Platelet Proteome Reveals Novel Targets for Hypercoagulation in Pseudoexfoliation Syndrome.

Pseudoexfoliation syndrome (PEX) is characterized by the accumulation of abnormal extracellular matrix material in ocular and non-ocular tissues, including blood vessel walls. Clot-forming dysfunction might be responsible for venous thrombosis in PEX. We investigated global coagulation, the proteome, and functions of platelets in PEX patients and aimed to determine prognostic biomarkers for thrombosis risk in PEX. Peripheral blood was collected from PEX and retinal vein occlusion (RVO) patients, and age-sex matched controls. Viscoelastic hemostasis was evaluated by rotational thromboelastometry (ROTEM). Platelet markers (CD41, CD42, CD61, and CD62p) and endothelial markers (P-selectin, E-selectin, and von Willebrand factor) were investigated by flow cytometry and ELISA, respectively. The platelet proteome was analyzed by 2D fluorescence difference gel electrophoresis followed by mass spectrometry. Clot formation time (CFT) is significantly reduced in PEX patients compared to the controls (p < 0.05). P-selectin levels were higher in PEX patients than in controls (p < 0.05); E-selectin and von Willebrand factor remained unchanged. The monitorization of CFT by ROTEM, and soluble P-selectin, may help assess thrombotic risk in PEX patients. Proteomic analysis revealed differential expression of Profilin-1 in platelets. Profilin-1 regulates the stability of actin-cytoskeleton and may contribute to impaired platelet hemostatic functions. Increased P-selectin levels together with impaired coagulation dynamics might be responsible for the thrombotic events in PEX disease.

NON-EXUDATIVE INTRARETINAL FLUID IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION.

BACKGROUND: To describe the occurrence of non-exudative intraretinal fluid (IRF) in intermediate age-related macular degeneration (iAMD). METHODS: A retrospective study was designed to include consecutive cases with iAMD associated with IRF. A multimodal imaging (MMI) approach was used to confirm diagnosis of IRF in iAMD. MMI included color fundus photograph, fundus autofluorescence, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and OCT angiography (OCT-A). RESULTS: Ten eyes of 10 patients (2 males and 8 females, ages 68-80) showing IRF in iAMD were included in the study. Mean best-corrected visual acuity was 20/40 Snellen equivalent. MMI including FA/ICGA, and OCT demonstrated the absence of macular neovascularization (MNV) in all cases; OCT-A did not detect any abnormal flow signal associated with IRF. Seven out of 10 patients developed IRF in correspondence of pigment epithelium detachment. Three out of 10 patients presented IRF in correspondence of an area of nascent geographic atrophy. CONCLUSION: Non-exudative intraretinal fluid in intermediate AMD is a novel, distinctive feature that is characterized by the presence of IRF with no evidence of MNV. We described different phenotypes of IRF in iAMD. The definite diagnosis of this condition requires further studies with thorough application of multimodal imaging.

Case Report: Acute Macular Neuroretinopathy Which Led to COVID-19 Infection Diagnosis.

We present a case of Acute Macular Neuroretinopathy (AMN), which led to the coronavirus disease of 2019 (COVID-19) infection diagnosis. A 27-year-old female patient with flu-like symptoms later proven to be COVID-19 infection presented with acute-onset bilateral gray-like paracentral scotomas. Fundus examination showed a hypopigmented, wedge-like lesion on the superior temporal juxtafoveal area in the right eye, while no significant finding was found in the left eye. Infrared reflectance images demonstrated bilateral hyporeflective lesions in the parafoveal regions of the macula. Spectral-domain optical coherence tomography scans over the corresponding areas detected focal hyperreflectivity in the outer nuclear layer with disruption in the ellipsoid zone and retinal pigment epithelium layers. Based on these findings, the AMN diagnosis was considered. The COVID-19 infection diagnosis was confirmed by a polymerase chain reaction test. COVID-19 disease may cause retinal vascular complications such as AMN. AMN, which shares common viral prodromal symptoms with COVID-19 infection, may be a presenting sign of COVID-19 infection.

Subretinal Pseudocysts: A Comprehensive Analysis of this Novel OCT Finding.

