Subretinal Coapplication of Tissue Plasminogen Activator and Bevacizumab with Concurrent Pneumatic Displacement for Submacular Hemorrhages Secondary to Neovascular Age-Related Macular Degeneration.

Objectives: To evaluate the functional and morphological outcomes of vitrectomy in combination with intravitreal 5% C3F8 tamponade and subretinal injections of tissue plasminogen activator (tPA) and anti-vascular endothelial growth factor (anti-VEGF) in patients with submacular hemorrhage (SMH) and to investigate the preoperative prognostic factors. Materials and Methods: This retrospective study included 30 patients (16 women, 14 men) diagnosed with SMH secondary to neovascular age-related macular degeneration (AMD). Preoperative SMH thickness and area, ellipsoid zone integrity, and postoperative reduction in the amount of subfoveal blood on optical coherence tomography and fundus photographs were assessed. Furthermore, visual acuity (VA), hemorrhage duration, and the need for additional intravitreal anti-VEGF injections were recorded. Results: The patients' mean age was 73.33±8.23 years. Mean VA improved from logMAR 2.11±0.84 at baseline to logMAR 1.32±0.91, 0.94±0.66, 1.13±0.84, and 1.00±0.70 at postoperative month 1, 2, 3, and 6, respectively. A significant negative correlation was found between hemorrhage duration and postoperative VA at month 2 (p=0.005), month 3 (p=0.019), and month 6 (p=0.012). The mean preoperative SMH duration was significantly shorter in patients who achieved total resolution of the hemorrhage compared with the subtotal resolution group (p<0.001). The mean SMH area was smaller in the patients with continuous ellipsoid zone. Conclusion: Vitrectomy and submacular tPA and anti-VEGF injections with concurrent C3F8 tamponade appears to provide adequate displacement of the hemorrhage, resulting in significant VA improvement in patients with hemorrhagic neovascular AMD. Timing of the surgery appears to be the most important factor determining the final VA.

Evaluation of retinal vascular structure after epiretinal membrane surgery by optical coherence tomography angiography.

PURPOSE: To evaluate the retinal vascular structure before and after the epiretinal membrane (ERM) surgery by optical coherence tomography angiography (OCTA). METHODS: Twenty-two eyes with ERM (study eyes) had been evaluated by OCTA for superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD) at foveal and parafoveal regions and foveal avascular zone (FAZ) before and after ERM removal surgery. Twenty-two fellow eyes were selected as control group. RESULTS: Preoperative VD of SCP and DCP were significantly lower in ERM eyes than in controls in both foveal and parafoveal areas (p < 0.05, for all). The difference regressed in SCP (fovea: 18.04 ± 3.1 vs 19.98 ± 18 p = 0.002 and parafovea: 47.33 ± 3.54 vs 49.71 ± 28 p = 0.001), but persisted in DCP (fovea: 17.25 ± 3.52 vs 17.57 ± 4.01 p = 0.856 and parafovea: 50.12 ± 4.35 vs 50.93 ± 3.24 p = 0.791) in study eyes, postoperatively. Superficial and deep FAZ areas were significantly smaller in study eyes than controls. Postoperatively, superficial FAZ area enlarged (0.288 ± 0.10 vs 0.307 ± 0.08 p = 0.012), whereas deep FAZ area did not (0.324 ± 0.09 vs 0.338 ± 0.07 p = 0.435). FAZ area was correlated with the best-corrected visual acuity in ERM eyes. CONCLUSION: Vascular damage in SCP and DCP was demonstrated by OCTA in eyes with ERM. ERM removal surgery mainly improves superficial changes caused by ERM. Changes in deep retinal flow may be associated with visual outcomes after ERM removal surgery.

The Effect of Nicotine on Macular Microcirculation in Healthy Subjects.

