Detection and Classification of Diabetic Macular Edema with a Desktop-Based Code-Free Machine Learning Tool.

Objectives: To evaluate the effectiveness of the Lobe application, a machine learning (ML) tool that can be used on a personal computer without requiring coding expertise, in the recognition and classification of diabetic macular edema (DME) in spectral-domain optical coherence tomography (SD-OCT) scans. Materials and Methods: A total of 695 cross-sectional SD-OCT images from 336 patients with DME and 200 OCT images of 200 healthy controls were included. Images with DME were classified into three main types: diffuse retinal edema (DRE), cystoid macular edema (CME), and cystoid macular degeneration (CMD). To develop the ML model, we used the desktop-based code-free Lobe application, which includes a pre-trained ResNet-50 V2 convolutional neural network and is available free of charge. The performance of the trained model in recognizing and classifying DME was evaluated with 41 DRE, 28 CMD, 70 CME, and 40 normal SD-OCT images that were not used in the training. Results: The developed model showed 99.28% sensitivity and 100% specificity for class-independent detection of DME. Sensitivity and specificity by labels were 87.80% and 98.57% for DRE, 96.43% and 99.29% for CME, and 95.71% and 95.41% for CMD, respectively. Conclusion: To our knowledge, this is the first evaluation of the effectiveness of Lobe with ophthalmological images, and the results indicate that it can be used with high efficiency in the recognition and classification of DME from SD-OCT images by ophthalmologists without coding expertise.

In vivo generated autologous plasmin assisted vitrectomy in young patients.

BACKGROUND: Autologous plasmin enzyme facilitates the induction of posterior vitreous detachment(PVD) during vitrectomy in young patients. We proposed the concept of in-vivo generated plasmin which is based on the injection of tissue plasminogen activator(t-PA) and autologous whole blood(AWB) into the vitreous cavity. The purpose of this pilot study is to report the efficacy of preoperative simultaneous intravitreal injection of(t-PA) and autologous whole blood in facilitating the intraoperative induction of PVD in young patients with various vitreoretinal pathologies. METHODS: Seventeen eyes of 16 young patients with various vitreoretinal pathologies requiring vitrectomy, who received simultaneous intravitreal injection of 0.1 ml of AWB and 25 µg of t-PA, 3 days prior to surgery were retrospectively reviewed. Outcome measures were the number of attempts required to achieve successful intraoperative separation of the posterior hyaloid; the postoperative visual acuity; and intraoperative and postoperative complications. RESULTS: The mean age of the patients was 23.87 ± 10.09 years, ranging from 10 to 39 years. Eight of 16 patients were men. The mean follow-up time was 19.35 ± 5.04 months, ranging from 12 to 26 months. Surgical indications for vitrectomy were chronic retinal detachment (n = 7), traumatic retinal detachment without proliferative vitreoretinopathy(n = 3), traumatic macular hole(n = 1), secondary vasoproliferative tumor(n = 4) and optic pit maculopathy(n = 2). Patients with retinal detachment complicated with PVR and those who were older than 40 years of age were excluded from the study. Separation of the Weiss ring from the optic nerve head was achieved intraoperatively in all cases, with a mean number of 2.86 ± 1.4 attempts. While the mean preoperative LogMAR visual acuity was 1.38 ± 0.59, ranging from 2.40 to 0.50, it was a mean of 0.51 ± 0.29, ranging from 1.00 to 0.10 at final postoperative exam(p < 0.001; paired samples t-test). No preoperative or intraoperative complications were noted. CONCLUSION: Preoperative simultaneous intravitreal injection of 25 µg t-PA with 0.1 ml of AWB facilitates the intraoperative induction of posterior vitreous detachment in young patients.

Effect of Previous Crosslinking on Intraoperative and Postoperative Outcomes and Complication Rates of Big-Bubble Deep Anterior Lamellar Keratoplasty for Keratoconus: A Comparative Study.