INTRODUCTION: In current clinical practice, several optical coherence tomography (OCT) biomarkers have been proposed for the assessment of severity and prognosis of different retinal diseases. Subretinal pseudocysts are subretinal cystoid spaces with hyperreflective borders and only a few single cases have been reported thus far. The aim of the study was to characterize and investigate this novel OCT finding, exploring its clinical outcome. METHODS: Patients were evaluated retrospectively across different centers. The inclusion criterion was the presence of subretinal cystoid space on OCT scans, regardless of concurrent retinal diseases. Baseline examination was set as the first time the subretinal pseudocyst was identified by OCT. Medical and ophthalmological histories were collected at baseline. OCT and OCT-angiography were performed at baseline and at each follow-up examination. RESULTS: Twenty-eight eyes were included in the study and 31 subretinal pseudocysts were characterized. Out of 28 eyes, 16 were diagnosed with neovascular age-related macular degeneration (AMD), 7 with central serous chorioretinopathy, 4 with diabetic retinopathy, and 1 with angioid streaks. Subretinal and intraretinal fluid were present in 25 and 13 eyes, respectively. Mean distance of the subretinal pseudocyst from the fovea was 686 µm. The diameter of the pseudocyst was positively associated with the height of the subretinal fluid (r = 0.46; p = 0.018) and central macular thickness (r = 0.612; p = 0.001). At follow-up, subretinal pseudocysts disappeared in most of the reimaged eyes (16 out of 17). Of these, two patients presented retinal atrophy at baseline examination and eight patients (47%) developed retinal atrophy at follow-up. Conversely, seven eyes (41%) did not develop retinal atrophy. CONCLUSION: Subretinal pseudocysts are precarious OCT findings, usually disclosed in a context of subretinal fluid, and are probably transient alterations within the photoreceptor outer segments and retinal pigment epithelium (RPE) layer. Despite their nature, subretinal pseudocysts have been associated with photoreceptor loss and incomplete RPE definition.

Fundus topographical distribution patterns of ocular toxoplasmosis.

BACKGROUND: To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions. METHODS: In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed. RESULTS: 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26 and 5.21±12.77 mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04 mm2 vs 4.09±8.90 mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267 and 5763±3491 µm, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278 µm inferotemporal to foveola. CONCLUSION: The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease.

Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes.

PURPOSE: Postoperative refraction in modern mi-croincision cataract surgery gained extra importance in patients with the previous laser-assisted in situ keratomileusis (LASIK) surgery. The surgically induced astigmatic changes in those eyes may differ not only in magnitude but also in direction compared to virgin corneas. This study aimed to compare the surgically induced astigmatic changes after microscopic cataract surgery between post-LASIK corneas and virgin eyes. METHODS: Cases that underwent microincision cataract surgery in eyes with and without previous LASIK surgery were reviewed. The demographics, the axial length at cataract surgery, the central corneal thickness, spheric and cylindric values, keratometry readings, and postoperative posterior corneal astigmatism were retrospectively evaluated. A modified Alpins method was used for astigmatic vector analysis, and baseline astigmatism, surgically induced astigmatism, difference vector, flattening effect, and torque were assessed. RESULTS: A total of 42 eyes from 24 subjects was evaluated. Group I consisted of 14 eyes with the previous LASIK, and Group II included 28 eyes without any refractive surgery. Preoperative mean central corneal thickness in Group I was significantly thinner (p=0.012). There was no significant difference in baseline astigmatism between the groups regarding magnitude and power vectors. After microincision cataract surgery, there were no significant differences in mean spheric and cylindric values and mean keratometry readings (all p>0.05). However, surgically induced astigmatism and difference vector were significantly higher on J45 vector component in post-LASIK eyes and microincision cataract surgery steepening effect on post-LASIK corneas was significantly higher than those in virgin eyes (p=0.001, p=0.002 and p=0.018, respectively). CONCLUSIONS: Cataract surgery has steepened the corneas in both groups with a significantly higher steepening effect in post-LASIK eyes. Certainly, corneal topography cataract surgery is particularly helpful to provide more precise surgically induced astigmatism interpretations.

Longitudinal Comparative Analysis of Semi-Automated Aqueous Flare Measurements with Clinical Grading and Visual Outcomes in Uveitic Eyes.