BACKGROUND AND OBJECTIVE: To evaluate the acute effects of nicotine on macular microvasculature by optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Non-smokers who were administered 4 mg nicotine gum (study group) or placebo gum (control group) were enrolled, 18 individuals in each group. All participants underwent OCTA at baseline and 1 hour after gum chewing. Macular flow area, macular vessel density, foveal avascular zone area, central foveal thickness, and subfoveal choroidal thickness were analyzed. RESULTS: Macular flow area, vessel density, and subfoveal choroidal thickness decreased in the nicotine group (P < .05). No statistically significant difference observed in central foveal thickness, when compared with baseline measurement (P > .05). CONCLUSIONS: Nicotine causes a significant decrease in macular microcirculation. Deterioration of macular microcirculation can be quantitatively detected by OCTA noninvasively. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:691-700.].

Intraocular lens tilt and decentration after Nd:YAG laser posterior capsulotomy: Femtosecond laser capsulorhexis versus manual capsulorhexis.

PURPOSE: To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser-assisted capsulotomy versus manual capsulorhexis. SETTING: Ekol Eye Hospital, Izmir, Turkey. DESIGN: Retrospective case series. METHODS: Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. RESULTS: Eighteen eyes had a femtosecond laser-assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P > .05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P < .05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P < .05) except decentration on the horizontal meridian (P = .669). CONCLUSIONS: Nd:YAG posterior capsulotomy performed after femtosecond laser-assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser-created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant.

Unmeasurable small size superficial and deep foveal avascular zone in nanophthalmos: the Collaborative Nanophthalmos OCTA Study.

AIM: To study the macular structure and vasculature in consecutive nanophthalmic eyes using optical coherence tomography angiography. METHODS: This is a prospective, multicentre, cross-sectional study of patients with nanophthalmos (one or both eyes). The superficial and deep foveal avascular zones (FAZ) were measured both manually and with the machine's built-in automated measurement tool. Correlations between best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT) were calculated. RESULTS: Sixty-five eyes of 35 subjects (16 men and 19 women) with a mean age of 37.4 years were analysed. The mean±SD of refractive error was 14.3±3.2 dioptres, axial length was 16.4±1.6 mm, CMT was 410.2±128.3 µm and SFCT was 450.1±108.3 µm. FAZ was unmeasurable small size in both the superficial and deep capillary plexus in all eyes, along with tortuosity of the superficial foveal capillaries and large vessels. Foveal folds were present in 29 eyes. Disc drusen was detected in 27 eyes and was absent in 31 eyes, while fundus autofluorescence was positive in 17 and negative in 24 eyes. BCVA varied from 20/20 to 20/800, with a mean of 20/76. Using Spearman's correlation, logarithm of the minimum angle of resolution BCVA correlated negatively with axial length (r=-0.30; p=0.015). CONCLUSIONS: FAZ attenuation, capillary tortuosity, foveal folds and thickened subfoveal choroid characterise the nanophthalmic macula. These findings may result from a redundant retina and the absence of apoptotic foveolar retraction because of developmental arrest of the optic vesicle after closure of the embryonic fissure.

Retinal detachment in albinism.

PURPOSE: To report the visual and anatomic outcomes of albino retinal detachment (ARD) repair. METHODS: Collaborative retrospective analysis of ARD. Outcome measures were number of surgical interventions, final retinal reattachment, and best corrected visual acuity (BCVA) at last follow-up. RESULTS: Seventeen eyes of 16 patients (12 males; mean age =37.8 years) had the following complications at presentation: macula off (14), total (7) or inferior detachment (5), proliferative vitreoretinopathy (5), detectable break (16), lattice (5), horseshoe tears (9), and giant tear or dialysis (4). Mean number of interventions was 1.8 (range =1-5) and included cryopexy (15) with scleral buckle (11), and/or vitrectomy (8). Mean initial BCVA was counting finger (CF) 1 m and at last follow-up (mean 77 months) CF4m with mean improvement of 4.5 lines (early treatment diabetic retinopathy study) (P=0.05). Intraoperative choroidal hemorrhage occurred in three eyes. The retina was finally attached in 14 eyes, with residual inferior detachment in three eyes with silicone oil in situ. Silicone oil was kept in six of seven eyes because of residual inferior detachment (3) and removal of silicone oil, which led to redetachment (1) or fear of redetachment (2). CONCLUSION: Repair of ARD may require several interventions, with the need to keep silicone oil in several cases due to nystagmus and reduced melanin pigment.