PURPOSE: To compare surgical outcomes and intraoperative and postoperative complications of big-bubble deep anterior lamellar keratoplasty (DALK) in patients with and without a history of previous corneal collagen crosslinking (CXL) for keratoconus. METHODS: Patients with keratoconus who underwent DALK surgery with big-bubble technique between January 2013 and January 2018 were retrospectively reviewed. Operative findings, intraoperative and postoperative complications, and visual and refractive outcomes were recorded. Patients were divided into 2 groups: with previous CXL (CXL-DALK group: 27 eyes) and without previous CXL (DALK group: 50 eyes). All parameters were compared between groups. RESULTS: Big bubble was successfully achieved in 24 eyes (88.9%) in the CXL-DALK group and in 45 eyes (90.0%) in the DALK group (P = 0.87). Type 1 bubble was obtained in 22 eyes (91.7%) in the CXL-DALK group and in 42 eyes (93.3%) in the DALK group (P = 0.79). Intraoperative microperforation occurred in 3 eyes (11.1%) in the CXL-DALK group and in 5 eyes (10.0%) in the DALK group (P = 1). Visual and refractive outcomes were similar between groups. The mean endothelial cell loss rates were 5.7% ± 2.3 at 1 year and 10.2 ± 3.1 at 2 years in the CXL-DALK group and 6.4% ± 4.7 at 1 year and 10.9% ± 5.4 at 2 years in the DALK group. Postoperatively, persistent epithelial defect was the most common complication in both groups, and postoperative complication rates were similar between groups. CONCLUSIONS: Our results have shown that previous CXL treatment does not influence the success of bubble formation and does not increase intraoperative or postoperative complication rates of DALK surgery for keratoconus. The improvement in visual acuity and refractive errors and endothelial cell loss rates were similar between CXL treated and untreated eyes after 2 years of follow-up.

Comparison of postoperative anterior segment changes associated with pars plana vitrectomy with and without vitreous base shaving.

AIM: To compare changes in anterior segment topography and axial length (AL) evaluated with Pentacam and IOL Master after pars plana vitrectomy (PPV) performed with and without vitreous base shaving. METHODS: This prospective study included patients who underwent PPV or phacoemulsification+PPV (Phaco+PPV) for various indications. Patients who underwent total posterior hyaloid detachment and excessive vitreous base shaving with scleral indentation were referred to as complete PPV (c-PPV). The patients whom posterior hyaloid was separated as far as the posterior arcades and vitreous base shaving with scleral depression was not performed were classified as the partial PPV (p-PPV) group. All patients underwent detailed ophthalmologic examinations preoperatively and 1wk, 1, and 3mo postoperatively. Changes in the anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), central corneal thickness (CCT), and keratometric measurements (K1 and K2) were evaluated with Pentacam HR. Changes in the AL measurements were analyzed with IOL Master. RESULTS: A significant increase in ACD was observed in c-PPV cases (P=0.02), but this increase was not significant in the p-PPV group (P=0.053). In contrast, ICA increased significantly in the c-PPV group (P=0.02) but decreased in the p-PPV group (P=0.09). BCVA was significantly improved in the c-PPV group from week 1 (P<0.001) while the increase in the p-PPV group reached significance at 3mo (P=0.035). CCT increased in the first week and later returned to baseline in both groups. No significant differences in the other parameters were observed between the groups, and there were no significant changes in intraocular pressure, ACV, AL, K1 or K2 values (P>0.05 for all). CONCLUSION: Incomplete posterior hyaloid excision and not removing the vitreous base in PPV surgeries may create a more stable anterior chamber, thus preventing the downward movement of the lens-iris diaphragm, and may cause ciliary body retraction, thereby reducing ICA. Awareness of these effects can provide some amount of guidance to physicians in selecting the appropriate PPV procedure and preempting surgical complications.

Fluorescein angiography as a primary guide for reduced-fluence photodynamic therapy for the treatment of chronic central serous chorioretinopathy.

PURPOSE: The aim of this study is to investigate the results of fluorescein angiography (FA)-guided reduced-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSCR), with the hypothesis that indocyanine green angiography (ICGA) guidance is avoidable in some cases. METHODS: This retrospective study includes a consecutive nonrandomized series of chronic CSCR cases. All eyes were examined with FA and the ones that had discrete active leakage areas or points had undergone reduced-fluence PDT. RESULTS: The study included 45 eyes of 41 patients with a mean age of 48.8 ± 10.7. The main duration of last chronic CSCR episode was 13.0 ± 11.9 months. Thirty-nine (86.7%) out of 45 consecutive eyes had active leakage area(s) on FA, which enabled them to be treated with PDT. Remaining six eyes had undergone ICGA examination and had received an ICGA-guided PDT. In FA-guided eyes, the mean BCVA improved from 0.44 ± 0.25 Snellen lines to 0.63 ± 0.32 lines in the last control visit (p < 0.001). Both central macular thickness and subfoveal choroidal thickness decreased significantly in treated eyes. Thirty-eight eyes (97.4%) in FA-guided group and six eyes (100.0%) in ICGA-guided group had total resorption of subretinal fluid. CONCLUSION: This study provides basis to support the hypothesis that FA-guided half-fluence PDT may be justified as an alternative method of treatment in appropriate cases of chronic CSCR without compromising the therapeutic success.

Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results.

PURPOSE: To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. METHODS: Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3 years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. RESULTS: The mean interval between CXL and DALK surgery was 47.5 ± 24.0 months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3 years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3 years. The mean ECD loss was 6.3 ± 4.4% at 1 year, 9.0 ± 6.3% at 2 years and 11.2 ± 7.4% at 3 years. CONCLUSION: Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients.

Autologous Platelet-Rich Fibrin in the Treatment of Refractory Macular Holes.

PURPOSE: To describe a novel method for the treatment of refractory macular holes. METHODS: Two case reports on the use of autologous platelet rich fibrin (PRF), followed by sulfur hexafluoride gas tamponade to facilitate closure of refractory macular holes. RESULTS: Macular holes were succesfully closed within a week in both cases. Best corrected Snellen visual acuities improved from counting fingers to 0.16 in the first case, and from 0.05 to 0.2 in the second case. No complication occurred during or after the procedures. CONCLUSION: The use of autologous PRF seems to be a safe and effective alternative method for the treatment of refractory macular holes. Further experience and studies are required to assess the value of autologous PRF in the management of challenging macular hole cases of different etiologies. To the best of our knowledge, this is the first use of autologous PRF in the treatment of macular holes.

Regression of Serous Macular Detachment After Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema.

Purpose: To assess the effect of intravitreal dexamethasone (Ozurdex®) implant in eyes with serous macular detachment (SMD) secondary to diabetic retinopathy (DRP) with diabetic macular edema (DME). Methods: Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP were included in this study. Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP, which was documented by optical coherence tomography, were included in this study. Intravitreal dexamethasone implantation was performed for treatment to all eyes. Main outcome measures included changes in best corrected visual acuity (BCVA), central neuroretinal thickness (CRT), and height of SMD. After intravitreal dexamethasone implantation, functional and anatomic responses were observed. Results: From the data at 3 months follow-up, we found that the Ozurdex implant was effective in treating SMD with DME, no eyes had lost vision from baseline, 22 eyes (92%) had improved visual acuity, and 22 eyes (92%) had presented SMD regression. Only two eyes had needed dexamethasone implant retreatment. Data at 6-months follow-up, no eyes had lost vision from baseline, 20 eyes (83%) had improved visual acuity, and all eyes had presented SMD regression. Also, after injections and at the end of the follow-up, mean CRT and BCVA were statistically different from the baseline. Conclusions: Intravitreal Ozurdex implantation increases BCVA and reduces SMD and CRT, in patients with SMD. In this context, intravitreal dexamethasone implantation is an effective treatment for SMD in patients with DME.

Evaluation of xenon, light-emitting diode (LED) and halogen light toxicity on cultured retinal pigment epithelial cells.

OBJECTIVE: To compare the possible toxic effects of three light sources used in vitreoretinal endoillumination systems; halogen, xenon, and light-emitting diode (LED) on retinal pigment epithelium (RPE) cell cultures, after two different exposure times. MATERIAL AND METHODS: ARPE-19 human RPE cell cultures were exposed to halogen, xenon, and LED light sources at a distance of 1.5 cm for 30 and 60 min with equal lumen output levels. Cells in the control group were not exposed. RPE cell cultures were compared in terms of cell viability, DNA damage, apoptosis rate, and IL-1ß, IL-6, and TNF- α levels. RESULTS: The halogen light group showed significantly more DNA damage, higher TNF-α, IL-1ß, and IL-6 levels, and lower viable cell count at 30 min compared to the control group. The rates of early and late apoptosis were also significantly higher at 60 min. There were no statistically significant differences in any of the parameters between the xenon and LED light sources and the control group at 30 or 60 min. CONCLUSION: New generation lights, xenon, and LED, seem to be safe in terms of RPE cells. Halogen light may cause toxic effects on RPE cells when used for a long time with maximal power output.

Oxidant-Antioxidant Balance in the Aqueous Humor of Patients with Retinal Vein Occlusion.

