ± 0.15 mm2 vs. 2.13 ± 0.21 mm2) (p = 0.088). CVI was significantly lower in group 1 than other groups (0.65 ± 0.01 vs 0.67 ± 0.02 vs 0.68 ± 0.02) (p < 0.001). CONCLUSION: As an OCT screening method, CVI may be used to assess the vascular status of the choroid on the eyes which are naive for or were exposed to SRNV secondary to MacTel 2, and to elucidate the pathogenesis of this disease.