INTRAVITREAL DEXAMETHASONE IMPLANT IN RETINITIS PIGMENTOSA-RELATED CYSTOID MACULAR EDEMA.

PURPOSE: To report the clinical outcome after intravitreal dexamethasone implant in patients with retinitis pigmentosa and cystoid macular edema. METHODS: Multicenter retrospective case series of eyes with retinitis pigmentosa and cystoid macular edema that underwent intravitreal dexamethasone implant. Primary outcome measures were best-corrected visual acuity in LogMAR and central macular thickness. Statistical analyses used two-tailed comparison with Wilcoxon signed-rank test. RESULTS: There were a total of 45 eyes from 34 patients with a mean age of 32.7 years (range 16-57) and mean follow-up of 15.5 ± 13.0 months. At Month 3 after the first injection, mean initial best-corrected visual acuity improved from 0.61 ± 0.38 (20/81) to 0.37 ± 0.16 (20/47) (P = 0.012), whereas mean central macular thickness (µm) decreased from 506 ± 288 µm to 311.7 ± 71.6 µm (P < 0.001) and mean intraocular pressure increased from 15.7 ± 2.3 mmHg to 19.8 ± 11.0 mmHg (P = 0.01). Fourteen eyes had multiple injections (1-7 reinjections) at a mean interval of 6 months. Treatment effect was durable with multiple injections, but with seven eyes developing visually significant cataracts. CONCLUSION: Best-corrected visual acuity improved up to 4 months in around half of the eyes. Eyes that benefited the most were pseudophakic, steroid nonresponsive, with large initial central macular thickness, and profuse fluorescein dye leakage.

Effect of 1- and 6-Hour-Delayed Corneal Collagen Cross-Linking on Corneal Healing in a Rabbit Alkali-Burn Model: Clinical and Histological Observations.

PURPOSE: To study the effect of 1- and 6-hour-delayed corneal collagen cross-linking (CXL) on wound-healing of experimental alkali burns of the cornea. METHODS: Twenty-four albino rabbits were used. Alkali burns were created using 1 M NaOH. The animals were divided randomly into 2 groups: group 1 (control group, n = 6) and group 2 (experimental group, n = 18). The experimental group was further divided into 3 subgroups as follows: group 2A, untreated (non-CXL) subgroup; group 2B, 1-hour-delayed CXL treatment subgroup; and group 2C, 6-hour-delayed CXL treatment subgroup. All rabbits were examined periodically for 21 days after treatment and then killed. The corneas were excised and histologically examined. RESULTS: Corneal ulceration, edema, and opacity scores were 4.0 ± 1.64, 1.6 ± 0.65, and 3.5 ± 1.21 in group 2A, 1.5 ± 1.76, 1.3 ± 0.87, and 3.1 ± 1.12 in group 2B, and 2.0 ± 1.90, 1.5 ± 0.79, and 3.3 ± 1.09 in group 2C, respectively. These scores were significantly less in groups 2B and 2C than in group 2A (P = 0.023, P = 0.043, and P = 0.034, respectively). Corneal epithelialization, evident upon staining, was best in group 2B and worst in group 2A (P = 0.012). Histopathology revealed that destruction of corneal collagen fibers and infiltration of inflammatory cells into corneal tissue were reduced in groups 2B and 2C compared with group 2A. CONCLUSIONS: We found that CXL treatment exerted positive effects on severe alkali-induced corneal burns. However, the effects were more pronounced in the 1-hour treatment group. We believe that CXL treatment may be a possible treatment for corneal alkali burn.

Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography.

PURPOSE: To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared. RESULTS: The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540). CONCLUSION: Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.

Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography / Avaliação de medidas de coroide e espessura da retina em pacientes em hemodiálise adultos usando tomografia de coerência óptica de domínio espectral

ABSTRACT Purpose: To assess the effect of hemodialysis on retinal and choroidal thicknesses using spectral-domain optical coherence tomography (SD-OCT). Methods: In this prospective interventional study, 25 hemodialysis patients (17 male, 8 female) were enrolled. All participants underwent high-speed, high-resolution SD-OCT (λ=840 mm; 26.000 A-scans/s; 5 µm resolution) before and after hemodialysis. Choroidal thickness was measured perpendicularly from the outer edge of the retinal pigment epithelium to the choroid-sclera boundary at the fovea and at five additional points: 500 µm and 1000 µm nasal to the fovea and 500 µm, 1000 µm, and 1500 µm temporal to the fovea. Two masked physicians performed the measurements. Choroidal and retinal thicknesses before and after hemodialysis were compared. Results: The median choroidal thicknesses before and after hemodialysis were 182 µm (range, 103-374 µm) and 161 µm (range, 90-353 µm), respectively (P<0.001). The median retinal thicknesses were 246 µm (range, 179-296 µm) before and 248 µm (range, 141-299 µm) after hemodialysis (P>0.05). Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, and ocular perfusion pressure significantly decreased after hemodialysis (P<0.001). Intraocular pressure did not vary significantly (P=0.540). Conclusion: Hemodialysis seems to cause a significant decrease in choroidal thickness, whereas it has no effect on retinal thickness. This significant decrease in choroidal thickness might be due to the extensive fluid absorption in hemodialysis, which could result in decreased ocular blood flow.

RESUMO Objetivo: Avaliar o efeito da hemodiálise (HD) na espessura da retina (RT) e na espessura da coroide (CT) usando tomografia de coerência óptica de domínio espectral (SD-OCT). Método: Neste estudo prospectivo intervencionista foram incluídos 25 pacientes em HD (17 homens e 8 mulheres). Todos os participantes foram submetidos a SD-OCT com dispositivo de alta resolução (λ=840 mm; 26.000 A-scans/seg e resolução de 5 µm), antes e após HD. A CT foi medida perpendicularmente a partir da borda externa do epitélio pigmentar da retina até o limite coroide-esclera na fóvea e em mais de 5 pontos localizados 500 µm nasal à fóvea, 1.000 µm nasal à fóvea; 500 µm temporal à fóvea, 1.000 µm temporal à fóvea, e 1.500 µm temporal à fóvea. Dois médicos realizaram as medidas sem o conhecimento do diagnóstico. Os dados da CT e RT, antes e após a HD foram comparados. Resultados: As CTs medianas antes e após a HD foram 182 µm (variação de 103-374 µm) e 161 µm (variação de 90-353 µm), respectivamente (p<0,001). A RT foi 246 µm (variação de 179-296 µm) antes e 248 µm (variação de 141-299 µm) após a HD (p>0,05). A pressão arterial sistólica, pressão arterial diastólica, as médias de pressão arterial média, frequência cardíaca e pressão de perfusão ocular diminuíram significativamente após HD (p<0,001). A pressão intraocular não alterou significativamente (p=0,540). Conclusão: A HD parece causar uma redução significativa da CT, e não ter efeito sobre a RT. Esta redução significativa da CT pode ser devida à grande absorção de fluido durante a HD, o que pode resultar numa diminuição do fluxo sanguíneo ocular.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with migraine: a comparative study.