PURPOSE: To analyze oxidative stress parameters in the aqueous humor with retinal vein occlusion. MATERIALS AND METHODS: A total of 56 patients who underwent cataract surgery were enrolled in this study. The eyes with retinal vein occlusion were included in the study group. Aqueous humor was sampled from all patients and analyzed by an automated measurement method. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stres index (OSI) were calculated. RESULTS: OSI was significantly higher in the study group (p = 0.04). TAS was significantly lower (p = 0.01) and OSI was significantly higher (p = 0.01) in cases with both central retinal vein occlusion and macular edema. Previous laser photocoalugation to the retina and the duration of disease had no significant effect on the levels of oxidative stress parameters. CONCLUSION: OSI was found higher in patients with retinal vein occlusion. This increase is more significant in patients with macular edema and central retinal vein occlusion; in which TAS was also found to decrease.

Are the effects of hemodialysis on ocular parameters similar during and after a hemodialysis session?

PURPOSE: To evaluate the changes in several ocular parameters, including choroidal thickness, during and after hemodialysis. METHODS: Twenty-seven eyes of 27 patients with chronic renal failure undergoing hemodialysis were included. The patients underwent an ophthalmic examination, including intraocular pressure, central corneal thickness, iridocorneal angle, subfoveal choroidal thickness, and blood pressure, just before a hemodialysis session, during the second hour of the session, and half an hour after the end of the session. Body weight was measured before and after the session, and ultrafiltration volume was noted after the session. Central corneal thickness, intraocular pressure, and subfoveal choroidal thickness were measured by optical coherence tomography. RESULTS: In comparison with baseline levels, mean intraocular pressure and central corneal thickness increased significantly during the second hour of hemodialysis (p=0.001 and p=0.011, respectively) and showed no significant changes after hemodialysis (p=0.844 and p=0.246, respectively). Mean iridocorneal angle did not significantly change during the second hour of hemodialysis (p=0.101) and after hemodialysis (p=0.589). Mean subfoveal choroidal thickness was significantly lower during the second hour of hemodialysis (p<0.001) and after hemodialysis (p<0.001). CONCLUSIONS: Mean intraocular pressure and central corneal thickness increased and subfoveal choroidal thickness decreased during the second half of the hemodialysis session. During the second half of the session, intraocular pressure and central corneal thickness had a trend toward reduction, while subfoveal choroidal thickness had a relatively steady course. Because of possible fluctuations in the values, it would be reasonable to evaluate the changes not only from before to after hemodialysis but also during hemodialysis when analyzing the ocular effects of dialysis.

Are the effects of hemodialysis on ocular parameters similar during and after a hemodialysis session? / Os efeitos da hemodiálise sobre os parâmetros oculares são semelhantes durante e após a sessão de hemodiálise?

ABSTRACT Purpose: To evaluate the changes in several ocular parameters, including choroidal thickness, during and after hemodialysis. Methods: Twenty-seven eyes of 27 patients with chronic renal failure undergoing hemodialysis were included. The patients underwent an ophthalmic examination, including intraocular pressure, central corneal thickness, iridocorneal angle, subfoveal choroidal thickness, and blood pressure, just before a hemodialysis session, during the second hour of the session, and half an hour after the end of the session. Body weight was measured before and after the session, and ultrafiltration volume was noted after the session. Central corneal thickness, intraocular pressure, and subfoveal choroidal thickness were measured by optical coherence tomography. Results: In comparison with baseline levels, mean intraocular pressure and central corneal thickness increased significantly during the second hour of hemodialysis (p=0.001 and p=0.011, respectively) and showed no significant changes after hemodialysis (p=0.844 and p=0.246, respectively). Mean iridocorneal angle did not significantly change during the second hour of hemodialysis (p=0.101) and after hemodialysis (p=0.589). Mean subfoveal choroidal thickness was significantly lower during the second hour of hemodialysis (p<0.001) and after hemodialysis (p<0.001). Conclusions: Mean intraocular pressure and central corneal thickness increased and subfoveal choroidal thickness decreased during the second half of the hemodialysis session. During the second half of the session, intraocular pressure and central corneal thickness had a trend toward reduction, while subfoveal choroidal thickness had a relatively steady course. Because of possible fluctuations in the values, it would be reasonable to evaluate the changes not only from before to after hemodialysis but also during hemodialysis when analyzing the ocular effects of dialysis.

