The relationship between reduced choroidal thickness due to high plasma asymmetrical dimethylarginine level and increased severity of diabetic retinopathy / Altos níveis de dimetil-arginina assimétrica no plasma podem aumentar a gravidade da retinopatia diabética através da redução da espessura da coroide

ABSTRACT Purpose: To evaluate the relationship between subfoveal choroidal thickness and plasma asymmetrical dimethylarginine level and the severity of diabetic retinopathy in patients with type 2 diabetes mellitus. Methods: A total of 68 cases, including 15 patients without diabetic retinopathy, 17 patients with nonproliferative diabetic retinopathy, 16 patients with type 2 diabetes mellitus and proliferative diabetic retinopathy, and 20 healthy patients (control group), were enrolled in this study. Subfoveal choroidal thickness was measured manually using the enhanced depth imaging optical coherence tomography scanning program, and plasma asymmetrical dimethylarginine level was measured using a commercial micro enzyme-linked immunosorbent assay kit. Results: The subfoveal choroidal thickness values and plasma asymmetrical dimethylarginine levels were significantly different between the four groups (p<0.001 and p<0.001). The subfoveal choroidal thickness values were significantly lower in the proliferative diabetic retinopathy group than in the other three groups (no diabetic retinopathy, nonproliferative diabetic retinopathy, and control groups; p<0.001, p=0.045, and p<0.001, respectively). The plasma asymmetrical dimethylarginine levels were significantly higher in the proliferative diabetic retinopathy group than in the other three groups (p<0.001, p<0.04, and p<0.001, respectively). In addition, a significant negative correlation was also found between plasma asymmetrical dimethylarginine level and subfoveal choroidal thickness (p<0.001, r=-0.479). Conclusion: Asymmetrical dimethylarginine is an important marker of endothelial dysfunction and endogenous endothelial nitric oxide synthase inhibitor. The severity of diabetic retinopathy was related to increased plasma asymmetrical dimethylarginine level and reduced subfoveal choroidal thickness in type 2 diabetic patients with diabetic retinopathy.

RESUMO Objetivo: Avaliar a relação da espessura subfoveal da coroide e dos níveis plasmáticos de dimetil-arginina assimétrica com a gravidade da retinopatia diabética em pacientes com diabetes mellitus tipo 2. Métodos: Foram incluídos 68 casos, compreendendo 15 pacientes sem retinopatia diabética, 17 pacientes com retinopatia diabética não proliferativa, 16 pacientes com retinopatia diabética proliferativa, e 20 casos saudáveis (grupo de controle). A espessura subfoveal da coroide foi medida manualmente, usando o programa de varredura com tomografia computadorizada óptica com imagem profunda aprimorada, e os níveis plasmáticos de dimetil-arginina assimétrica foram medidos usando um kit microELISA comercial. Resultados: Os valores da espessura subfoveal da coroide e os níveis plasmáticos de dimetil-arginina assimétrica foram significativamente diferentes nos quatro grupos (p<0,001 para ambos os parâmetros). Os valores da espessura subfoveal da coroide foram significativamente menores no grupo com retinopatia diabética proliferativa do que nos outros três grupos (sem retinopatia diabética, retinopatia diabética não proliferativa e grupo de controle, com p<0,001, p=0,045 e p<0,001, respectivamente). Já os níveis plasmáticos de dimetil-arginina assimétrica foram significativamente maiores no grupo com retinopatia diabética proliferativa do que nos outros três grupos (p<0,001, p=0,04 e p<0,001, respectivamente). Além disso, também foi encontrada uma correlação negativa significativa entre os níveis plasmáticos de dimetil-arginina assimétrica e a espessura subfoveal da coroide (p<0,001, r=-0,479). Conclusão: A dimetil-arginina assimétrica é um importante marcador de disfunção endotelial e um inibidor endógeno da óxido nítrico sintase. Foi encontrada uma relação da gravidade da retinopatia diabética e de níveis elevados de dimetil-arginina assimétrica no plasma com a redução da espessura subfoveal da coroide em pacientes diabéticos tipo 2 com retinopatia diabética.

The relationship between reduced choroidal thickness due to high plasma asymmetrical dimethylarginine level and increased severity of diabetic retinopathy.

