Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

Purpose: The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods: The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results: In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions: Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Retinal findings similar to retinopathy of prematurity in a term-infant with congenital cytomegalovirus infection.

PURPOSE: To present a term-born infant with congenital cytomegalovirus (C-CMV) infection with an atypical retinal finding mimicking retinopathy of prematurity (ROP). CASE DESCRIPTION: A term-born infant was referred to our clinic due to a C-CMV infection. Fundoscopic examination of both eyes revealed a demarcation line at zone II level and peripheral avascular retina along the temporal retina. There was no chorioretinitis, no vitritis, and no retinal vasculitis. There was no history of oxygen supplementation. The demarcation lines in both eyes regressed spontaneously within 3 weeks without any sequelae. CONCLUSIONS: It has been known for many years that C-CMV infection may affect the eye, and chorioretinitis is the most common finding. In this case report, we presented an atypical ROP-like retinal finding in an infant with C-CMV infection. We think that the development of retinal vascularization may be affected by C-CMV infection. We hope that this finding may provide a clue for future investigations to understand the relationship between the pathogenesis of ROP and infection-induced inflammatory processes in prenatal and perinatal life.

The effects of smoking on dry eye parameters in healthy women.

AIM: To investigate the effects of chronic smoking on dry eye parameters. METHODS: Ocular surface disease index (OSDI) and tear function tests such as Schirmer's test, tear break-up-time (TBUT) test and impression cytology of 63 female chronic smokers and 40 age-matched female non-smokers were analyzed statistically. RESULTS: The mean OSDI scores, Schirmer test results and TBUT levels were 35.85 ± 24.01 point, 14.25 ± 5.94 mm and 5.17 ± 2.85 s in chronic smokers and 15.20 ± 12.93 point, 15.48 ± 7.01 mm and 10.03 ± 3.44 s in non-smokers, respectively. Differences in OSDI scores, TBUT levels and impression cytology grades among the chronic smokers and non-smokers were statistically significant. CONCLUSION: Smoking behavior seems to affect the dry eye parameters negatively.

The Effect of Laser Photocoagulation on Intraocular Pressure in Premature Infants With Retinopathy of Prematurity.

PURPOSE: To evaluate the effects of diode laser treatment on intraocular pressure (IOP) of premature infants with retinopathy of prematurity (ROP). PATIENTS AND METHODS: The premature infants who underwent retinal laser photocoagulation therapy for ROP, and gestational age-matched, birth weight-matched, and sex-matched premature infants with ROP which recovered spontaneously without any treatment were enrolled into the study. Anterior segment examination and longitudinal IOP and central corneal thickness measurements were performed 5 times as follows: 1 day before the laser treatment (T0), and 24 hours (T1), 1 week (T2), 1 month (T3), and 3 months (T4) after the laser treatment. Premature infants who experienced any complication related to the laser treatment were excluded from the study. RESULTS: Laser treated 67 premature infants and 70 premature infants in control group met inclusion criteria. Significant linear decreases in IOP and central corneal thickness values were measured throughout the study period for both groups (both, P<0.001). These changes were similar in 2 groups. There was a statistically insignificantly (P=0.999) and transient increase in the mean IOP value in the laser-treated group 24 hours after laser treatment. None of the patients in the laser-treated group experienced a shallow anterior chamber or a remarkable IOP elevation. CONCLUSIONS: Diode laser treatment for ROP was safe, and did not raise the IOP of premature infants.

Clinical features of infants treated for severe retinopathy of prematurity: 8-yearstudy from a large tertiary neonatal intensive care unit in Turkey.

BACKGROUND/AIM: The aim of this study was to report the gestational age (GA) and birth weight (BW) distribution of premature babies who needed treatment for retinopathy of prematurity (ROP) and to assess the timing of the treatment. MATERIALS AND METHODS: The records of 9008 infants who were screened for ROP were examined and 556 infants who underwent laser therapy for ROP were reviewed. Sex, GA, BW, postnatal age, and postmenstrual (PM) age at the time of laser therapy were recorded. The babies were classified as in-born (Group 1) and out-born infants (Group 2). RESULTS: The mean GA was 27.3 weeks (range: 22-33 weeks) and the mean BW was 991.1 g (range: 520-2160 g). Of the treated infants, 7.0% were born later than 32 weeks and 8.3% were born over 1500 g. The mean postnatal age was 9.48 weeks (range: 5-22 weeks) and the mean PM age was 36.72 weeks (range: 29-48 weeks) at the time of treatment. Mean BWs and GAs were significantly higher and the mean postnatal age at the time of laser therapy was significantly earlier in Group 2. CONCLUSION: Infants with severe ROP had a wider range of BWs and GAs compared to those from developed countries and earlier treatment was needed for out-born infants.