RESUMO Objetivo: Avaliar as alterações em vários parâmetros oculares, incluindo a espessura da coroide, durante e após a hemodiálise. Métodos: Foram incluídos 27 olhos de 27 pacientes portadores de insuficiência renal crônica e submetidos a hemodiálise. Todos foram submetidos ao exame oftalmológico, incluindo pressão intraocular, medida da espessura corneana central, ângulo iridocorneal e espessura da coroide subfoveal, além da medida da pressão arterial. A espessura corneana central, o ângulo iridocorneal e a espessura da coroide subfoveal foram medidos através da tomografia de coerência óptica. Os exames foram realizados logo antes, durante (na segunda hora) e meia hora após uma única sessão de hemodiálise. O peso corporal foi medido antes e depois da sessão, e os volumes de ultra filtração foram anotados após a sessão de hemodiálise. Resultados: Em comparação com os níveis basais, a pressão intraocular média e a espessura corneana central aumentaram significativamente na segunda hora de hemodiálise (p=0,001 e p=0,011, respectivamente), mas não houve diferença após a hemodiálise (p=0,844 para pressão intraocular e p=0,246 para espessura corneana central). O ângulo iridocorneal mostrou ligeira diminuição na segunda hora de hemodiálise (p=0,101) e após a sessão de hemodiálise (p=0,589), porém esta redução não foi estatisticamente significativa. Já a espessura da coroide subfoveal mostrou uma redução significativa tanto na segunda hora de hemodiálise (p<0,001) quanto após a sessão de hemodiálise (p<0,001). Conclusões: A pressão intraocular e a espessura corneana central aumentaram, enquanto a espessura da coroide subfoveal diminuiu na primeira metade da sessão de hemodiálise. Na segunda metade da sessão, a pressão intraocular e a espessura corneana central mostraram uma tendência de redução, enquanto a espessura da coroide subfoveal permaneceu estável. Ao analisar os efeitos oculares da hemodiálise, seria interessante avaliar as mudanças não só antes e depois da sessão, como também durante a hemodiálise, devido a possíveis flutuações dos valores.

Intravitreal Dexamethasone Implant for Treatment of Serous Macular Detachment in Central Retinal Vein Occlusion.

PURPOSE: To evaluate the effect of intravitreal dexamethasone implant (Ozurdex) treatment on serous macular detachment (SMD) in patients with nonischemic central retinal vein occlusion (CRVO). METHODS: Retrospective, interventional, noncomparative case series was conducted. Twenty-four eyes of 24 patients with macular edema (ME) and SMD secondary to nonischemic CRVO made up the study population. Patients who had received intravitreal triamcinolone and/or antivascular endothelial growth factor treatment and/or had undergone retinal photocoagulation were excluded from the study. After Ozurdex injection, visual and anatomical responses were observed. RESULTS: The mean follow-up time was 9.96 ± 2.44 months (minimum 7, maximum 14). After injection of Ozurdex, ME and SMD regressed except for 1 patient. Twenty cases showed relapse within a 5.45 ± 1.43 months mean time. Seventeen of them had SMD. Eight cases revealed a second relapse and 1 case revealed a third relapse after retreatments. The mean time for the second relapse was 5.50 ± 1.19 months. The height of SMD was found to be lower in all follow-up examinations-including relapses-than baseline measurements. The median SMD value decreased from 247.5 µm (minimum 80, maximum 745) at baseline to 0 µm (minimum 0, maximum 426) at the final examination (P < 0.001). No eyes lost vision at any control visit. The mean best corrected visual acuity increased from 0.89 ± 0.31 logMAR at baseline to 0.62 ± 0.31 logMAR at the final examination (P < 0.01). No local or systemic complication was observed. CONCLUSION: In this case series, Ozurdex was found as a safe and effective treatment for SMD and ME associated with nonischemic CRVO.

Comparison of serum thiol-disulphide homeostasis and total antioxidant-oxidant levels between exudative age-related macular degeneration patients and healthy subjects.