PURPOSE: To assess choroidal thickness in patients with migraine and compare them with healthy controls, using spectral-domain optical coherence tomography (OCT). METHODS: In this prospective case-control study, choroidal thicknesses of 20 newly diagnosed migraine patients and 20 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain (FD) OCT device (λ = 840 nm, 26.000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 AM), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in median choroidal thickness between the migraine patients (277.00 [interquartile range (IQR) 85.75] µm) and controls (301.00 [IQR 90.50] µm) (p = 0.012). There were significant differences at all measurement points (p<0.05 for all). CONCLUSIONS: The decreased choroidal thickness of patients with migraine might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and migraine.

Choroidal thickness changes in patients with pseudoexfoliation syndrome.

To evaluate the choroidal thickness using spectral-domain optical coherence tomography (OCT) in patients with pseudoexfoliation syndrome (PXS) and to compare them with healthy controls. This observational comparative study consisted of 35 PXS patients and 35 age- and sex-matched control cases. The control cases had neither systemic nor ocular disease. All 70 patients underwent a complete ophthalmic examination as well as choroidal thickness measurement using a high speed and high resolution SD-OCT device (Topcon 3D OCT-2000, Japan). There was no significant difference with respect to mean refractive error and intraocular pressure measurement between patients with PXS and controls (p = 0.237 and 0.433, respectively). The mean choroidal thickness was found as 206.6 ± 37.6 µm in the PXS group and 215.9 ± 47.3 µm in controls, respectively. The mean choroidal thickness was not significant between the PXS patients and the control cases (p = 0.362). Although PXS patients had lower mean choroidal thickness than controls, our results did not reach any statistical significance.

The effect of caffeine on choroidal thickness in young healthy subjects.

BACKGROUND: To investigate the effect of oral caffeine intake on choroidal thickness using optical coherence tomography (OCT). METHODS: Eighteen otherwise healthy caffeine users and 18 controls were enrolled. All participants underwent OCT scanning with high-speed and resolution spectral-domain OCT device (3D OCT 2000, Topcon, Japan) at baseline, and 1 and 3 h following 200-mg oral caffeine intake in the study and after oral placebo in the control group. The measurements were taken in the morning (10-12 am) to avoid diurnal fluctuation. RESULTS: The median choroidal thickness at the fovea prior to oral caffeine intake was 337.00 (IQR 83.75) µm, which decreased to 311.00 (IQR 79.25) µm at 1 h and 311.00 (IQR 75.00) µm at 3 h following oral caffeine intake (p = 0.001, 0.002, respectively). The median choroidal thickness was also significantly decreased following oral caffeine intake at other five extrafoveal points (p < 0.05 for all). The difference in choroidal thickness was not statistically significant between 1 and 3 h of caffeine intake at all six points. In the control group, the median baseline choroidal thickness at the fovea was 330.00 (IQR 88.75) µm, which was 330.50 (IQR 80.75) µm at 1 h and 330.50 (IQR 90.75) µm at 3 h (p = 0.552, 0.704, respectively). CONCLUSIONS: Caffeine causes a significant decrease in choroidal thickness following oral intake. This decrease might be a result of reduced ocular blood flow due to its vasoconstrictive effect.

Choroidal thickness changes in patients with migraine.

This observational study evaluated choroidal thickness using spectral domain optical coherence tomography (SD-OCT) in patients with migraine and compared the results with healthy controls. The study population consisted of 42 migraine patients (36 females and 6 males) who were referred from neurology clinics and 42 controls (36 female and 6 male) with no systemic or ocular disease and no headache of any type. All 84 patients underwent complete ophthalmic examination as well as determination of choroidal thickness using a high-speed, high-resolution SD-OCT device (λ = 840 nm, 27.000 A-scans/s, 5-µm axial resolution). The migraine patients were classified into the migraine with aura group or the migraine without aura group, and a pain score from 1 to 10 was determined for each patient based on the Visual Analogue Scale (VAS). The mean choroidal thicknesses were 276.81 ± 37.76 µm in the migraine group and 300.44 ± 24.93 µm in controls. The difference in choroidal thickness between the migraine patients and the controls was significant (P = 0.001). Choroidal thickness measurements of five patients during an attack showed an acute decrease (mean 45.50 µm) in choroidal thickness from the values in the same patients during the attack-free period. There was no correlation between VAS score and the type of migraine with choroidal thickness (P > 0.05). The decrease in mean choroidal thickness in patients with migraine compared to controls may be related to the vascular pathology of the migraine. The acute decrease in choroidal thickness during an attack also lends support to this hypothesis of reduced ocular blood flow in these patients.