PURPOSE: To evaluate the correlation between longitudinal changes in aqueous flare measured by laser flare photometer (LFP), best-corrected visual acuity (BCVA), and clinical grade using both Standardization of Uveitis Nomenclature (SUN) and modified SUN (MSUN) scales uveitis patients. METHODS: Patients were classified according to both SUN and MSUN grading scales. LFP measurements were acquired (Kowa FM-700) at each visit. Mean change in LFP was assessed longitudinally, comparing with those in visual acuity, SUN, and MSUN grading scales. RESULTS: Mean change in LFP was correlated to those in BCVA (p = .018), SUN scale (p < .001), and MSUN scale (p = .008). Cases within same initial SUN (0 and 1+) and MSUN (0.5+ and 1+) grades and different longitudinal flare prognosis (decreased/unchanged/increased) had significantly different initial LFP values (all p < .05). CONCLUSIONS: LFP measurement is beneficial in monitoring inflammatory activity. Cases of identical clinical flare scores with different clinical prognosis may be predicted by LFP.

Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes / Comparação de alterações astigmáticas induzidas cirurgicamente após cirurgia de catarata em córneas ceratomileusis in situ pós-Laser versus olhos virgens

ABSTRACT Purpose: Postoperative refraction in modern mi­croincision cataract surgery gained extra importance in patients with the previous laser-assisted in situ keratomileusis (LASIK) surgery. The surgically induced astigmatic changes in those eyes may differ not only in magnitude but also in direction compared to virgin corneas. This study aimed to compare the surgically induced astigmatic changes after microscopic cataract surgery between post-LASIK corneas and virgin eyes. Methods: Cases that underwent microincision cataract surgery in eyes with and without previous LASIK surgery were reviewed. The demographics, the axial length at cataract surgery, the central corneal thickness, spheric and cylindric values, keratometry readings, and postoperative posterior corneal astigmatism were retrospectively evaluated. A modified Alpins method was used for astigmatic vector analysis, and baseline astigmatism, surgically induced astigmatism, difference vector, flattening effect, and torque were assessed. Results: A total of 42 eyes from 24 subjects was evaluated. Group I consisted of 14 eyes with the previous LASIK, and Group II included 28 eyes without any refractive surgery. Preoperative mean central corneal thickness in Group I was significantly thinner (p=0.012). There was no significant difference in baseline astigmatism between the groups regarding magnitude and power vectors. After microincision cataract surgery, there were no significant differences in mean spheric and cylindric values and mean keratometry readings (all p>0.05). However, surgically induced astigmatism and difference vector were significantly higher on J45 vector component in post-LASIK eyes and microincision cataract surgery steepening effect on post-LASIK corneas was significantly higher than those in virgin eyes (p=0.001, p=0.002 and p=0.018, respectively). Conclusions: Cataract surgery has steepened the corneas in both groups with a significantly higher steepening effect in post-LASIK eyes. Certainly, corneal topography cataract surgery is particularly helpful to provide more precise surgically induced astigmatism interpretations.

RESUMO Objetivo: A refração pós-operatória na cirurgia mo­derna de catarata por microincisão ganha ainda mais importância em pacientes com cirurgia prévia de ceratomileuse in situ assistida por laser (LASIK). As alterações astigmáticas induzidas cirurgicamente nesses olhos podem diferir não apenas em magnitude, mas também em direção em comparação com córneas virgens. O objetivo deste estudo foi comparar as alterações astigmáticas induzidas cirurgicamente após cirurgia de catarata por microincisão entre córneas pós-LASIK e olhos virgens. Métodos: Foi revisada uma série de casos de cirurgia de catarata por microincisão em olhos com e sem cirurgia LASIK anterior. Os dados demográficos, o comprimento axial no momento da cirurgia de catarata, a espessura central da córnea, os valores esféricos e cilíndricos, as leituras da ceratometria e o astigmatismo corneano posterior pós-operatório foram avaliados retrospectivamente. O método Alpins modificado foi usado para análise vetorial astigmática e foram avaliados o astigmatismo basal, o astigmatismo induzido cirurgicamente, o vetor de diferença, o efeito de achatamento e o torque. Resultados: Ao todo, 42 olhos de 24 indivíduos foram avaliados. O Grupo I consistiu em 14 olhos com LASIK prévio; o Grupo II incluiu 28 olhos sem qualquer cirurgia refrativa. A média da espessura corneana central pré-operatória no Grupo I foi significativamente mais fina (p=0,012). Não houve diferença significativa no astigmatismo basal entre os grupos em termos de magnitude e vetores de potência. Após a cirurgia de catarata por microincisão, não houve diferenças significativas nos valores médios esféricos, cilíndricos e leituras médias de ceratometria (todos com p>0,05). No entanto, o astigmatismo induzido cirurgicamente e o vetor de diferença foram significativamente maiores no componente do vetor J45 em olhos pós-LASIK, e o efeito de aumento da inclinação pela cirurgia de catarata por microincisão nas córneas pós-LASIK foi significativo em comparação com olhos virgens (p=0,001, p=0,002 e p=0,018, respectivamente). Conclusões: A cirurgia de catarata aumentou a inclinação das córneas em ambos os grupos, sendo esse aumento significativamente maior nos olhos pós-LASIK. Certamente, a topografia da córnea antes da cirurgia de catarata é particularmente útil para fornecer interpretações mais precisas do astigmatismo induzido cirurgicamente.