PURPOSE: The purpose of the study was to calculate serum total oxidant status (TOS), total antioxidant status (TAS), and dynamic thiol-disulphide (T-D) homeostasis in patients with age-related macular degeneration (AMD), and compare the results with healthy individuals. METHODS: Thirty-three exudative AMD patients and 33 healthy controls were included in this case-control study. Participants' serum TAS and TOS levels were measured. In addition, total thiol (TT), native thiol (NT), and disulphide (DS) concentrations were assessed using a novel automated method of measurement. RESULTS: In comparison with the control group, serum TAS, TT, and NT levels were found to be significantly lower (p < 0.0001, p = 0.004, p = 0.003, respectively) and TOS levels were detected higher (p = 0.032) in AMD patients. Serum DS levels were elevated in the AMD patient group, but the difference was not statistically significant (p = 0.219). DS/TT and DS/NT ratios were significantly higher (p = 0.012, p = 0.013, respectively) in AMD patients. A positive correlation was found between TT and NT (p < 0.0001) in AMD group. CONCLUSIONS: Serum TOS levels are higher, TAS levels are lower, and the T-D balance is shifted to the DS bond side in AMD patients. These results suggest that increased oxidative stress and decreased antioxidant levels may play a role in AMD progression. Further studies are needed to confirm the pathophysiologic role of T-D homeostasis in AMD.

The Effect of Systemic Tamsulosin Hydrochloride on Choroidal Thickness Measured by Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography.

BACKGROUND: To evaluate the effects of selective α1A-adrenoceptor antagonist tamsulosin hydrochloride on choroidal thickness using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). METHODS: This is a prospective observational study including 29 eyes of 29 patients with newly diagnosed benign prostatic hyperplasia. Choroidal thickness and retrobulbar ocular blood flow measurements were performed at baseline and after 3 months of treatment. Results were analyzed by the masked observer. RESULTS: The mean subfoveal choroidal thickness (275.8-291.9 µm) and thicknesses 750 µm nasal (257.9-270.4 µm) and 750 µm temporal (262.4-277.0 µm) to the fovea were significantly increased after 3 months of treatment (p < 0.001). No statistically significant change was found in retrobulbar ocular blood flow. CONCLUSIONS: Tamsulosin causes a significant increase in EDI-OCT-based choroidal thickness measurements. This increase might be associated with choroidal vasodilation in consequence of blockade of sympathetic α1A-adrenoceptors, which is critical for the maintenance of vascular tone and resistance in the choroidal vascular architecture. This should be kept in mind when choroidal disease and its response to treatment are followed by EDI-OCT imaging.

Surgically induced astigmatism following medial rectus recession: short-term and long-term outcomes.

PURPOSE: The current study aimed to investigate short- and long-term postoperative ocular refractive effects of medial rectus recession on the involved eye and to describe the detectable effects in detail by the results of vector analysis. METHODS: Data of patients in whom medial rectus recession was performed between 2010 and 2012 were retrospectively evaluated. The study included 52 eyes of 32 patients. Patients with a history of previous ocular surgery, congenital or progressive corneal disease, familial or acquired posterior segment disease, glaucoma, a history of ocular trauma, or any neurological or systemic disease were excluded. Best-corrected and uncorrected visual acuities and refraction examination findings of the patients were recorded before the surgery and at the postoperative first month and first year. A vector analysis program was used to analyze surgically induced astigmatism. RESULTS: Significant myopic shift and astigmatic change were determined in the spherical equivalent refraction in the early postoperative period (first month); however, these changes disappeared in the long term (at the postoperative first year). A positive correlation was not observed between the amount of surgical recession and the results of ophthalmic examination at the postoperative first month and first year. CONCLUSIONS: Only postoperative first month spherical equivalent showed a positive correlation with the amount of surgical recession; however, this correlation disappeared at the postoperative first year.

The prevalence of 4G/5G polymorphism of plasminogen activator inhibitor-1 (PAI-1) gene in central serous chorioretinopathy and its association with plasma PAI-1 levels.