Switching intravitreal anti-VEGF treatment in neovascular age-related macular degeneration.

PURPOSE: To compare the outcomes after switching between bevacizumab and ranibizumab therapy due to poor treatment effect in neovascular age-related macular degeneration (AMD). METHODS: This is a retrospective review of patients with neovascular AMD with first treatment using intravitreal bevacizumab (group 1) or ranibizumab (group 2) who switched to the other drug due to poor treatment effect. Primary outcome measures were change in mean best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT) at 1 year and last visit. RESULTS: Eighty-seven eyes met the inclusion criteria. In group 1 (43 eyes), the mean BCVA decreased from 20/94 to 20/100 at 1 year after being switched (p = 0.573) and to 20/150 (p = 0.015) at final visit (mean 29.2 months, range 12-53). In group 2 (44 eyes), mean BCVA decreased from 20/72 to 20/90 (p = 0.401) and 20/100 (p = 0.081) at 1 year after switch and at final visit (mean 20.1 months, range 10-40), respectively. The mean CRT at switch, 1 year after switch, and at final visit were 344.4 ± 140 µm (mean ± SD), 286.26 ± 155 µm (p = 0.019), and 290.58 ± 196 µm (p = 0.009) in group 1 and 329.36 ± 144 µm, 302.0 ± 179 µm (p = 0.215), and 309.5 ± 220 µm (p = 0.154) in group 2, respectively. CONCLUSIONS: The mean BCVA decreased over time in both groups; however, nearly 30% of the eyes in each group showed vision improvement after switching. Mean CRT decreased in both groups, which was more pronounced after being switched from bevacizumab to ranibizumab. In neovascular AMD, a switch between ranibizumab and bevacizumab can be considered as a further therapy option if poor treatment effect is seen with the initial therapy.

Spontaneous resolution of macular edema after silicone oil removal.

AIM: To investigate the macular changes in eyes filled with silicone oil (SO) and course of these changes after SO removal. METHODS: A retrospective optical coherence tomography scan review was conducted for twenty-four patients who underwent uncomplicated pars plana vitrectomy with SO tamponade for complex retinal detachments were detected with optical coherence tomography before, and one week, one month and three months after SO removal. RESULTS: Mean duration of SO tamponade was 3.6±1.0mo (range: 3-7mo). Cystoid macular edema (CME) was detected in 3 eyes before SO removal. Submacular fluid was represented in 1 eye before silicone SO removal. Resolution of CME and submacular fluid was achieved 1mo after SO removal in all eyes. Mean best corrected visual acuity (BCVA) was 1.15±0.65 (range, hand movement to 0.2) before SO removal in the eyes without macular changes. After SO removal, the mean BCVA values at 1wk and 1 and 3mo, and 0.82±0.23, 0.76±0.21, and 0.70±0.19, all of which were significantly better than baseline (P=0.030, 0.017, 0.006 respectively). In the eyes with macular CME and subretinal fluid the mean BCVA was significantly improved at 3mo after SO removal compared with baseline (P=0.037). CONCLUSION: Decreased visual acuity in eyes filled with SO could be caused by macular complications due to SO. CME and subretinal fluid may resolve without any additional macular surgery after SO removal.