Growth of biometric components and development of refractive errors in premature infants with or without retinopathy of prematurity.

BACKGROUND/AIM: To investigate the biometric components and refractive errors in premature infants with or without retinopathy of prematurity (ROP). MATERIALS AND METHODS: Anterior chamber depth, lens thickness, vitreous length, and axial length were measured with an ultrasound biometer. Cycloplegic refraction was performed by streak skiascopy. Infants with or without ROP were grouped according to postmenstrual age at the time of ocular examination: Group 1, ≤33 weeks; Group 2, 34-37 weeks; Group 3, 38-41 weeks; Group 4, 42-45 weeks; Group 5, ≥46 weeks. RESULTS: The mean postnatal age of 894 infants (451 females and 443 males) was 8.7 ± 4.5 weeks, gestational age was 30.9 ± 2.8 weeks, and birth weight was 1506 ± 484 g. In Group 2, the mean vitreous length and axial length of infants with ROP were significantly lower than those of infants without ROP (P = 0.011, P = 0.001). The mean anterior chamber depth, lens thickness, spherical equivalent, and astigmatism in all groups did not differ significantly among the infants with or without ROP (P > 0.05). CONCLUSION: The anterior chamber depth, lens thickness, vitreous length, and axial length showed a linear growth throughout the follow-up period. The maximum elongation was observed in vitreous length and axial length.

Determination of normal values of intraocular pressure and central corneal thickness in healthy premature infants-a prospective longitudinal study.

PURPOSE: To evaluate the longitudinal change of intraocular pressure (IOP) and central corneal thickness (CCT) in healthy premature infants. METHODS: Premature infants born at 28 weeks' gestational age were included in this prospective, single-center longitudinal study. IOP was measured by handheld applanation tonometer (Tono-Pen Avia); CCT measurements were performed by ultrasonic pachymeter. Examinations were held at 32 weeks' gestational age initially and at 2-week intervals thereafter for a total of 5 consecutive measurements by the same ophthalmologist. RESULTS: A total of 110 right eyes of 110 healthy premature infants were analyzed. The mean IOP at 32 weeks' gestational age was 18.28 ± 2.78 mm Hg; mean CCT, 670.56 ± 55.72 µm. Mean IOP and CCT thereafter were 16.13 ± 2.20 mm Hg and 613.67 ± 48.11 µm in week 34, 14.67 ± 2.04 mm Hg and 579.24 ± 43.73 µm in week 36, 13.49 ± 2.08 mm Hg and 551.91 ± 40.75 µm in week 38, and 13.21 ± 1.94 mm Hg and 546.18 ± 38.70 µm in week 40. The longitudinal changes of mean IOP and CCT values between 5 consecutive measurements were statistically significant (P < 0.001, for each). CONCLUSIONS: IOP and CCT values decrease longitudinally in healthy premature infants between 32 and 40 weeks' gestational age. Elevated IOP values, which were identified in the early premature period, seem to be associated with higher CCT values.

Effects of commonly used intravitreal anti-vascular endothelial growth factor drugs on mesenchymal stem cells derived from the limbus and ciliary body.

BACKGROUND: To investigate the effects of commonly used intravitreal anti-vascular endothelial growth factor (anti-VEGF) antibodies on proliferation index and viability of mesenchymal stem cells derived from ciliary body and limbus (CB-MSC and LMSC). METHODS: CB-MSCs and LMSCs were isolated from newborn rats' eyes, and they were expanded in medium by the explant method. Intravitreally used anti-VEGF drugs, aflibercept, bevacizumab and ranibizumab were tested into the 16-well plates, respectively, at four different concentrations. After keeping them for 48 h, the proliferation indexes and viabilities of CB-MSCs and LMSCs were compared separately by Real-Time Cell Analyzer and Methylthiazoltetrazoli (MTT) test. RESULTS: Anti-VEGFs used at 5-times and 10-times of the standard clinical dosage caused statistically significant negative effects on proliferation indexes of CB-MSCs and LMSCs at the 24th hour compared to control group. Only the anti-VEGF group that had 10-times dosage of those used clinically had a statistically significant negative effect on the viabilties of CB-MSCs and LMSCs. CONCLUSION: Administrations of high doses or repeated standard doses of intravitreal anti-VEGF agents may affect the proliferation indexes and viabilities of CB-MSCs and LMSCs adversely. These novel findings deserve further in vivo investigations.