Developing a Measure to Quantify Ocular Pain Postoperatively: The Adaptation of the Ocular Pain Assessment Survey.

Purpose: Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods: We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results: We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion: Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.

Evaluation of Vision-Related Quality of Life After Unilateral Implantation of a New Trifocal Intraocular Lens.

Objectives: The objective of the study was to evaluate visual performance and subjective quality of life after unilateral implantation of a new trifocal intraocular lens (IOL) in young and middle-aged patients. Methods: Patients that underwent unilateral cataract surgery with implantation of trifocal TFNT00 IOL with an emmetropic fellow eye were included in the study. Vision related daily activity performance was evaluated in postoperative 6th month. Patients were divided in two groups according to the uncorrected near visual acuity of their fellow eyes: In Group I if worse than the operated eye and in Group II if equal or better than the operated eye. The visual function-14 (VF-14) questionnaire was used with scores of 4 with no difficulty, 3 points with mild difficulty, 2 points with moderate difficulty, 1 point with severe difficulty, and 0 point if unable to perform. Results: Twenty-one patients were enrolled in this study. Patients had good visual performance, showing VF-14 scores above 3 in all categories. Reading small print (3.67±0.48) and driving at night (3.67±0.48) were found to be the most difficult tasks to perform. No significant difference was found between two groups in any category that was investigated by the VF-14 questionnaire. Conclusion: Unilateral implantation of TFNT00 trifocal IOL is well tolerated with good patient satisfaction assessed by VF-14 questionnaire in subjects that have cataract in one eye, encouraging single-eye surgical procedure in this particular group of patients.

The Effect of Anterior Segment Depth on the Accuracy of 7 Different Intraocular Lens Calculation Formulas.

Objectives: To evaluate the effect of anterior segment depth (ASD; sum of anterior chamber depth and lens thickness) on the accuracy of 7 intraocular lens formulas calculated in patients with axial length (AL) between 22.5 and 24.5 mm. Materials and Methods: In this retrospective study, patients who underwent cataract surgery were divided into three groups based on their ASD measurements (Group I: ASD <7.30 mm, Group II: ASD between 7.30-7.90 mm, Group III: ASD >7.90 mm). The mean predictive error (MPE), mean absolute error (MAE), and median absolute error (MedAE) values of each group were compared. The effect of ASD on the predictive error (PE) of each lens formula was additionally tested in subgroups based on mean keratometry (K) values (Subgroup I: K <42.0 D, Subgroup II: K between 42.0-44.5 D, Subgroup III: K >44.5 D). Results: The study included 184 eyes of 184 patients. In Group I, all formulas except Olsen OLCR and Barrett II had clinically myopic MPEs. In Group II, the MPEs of all lens formulas except Barrett II were statistically non-different from zero (p>0.05). In Group III, the MPEs of all lens formulas were found to be statistically hyperopic. In Group III, all formulas except Olsen OLCR were significantly shifted to more hyperopic results when compared with Groups I and II (p<0.05). ASD was positively correlated with the PEs of the SRK/T, Holladay I, Hoffer Q, Barrett II, Hill-RBF, and Haigis formulas. In cases with mean K greater than 42.0 D, ASD was similarly correlated with PE for all formulas except Olsen OLCR. Conclusion: In eyes with AL between 22.5 and 24.5 mm, the predictions of lens formulas were significantly hyperopic in cases with greater ASD.