Changes in choroidal thickness in patients with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVE: To evaluate choroidal thickness using spectral-domain optical coherence tomography (SD-OCT) in patients with obstructive sleep apnea syndrome (OSAS) in comparison to healthy controls. PATIENTS AND METHODS: This observational, comparative study consisted of 35 patients with OSAS and 32 age- and sex-matched controls. The controls did not have systemic or ocular diseases. All study participants underwent complete ophthalmic examination as well as choroidal thickness measurement using a high-speed, high-resolution SD-OCT device. RESULTS: The mean horizontal and vertical choroidal thicknesses, respectively, were 237.84 ± 69.9 µm and 234.97 ± 62.0 µm (P = .654) in patients with OSAS and 244.09 ± 41.2 µm and 241.88 ± 40.9 µm (P = .590) in the healthy controls. The mean choroidal thicknesses were thinner in patients with OSAS, but the difference was not significant (P > .05 for all values). CONCLUSION: No differences in choroidal thickness were found between patients with OSAS and healthy controls.

Does topical bevacizumab prevent postoperative recurrence after pterygium surgery with conjunctival autografting?

AIM: To assess the effect of topical bevacizumab use on postoperative pterygium recurrence in eyes who underwent pterygium excision with limbal-conjunctival autograft transplantation (LCAT). METHODS: Eighty-eight eyes of 88 patients with primary pterygium were included. Pterygia were graded preoperatively from type 1 to type 3 (type 1 atrophic, type 3 inflamed) according to the inflammatory status. The eyes were preoperatively randomized to receive topical steroid and antibiotic treatment (group 1, 46 eyes) and additional topical bevacizumab (5 mg/mL; group 2, 42 eyes) in the postoperative period. All eyes underwent pterygium excision and LCAT. Medications were tapered and discontinued at one month. Postoperative complications and recurrence rates were recorded. RESULTS: The mean follow-up duration was 29.3±4.2mo (24-52mo) and 28.5±3.4 (24-48mo) in group 1 and 2, respectively (P>0.05). There were no statistically significant differences regarding the age or gender between groups (P>0.05). Also, the difference between groups with respect to pterygium type was not significant. During the follow-up period, recurrence developed in 2 eyes (4.3%) in group 1, whereas in one eye (2.4%) in group 2. No statistically significant difference between groups was found in recurrence rates (P>0.05). No re-operation for recurrence was necessary during the follow-up period in both groups. CONCLUSION: Topical bevacizumab seems to have no additonal effect on pterygium recurrence after LCAT.

Retinal and choroidal thickness changes after single anti-VEGF injection in neovascular age-related macular degeneration: ranibizumab vs bevacizumab.

PURPOSE: To evaluate and compare the effects of single intravitreal injection of ranibizumab and bevacizumab on central retinal and choroidal thickness in patients with neovascular age-related macular degeneration (AMD). METHODS: Forty eyes of 40 patients with neovascular AMD that underwent intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGFs) were included. Patients were randomized into 2 groups: 20 eyes received ranibizumab and 20 eyes received bevacizumab injection. Central retinal and choroidal thicknesses of all eyes at baseline and 1 month postinjection scans were measured with Fourier-domain optical coherence tomography (OCT). Student t test and Mann-Whitney U test were used to compare the data. RESULTS: The mean central retinal thickness (CRT) showed significant decrease after single injection of ranibizumab (from 345.0 µm to 253.5 µm, p<0.01) and bevacizumab (from 329.5 µm to 251.0 µm, p<0.01) at the first month, respectively. There was no significant difference regarding the CRT change between groups (p = 0.39). The mean choroidal thickness decreased from 158.6 µm (115-317) to 155.5 µm (111-322) in the ranibizumab group and from 211.5 µm (143-284) to 201.5 µm (93-338) in bevacizumab group. The decrease was not significant between groups (p = 0.35). CONCLUSIONS: Intravitreal injection of both ranibizumab and bevacizumab provided a significant decrease in CRT; however, the agents caused no significant change in choroidal thickness. Additionally, no difference between ranibizumab versus bevacizumab was observed related to macular edema inhibition.