The effects of commonly used intravitreal steroids on proliferation index of ciliary body-derived mesenchymal stem cells: an in vitro study.

AIM: To investigate the effects of commonly used intravitreal steroids on survival and proliferation (namely, proliferation index) of ciliary body-derived mesenchymal stem cells (CB-MSC). METHODS: CB-MSCs were isolated from newborn rats' eye, and they were expanded in the medium. Commonly used intravitreal steroids such as dexamethasone (Dex) and triamcinolone acetonide (TA) were added into the medium at commonly used concentration in clinical practice (0.1 mg/mL) and at lower concentration (0.01 mg/mL). Proliferation indexes of CB-MSCs were analyzed with the xCELLigence system at nine consecutive times (at 3rd, 6th, 21th, 30th, 45th, 60th, 75th, 90th and 100th h). RESULTS: Both TA and Dex at both 0.01 mg/mL and 0.1 mg/mL concentrations had negative effect on proliferation indexes of CB-MSC. Although negative effect of TA on proliferation index of CB-MSC at both concentrations was not statistically significant, statistically significant negative effect of Dex at 0.01 mg/mL concentration started 60th h (p = 0.017) and 0.1 mg/mL concentration started 30th h (p = 0.014). DISCUSSION: Even therapeutic doses of intravitreal corticosteroid agents might have negative effects on limited numbers of stem cells. Especially, Dex caused statistically significant toxic effects on CB-MSCs even at lower concentrations of those used clinically. These novel findings deserve further in vivo investigations.

Dry eye findings worsen with anticholinergic therapy in patients with urge incontinence.

INTRODUCTION AND HYPOTHESIS: To evaluate the effects of oral anticholinergic (OAC) drugs on tear secretion in women with overactive bladder over a 3-month follow-up period. METHODS: In this prospective study, 108 women with a diagnosis of overactive bladder were evaluated. All patients were examined ophthalmologically at baseline (day 0), and after 1 month (day 30) and 3 months (day 90) of OAC treatment. Tear film break-up time (BUT) and Schirmer 1 test results were recorded. The subjective complaints of the patients including dry mouth, and burning, dryness and foreign body sensation in the eyes, were also recorded. The chi-squared test or the paired sample t test as appropriate, was used for statistical analysis. RESULTS: The mean age of the patients was 51.8 ± 9.2 years (30 - 69 years). The most frequent subjective complaints were dry mouth and dry eyes and both complaints were significant on both day 30 and day 90. Both tear film BUT and Schirmer 1 test results were significantly lower on day 30 and day 90. Dry eye measurement values worsened with prolongation of OAC treatment (p = 0.037 and p = 0.012 for BUT, and p = 0.046 and p = 0.035 for Schirmer 1 test, on day 30 and day 90, respectively). CONCLUSIONS: OAC treatment in women with overactive bladder significantly and progressively affects tear secretion.

The short-term and long-term adverse ocular effects of fesoterodine fumarate.

AIM: To evaluate the short-term and long-term effects of fesoterodine fumarate treatment which is used for overactive bladder (OAB) on pupil diameter (PD), intraocular pressure (IOP) and accommodation amplitude (AA). METHOD: Ophthalmic examination was performed before and after receiving medication (on the 30th and 90th day) on 120 eyes of 120 women whom were planned to begin anticholinergic treatment (fesoterodine fumarate, 4 mg/day, peroral) for OAB, prospectively. The changes in PD, IOP and AA were analyzed statistically. RESULTS: The mean age of 120 women was 52.06 ± 9.39 years (30-70 years). The mean PD, IOP and AA values were 4.12 ± 0.61 mm (3.00-5.70 mm), 15.58 ± 1.74 mmHg (11-20 mmHg) 2.28 ± 1.26 Diopter (D) (0.50-5.50 D) at baseline; 4.68 ± 0.65 mm (3.20-5.80 mm), 16.11 ± 1.72 mmHg (11-20 mmHg), 1.68 ± 1.04 D (0.25-4.50 D) at 30th day; and 4.28 ± 0.58 mm (3.10-5.70 mm), 16.09 ± 1.96 mmHg (11-19 mmHg), 2.18 ± 1.19 D (0.50-5.00 D) at 90th day, respectively. Although increases in PD values and decreases in AA values were statistically significant (p < 0.001 for each), the changes in IOP values were not as such (p = 0.642). Visual complaint was not observed in any patient. DISCUSSION: The newest anticholinergic medication in women with OAB increased the PD and decreased the AA statistically significantly. Clinically, it seems to be well-tolerated by the patient.