HENLE FIBER LAYER MAPPING WITH DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To perform a macular volumetric and topographic analysis of Henle fiber layer (HFL) from retinal scans acquired by directional optical coherence tomography. METHODS: Thirty healthy eyes of 17 subjects were imaged using the Heidelberg spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany) with varied horizontal and vertical pupil entry. Manual segmentation of HFL was performed from retinal sections of horizontally and vertically tilted optical coherence tomography images acquired within macular 20 × 20° area. Total HFL volume, mean HFL thickness, and HFL coverage area within Early Treatment for Diabetic Retinopathy Study grid were calculated from mapped images. RESULTS: Henle fiber layer of 30 eyes were imaged, segmented and mapped. The mean total HFL volume was 0.74 ± 0.08 mm 3 with 0.16 ± 0.02 mm 3 , 0.18 ± 0.03 mm 3 , 0.17 ± 0.02 mm 3 , and 0.19 ± 0.03 mm 3 for superior, temporal, inferior, and nasal quadrants, respectively. The mean HFL thickness was 26.5 ± 2.9 µ m. Central 1-mm macular zone had the highest mean HFL thickness with 51.0 ± 7.6 µ m. The HFL coverage that have thickness equal or above to the mean value had a mean 10.771 ± 0.574 mm 2 of surface area. CONCLUSION: Henle fiber layer mapping is a promising tool for structural analysis of HFL. Identifying a normative data of HFL morphology will allow further studies to investigate HFL involvement in various ocular and systemic disorders.

Comparison of Postoperative Corneal Astigmatism Induced by Two Different Corneal Incisions during Microincisional Cataract Surgery.

Objectives: Clear corneal incision (CCI) architecture in modern microincision cataract surgery (MICS) plays an undeniable role in postoperative refraction. The goal of this study was to evaluate the effect of hinge incision prior to two-step CCI on postoperative refractive astigmatism after cataract surgery and to demonstrate the schematic presentation of these postoperative astigmatic changes via double-angle polar plots. Methods: This study involved a consecutive case series of patients who had MICS. The first incision was performed as a two-step CCI, whereas the second was made as a hinge incision prior to 2-step CCI. The preoperative corneal and postoperative refractive astigmatism and surgically induced astigmatism (SIA) were calculated by vectorial analysis. Hotelling's T2 test was performed to compare the centroid values of preoperative and postoperative corneal astigmatism. Results: A total of 63 eyes from 57 subjects were evaluated. Group I consisted of 27 eyes with the two-step CCI, and Group II included 36 eyes with the hinge incision prior to two-step CCI. No significant difference was found between the groups in terms of age, sex, axial length, keratometry readings, implanted intraocular lens power, and postoperative spherical equivalent. The centroids of corneal astigmatism postoperatively increased to 0.21 D at 87.6°±0.61 with no significance in Group I (p=0.525) and to 0.70 D at 90.6°±0.47 with significance in Group II (p=0.032). The difference in postoperative centroids between the two groups was also significantly different (p=0.043). Finally, the centroids of SIA were 0.12 D at 85.5°±0.50 and 0.22 D at 91.1°±0.49 for Group I and Group II, respectively, with no significance. Conclusion: A hinge incision did not have an unfavorable effect on postoperative refractive astigmatism; therefore, it may be preferred for controlled entrance to the anterior chamber.

Correlation of Clinical Aqueous Flare Grading to Semi-Automated Flare Measurements Using Laser Flare Photometry.

PURPOSE: To compare laser flare photometry (LFP) measurements of aqueous flare with Standardization of Uveitis Nomenclature (SUN) and modified SUN grading. METHODS: In this prospective study with multicenter design, uveitis patients were classified according to SUN and modified SUN grading scales. LFP was performed with Kowa FM-700 flaremeter. Mean LFP values were compared with SUN and MSUN scores. RESULTS: The study included 475 LFP measurements, of which 216, 48, 150, 31, 28 and 2 had 0, 0.5+, 1+, 1.5+, 2+ and 3+ flare, respectively. LFP values were significantly different between each two consecutive steps for both clinical gradings (all P < .05). Cut-off values for modified SUN grading steps were defined as 5.7, 9.7, 15.7 and 43.2 for 0/0.5+, 0.5+/ 1+, 1+/1.5+ and 1.5/2+ borders of clinical flare, respectively. CONCLUSIONS: LFP proves to be an objective measurement in analyzing aqueous flare comparable to both SUN and MSUN clinical grading systems.

Laser flare photometry in uveitis.