CONTEXT: Central serous chorioretinopathy (CSCR) is a poorly understood disease and the choroidal circulation abnormality induced by the plasminogen activator inhibitor type 1 (PAI-1) seems to be associated with the pathogenesis. There are many reports indicating that 4 G/5 G polymorphism of the PAI-1 gene is a risk factor for several diseases related to the elevated serum levels of PAI-1. OBJECTIVE: To evaluate the 4 G/5 G polymorphism of the PAI-1 gene and its association with serum levels of PAI-1 in acute CSCR patients. MATERIALS AND METHODS: Sixty CSCR patients and 50 healthy control patients were included. The PAI-1 4 G/5 G was genotyped using the polymerase chain reaction-restriction technique. Serum PAI-1 level was measured using enzyme-linked immunosorbent assay. Demographic data consisting of age, sex, body mass index (BMI) as well as genotype disturbances and serum PAI-1 levels were compared between the groups. Statistical significance for differences in the serum PAI-1 levels of each group with different genotypes was also analyzed. RESULTS: The CSCR group consisted of 40 male (66.7%) and 20 female (33.3%) patients with a mean age of 46.7 ± 8.39 years. The control group consisted of 32 male (64%) and 18 female (36%) healthy subjects with a mean age of 45.8 ± 8.39 years. There was no statistically significant difference between the groups in terms of age, sex and BMI. In the CSCR group the genotype frequencies were 4 G/4G: 30% (n = 18), 4G/5 G: 50% (n = 30), 5 G/5G: 20% (n = 12) and in the control group genotype frequencies were 34% (n = 17), 42% (n = 21) and 24% (n = 12), respectively. There was no statistically significant difference in the distribution of genotypes among the groups (chi-squared, p = 0.70). The CSCR group had a significantly higher serum PAI-1 concentration than the control group (p = 0.001). In both groups the mean plasma PAI-1 concentration did not vary significantly among the different genotypes (p > 0.05). DISCUSSION AND CONCLUSION: Although our results demonstrated that the patients with acute CSCR have higher serum PAI-1 concentrations than the controls, no significant difference was found in the genotype disturbances of the PAI-1 gene between the groups. The current study indicates that 4 G/5 G polymorphism in the promoter of the PAI-1 gene cannot be considered a risk factor for the elevated serum PAI-1 levels and consequent development of CSCR.

The effect of intracameral anesthesia on macular thickness and ganglion cell-inner plexiform layer thickness after uneventful phacoemulsification surgery: prospective and randomized controlled trial.

BACKGROUND: To evaluate the effect of intracameral lidocaine anesthesia on macular thickness and macular ganglion cell-inner plexiform layer (GC-IPL) thickness following uneventful phacoemusification in healthy subjects. METHODS: This is a prospective, randomized and double- masked study. One hundred eyes of 74 consecutive patients were randomized to receive intracameral preservative-free lidocaine 1 % (intracameral lidocaine group) or intracameral injection of balanced salt solution (sham injection group) at the time of the phacoemulsification surgery. Preoperative and postoperative macular thickness analyses with spectral domain optical coherence tomography (SD-ODT) were performed and the results between the two groups were compared. RESULTS: Postoperatively, both the central foveal thickness (CFT) and the thickness of perifoveal macula were significantly improved in both groups (p < 0.001). There was no statistically significant difference between CFT and the inner and outer macular zone thicknesses of the two groups at any follow-up time. In both groups, GC-IPL thickness was significantly increased at the first week and first month visits (p < 0.001). There was no statistically significant difference between GC-IPL thickness measurements of the two groups at any follow-up time. CONCLUSION: The current study demonstrated that supplementary intracameral lidocaine 1 % did not cause more macular thickening than the intracameral sham injection during a follow-up period of 3 months. The present study also showed a tendency for a transient increase in high definition SD-OCT-based GC-IPL thickness measurements within a few months following cataract surgery under both intracameral lidocaine anesthesia and intracameral sham injection.

Repeated bevacizumab injections versus mitomycin C in rotational conjunctival flap for prevention of pterygium recurrence.

AIMS: To evaluate the efficacy of repeated bevacizumab injection in rotational conjunctival flap surgery versus rotational conjunctival flap with adjunctive mitomycin C (MMC) or rotational conjunctival flap alone. MATERIALS AND METHODS: Ninety eyes of 90 patients who underwent primary pterygium surgery with rotational flap were evaluated. Patients were randomly assigned to undergo conjunctival rotational flap alone (Group A) or conjunctival rotational flap with either 0.02% MMC application (Group B) or adjunctive subconjunctival 2.5 mg/0.1 ml bevacizumab injection (Group C). Each group consisted of 30 eyes. Recurrence rates at 9 months were evaluated. RESULTS: There were no statistically significant differences in mean size of the pterygium across the limbus in terms of length (P > 0.5). The recurrence rates at 9 months were 26.6% (n = 8) in Group A, 13.3% (n = 4) in Group B, and 10% (n = 3) in Group C. The recurrence rates in Group B and C were significantly lower than in Group A (P = 0.1806). The recurrence rates were similar in Group B and C (P > 0.05). CONCLUSIONS: Subconjunctival bevacizumab injection may decrease the recurrence rate of primary pterygium surgery with rotational conjunctival flap. Further studies with a larger population and longer follow-up period are needed to supplement this study.