Comparison of non-cycloplegic photorefraction, cycloplegic photorefraction and cycloplegic retinoscopy in children.

AIM: To compare the results of noncycloplegic photorefraction, cycloplegic photorefraction and cycloplegic refraction in preschool and non-verbal children. METHODS: One hundred and ninety-six eyes of 98 children (50 females, 48 males) were included in the study. Firstly, non-cycloplegic photorefraction was achieved with Plusoptix A09; secondly, cycloplegic photorefraction was carried out with Plusoptix A09 after 10 min cyclopentolate. Finally, 30min after instillation of twice cyclopentolate, cycloplegic refraction was obtained with autorefraction and/or standard retinoscopy. Spheric equivalent, spheric power, cylindric power and cylindrical axis measurements were statistically compared. RESULTS: The mean age was 28.8±18.5mo (range 12-72mo). The differences in spherical equivalent, spheric power and cylindrical power measured by the three methods were found statistically significant (P<0.05). The spherical equivalent and spheric power measured by cycloplegic photorefraction were statistically higher than the measurements of the other methods (P<0.05). The cylindrical power measured by cycloplegic refraction was statistically lower than the measurements of the photorefraction methods (P<0.05). There was no significant difference in cylindrical axis measurements between three methods (P>0.05). CONCLUSION: For the determination of refractive errors in children, the Plusoptix A09 measurements give incorrect results after instillation of cyclopentolate. Additionally, the cylindrical power measured by Plusoptix A09 with or without cycloplegia is higher. However, the non-cycloplegic Plusoptix A09 measures spheric equivalent and spheric power similar to cycloplegic refraction measurements in preschool and non-verbal children.

Posttraumatic intraocular pressure elevation and associated factors in patients with zone I open globe injuries.

BACKGROUND: The object of this study was to determine factors that might be associated with intraocular pressure (IOP) elevation after anterior segment open globe injuries (zone I). METHODS: Data were obtained from the records of 68 patients who experienced zone I open globe injury between January 2008 and October 2010. Group I was composed of patients with chronically elevated IOP of at least 21 mmHg within a 1-year follow-up period. The rate of posttraumatic IOP elevation and associated structural and functional risk factors were evaluated. RESULTS: Of the 68 patients, 17 (25%) developed posttraumatic IOP elevation (Group 1). The mean age in group I was significantly older compared to group II (36.8±24.4 and 15.7±15.3 years, respectively [p=0.003]). Iris damage, postoperative inflammation, and use of long-term corticosteroids were significantly greater in group I (p<0.001, p<0.001, p=0.005 respectively). In group I, 13 of 17 patients (76.5%) had a wound size larger than 6 mm compared to only one patient (1/51, 2%) in group II, and the result was statistically significant (p<0.001). The size of wound larger than 6 mm also retained its statistical significance in multivariate analysis (p<0.001, odds ratio: 162.5). CONCLUSION: This study shows a significant relationship between larger wound size (>6 mm) and elevation of IOP after trauma in zone I open globe injuries.

Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism.

OBJECTIVES: Radioiodine (RAI) is used in the treatment of hyperthyroidism and differentiated thyroid cancer. Radioiodine therapy is associated with dry eyes and some side effects are seen especially due to beta rays. In this study, the functional and cytological status of lacrimal glands after RAI therapy was evaluated. METHODS: Twenty-five patients with a mean age of 55.16 years with planned low-dose RAI therapy were evaluated. Just before and 6 months after the treatment, the lacrimal glands were evaluated with tear break-up time (BUT), Schirmer's test, impression cytology and "Ocular Surface Disease Index (OSDI)" questionnaire. RESULTS: The mean value of Schirmer's test was 16.20 ± 3.61 pre-treatment and 11.28 ± 4.39 post-treatment for the right eye, and 15.76 ± 3.27 and 10.60 ± 4.42 for the left eye, respectively. The mean value of Schirmer's test decreased significantly post-treatment in both eyes (p = 0.0001). The BUT score also decreased significantly post-treatment (p = 0.001). The mean value of OSDI score was 27.5 ± 8.02 pre-treatment and 46.36 ± 10.27 post-treatment. The mean value of OSDI score increased post-treatment (p = 0.0001). The impression scores also increased post-treatment in both eyes (p = 0.0001). CONCLUSION: Even low-dose (≤30 mci) RAI treatment affects lacrimal gland functions. Low-dose RAI causes a decrease in the value of Schirmer's test and the BUT test, and an increase in the value of OSDI score and impression scores.