Aqueous flare and cells are inflammatory parameters of anterior chamber inflammation resulting from disruption of the blood-ocular barrier. The ocular inflammation related to anterior chamber cells and flare is assessed by conventional clinical grading systems through using the slit-lamp examination. However, a more quantitative and objective assessment is needed for more precise and reproducible inflammatory assessment in uveitis. Laser flare photometer (LFP) was introduced as a noninvasive, objective, and quantitative evaluation of aqueous flare intensity and number of cells in the anterior chamber with good accuracy and repeatability. The success of LFP allowed clinicians to further evaluate the pathophysiology of intra-ocular inflammation and to incorporate LFP measurements to their routine clinical practice for diagnosis, management, and treatment of uveitis cases. In this review, we will discuss the importance of clinical utilization of LFP and the correlation between LFP and clinical grading systems along with some technical aspects. Furthermore, we will give a literature summary on the current applications of LFP in clinical practice of cases which present with various types of uveitis and diverse ocular conditions with or without inflammation.

Peripapillary Choroidal Vasculature in Pediatric Eyes with Type 1 Diabetes Mellitus.

Objectives: Choroidal vasculature change in children with diabetes mellitus is not investigated enough although it could reflect clinical outcome. Methods: Pediatric Type 1 diabetes mellitus (T1DM) patients and healthy controls were retrospectively evaluated. Peripapillary retinal nerve fiber layer optical coherence tomography (OCT) images of the right eyes were analyzed. Choroidal parameters including total choroidal area, luminal area, stromal area, and choroidal vascularity index were measured through image binarization. Results: Twenty eyes of 20 patients were compared with 46 eyes of 46 healthy controls. Mean total choroidal area, luminal area, and stromal area were 1.59±0.35, 1.10±0.24, and 0.50±0.13 mm2 in patients' eyes and 1.52±0.49, 1.05±0.34, and 0.47±0.17 mm2 in healthy eyes. No difference was found in choroidal vascularity indices between patients and healthy eyes (68.8±3.9% vs. 69.4±4.4%, p=0.521). Temporal choroidal vascularity index was significantly higher than its nasal counterpart in healthy eyes (71.8±5.0% vs. 68.6±4.9%, p<0.001) which was not significant in patients' eyes (70.7±4.0% vs. 68.9±5.1%, p=0.067). Temporal quadrant had the highest choroidal vascularity index score among all quadrants in healthy controls (all p<0.05), whereas no choroidal vascularity index difference between quadrants was detected in patients (p=0.75). Conclusion: Peripapillary choroidal vasculature has shown subtle sectoral changes which did not reflect the overall peripapillary OCT section in pediatric T1DM patients when compared with healthy controls.

FourierNet: Shape-Preserving Network for Henle's Fiber Layer Segmentation in Optical Coherence Tomography Images.

Henle's fiber layer (HFL), a retinal layer located in the outer retina between the outer nuclear and outer plexiform layers (ONL and OPL, respectively), is composed of uniformly linear photoreceptor axons and Müller cell processes. However, in the standard optical coherence tomography (OCT) imaging, this layer is usually included in the ONL since it is difficult to perceive HFL contours on OCT images. Due to its variable reflectivity under an imaging beam, delineating the HFL contours necessitates directional OCT, which requires additional imaging. This paper addresses this issue by introducing a shape-preserving network, FourierNet, which achieves HFL segmentation in standard OCT scans with the target performance obtained when directional OCT is available. FourierNet is a new cascaded network design that puts forward the idea of benefiting the shape prior of the HFL in the network training. This design proposes to represent the shape prior by extracting Fourier descriptors on the HFL contours and defining an additional regression task of learning these descriptors. FourierNet then formulates HFL segmentation as concurrent learning of regression and classification tasks, in which Fourier descriptors are estimated from an input image to encode the shape prior and used together with the input image to construct the HFL segmentation map. Our experiments on 1470 images of 30 OCT scans of healthy-looking macula reveal that quantifying the HFL shape with Fourier descriptors and concurrently learning them with the main segmentation task leads to significantly better results. These findings indicate the effectiveness of designing a shape-preserving network to facilitate HFL segmentation by reducing the need to perform directional OCT imaging.

Comparative Analysis of a New Hybrid EDOF-Multifocal Diffractive Intraocular Lens with a Trifocal Diffractive Intraocular Lens.

PURPOSE: To compare visual acuity, defocus curve and visual quality of life performances of a new hybrid refractive-diffractive intraocular lens (IOL) and a trifocal diffractive IOL. METHODS: Patients who underwent cataract surgery with bilateral implantation of ZFR00V or TFNT00 IOLs were enrolled in this study. The main outcomes were defined as uncorrected distant, intermediate and near visual acuities (UDVA, UIVA and UNVA, respectively), defocus curve and VF-14 questionnaire aimed for visual performance. RESULTS: Fifty patients, of whom 30 had bilateral ZFR00V implantation, were enrolled in the study. Patients with ZFR00V had significantly better UIVA than patients with TFNT00 (0.05 ± 0.03 vs. 0.07 ± 0.04 logMAR, P = 0.02). Defocus curve showed significantly higher visual acuity in intermediate range for ZFR00V IOL between -1.00 and -1.50 dioptres (all P < 0.05). All patients had good visual performance with mean VF-14 scores above 3 points with no significant difference between two IOL models. Spectacle independence was 100% for both distant and near vision in both group of patients. CONCLUSION: Bilateral implantation of ZFR00V in cataract patients shows better intermediate visual acuity scores and similar daily visual performance when compared with trifocal TFNT00 IOL.

Visual acuity, defocus curve and patient satisfaction of a new hybrid EDOF-multifocal diffractive intraocular lens.

Purpose: To evaluate the visual acuity, defocus curve and visual quality of life following bilateral implantation of a new hybrid extended depth of focus (EDOF)-multifocal diffractive intraocular lens (IOL). Methods: Patients who underwent cataract surgery with bilateral implantation of Tecnis Synergy IOL were enrolled in this study. The main outcomes were defined as uncorrected distant, intermediate and near visual acuities (UDVA, UIVA and UNVA, respectively), defocus curve and VF-14 questionnaire aimed for visual performance. Results: The mean ± SD values for binocular UDVA, UIVA and UNVA were -0.01 ± 0.04, 0.05 ± 0.03 and 0.03 ± 0.05 logMAR, respectively. Defocus curve showed a continuous vision above 0.16 logMAR between +0.50 D and -2.50 D. Patients had good visual performance with mean VF-14 scores above 3 points. Driving at night (3.47 ± 0.64) was found to be the most difficult task to perform. Spectacle independence was 100% for both distant and near vision. Conclusion: Bilateral implantation of Tecnis Synergy IOL in cataract patients shows good visual acuity and performance, covering a good visual range without any need of spectacles.

Astigmatic Vectorial Analysis in Pediatric Keratoconus After Unilateral Cross-Linking Treatment.

PURPOSE: The aims of this study were to evaluate the treatment response of pediatric keratoconus (KC) patients to unilateral corneal collagen cross-linking (CXL) in treated eyes, disease progression in untreated eyes, and define the predictive value of astigmatic parameters by astigmatic vectorial analysis. METHODS: Pediatric patients with KC with CXL-treated progressive eye and untreated fellow eye were included. Patients with other ocular conditions and a history of previous ocular surgery were excluded. Astigmatic changes in anterior and posterior corneal surfaces were evaluated with vectorial analysis. The receiver operating characteristic curves were analyzed to detect the best parameter that discriminates treated and untreated groups. RESULTS: Thirty-two eyes of 16 patients with at least 2-year follow-up were analyzed. The maximum keratometry (K) in CXL-treated eyes remained stable (from 53.51 ± 2.86-53.41 ± 2.84 diopter (D), P = 0.84) while the steepest K increased in untreated eyes (from 47.82 ± 1.71-49.59 ± 3.32 D, P = 0.03). The oblique components of corneal astigmatism in CXL-treated eyes were higher than those of fellow eyes (all P < 0.05), which significantly decreased in the anterior 3-mm zone after treatment (P = 0.048). The mean differential astigmatism magnitudes were significantly higher in treated eyes (all P < 0.05). The refractive centroid remained unchanged in treated eyes (P = 0.553) and shifted in the oblique direction in untreated eyes (P = 0.04). The oblique differential astigmatism in the anterior 7-mm zone showed the highest area under the curve value in predicting treatment efficacy (0.813, 95% confidence interval: 0.646-0.981, P < 0.001). CONCLUSIONS: Astigmatic vectorial analysis is an objective tool for longitudinal assessment of clinical outcomes in KC. Changes in the oblique components of corneal astigmatism might predict progression and treatment efficacy.