PURPOSE: To evaluate the relationship between subfoveal choroidal thickness and plasma asymmetrical dimethylarginine level and the severity of diabetic retinopathy in patients with type 2 diabetes mellitus. METHODS: A total of 68 cases, including 15 patients without diabetic retinopathy, 17 patients with nonproliferative diabetic retinopathy, 16 patients with type 2 diabetes mellitus and proliferative diabetic retinopathy, and 20 healthy patients (control group), were enrolled in this study. Subfoveal choroidal thickness was measured manually using the enhanced depth imaging optical coherence tomography scanning program, and plasma asymmetrical dimethylarginine level was measured using a commercial micro enzyme-linked immunosorbent assay kit. RESULTS: The subfoveal choroidal thickness values and plasma asymmetrical dimethylarginine levels were significantly different between the four groups (p<0.001 and p<0.001). The subfoveal choroidal thickness values were significantly lower in the proliferative diabetic retinopathy group than in the other three groups (no diabetic retinopathy, nonproliferative diabetic retinopathy, and control groups; p<0.001, p=0.045, and p<0.001, respectively). The plasma asymmetrical dimethylarginine levels were significantly higher in the proliferative diabetic retinopathy group than in the other three groups (p<0.001, p<0.04, and p<0.001, respectively). In addition, a significant negative correlation was also found between plasma asymmetrical dimethylarginine level and subfoveal choroidal thickness (p<0.001, r=-0.479). CONCLUSION: Asymmetrical dimethylarginine is an important marker of endothelial dysfunction and endogenous endothelial nitric oxide synthase inhibitor. The severity of diabetic retinopathy was related to increased plasma asymmetrical dimethylarginine level and reduced subfoveal choroidal thickness in type 2 diabetic patients with diabetic retinopathy.

Mask-associated Dry Eye Syndrome in Healthcare Professionals as a New Complication Caused by the Prolonged Use of Masks during Covid-19 Pandemic Period.

PURPOSE: The aim of this study is to demonstrate the prevalence of self-reported mask-associated dry eye (MADE) in health-care professionals and the possible risk factors that give rise to MADE. METHODS: A self-administered questionnaire consisting of 12 questions about MADE and possible risk factors that give rise to MADE was created on web-based "google forms" application, and was then sent to 437 healthcare professionals working in a coronavirus-19 (COVID-19) pandemic hospital, using common telecommunication devices. RESULTS: Three hundred and thirty-three of the 437 health-care professionals, who answered the questionnaire, were included in the study. The prevalence of self-reported MADE among these health-care professionals was found to be 70% (n = 233). Having at least one of the symptoms of dry eye while not having a mask on and advanced age were determined as the possible risk factors for MADE (p = .02 and p < .001, respectively). The clinical examinations of the 195 participants, who had self-reported MADE and accepted the invitation to undergo a clinical evaluation with respect to the symptoms of MADE, revealed that only 60 (30.7%) of these participants had aqueous-type dryness with staining on the ocular surface with fluorescein. CONCLUSION: The high prevalence of self-reported MADE among health-care professionals can be attributed to the prolonged use of masks associated with longer working hours. Therefore, it is important that the ocular complaints of professionals are addressed by ophthalmology consultants/ophthalmologists during these difficult times.

Evaluation of retinal nerve fiber layer and choroidal thickness with spectral domain optical coherence tomography in children with sickle cell anemia.

BACKGROUND: The aim of this study is to examine the thickness of choroidal, macular and peripapillary retinal nerve fiber layer by spectral-domain optical coherence tomography (SD-OCT) in pediatric patients with sickle cell anemia (SCA) without retinopathy. METHODS: A total of 75 children (30 SCA patients (Group 1) and 45 healthy individuals (Group 2) were included in the study. Macular (central, superior, inferior, nasal, temporal), choroidal (subfoveal, at nasal distances from the central fovea of 1000 µm [N1], 2000 µm [N2], 3000 µm [N3], at temporal distances from the central fovea of 1000 µm [T1], 2000 µm [T2], 3000 µm [T3]) and RNFL (average, temporal, superotemporal, inferotemporal, nasal, inferonasal and superonasal) measurements were performed by SD-OCT. These parameters were compared with healthy children with similar demographic characteristics. RESULTS: The mean age was 14.11±3.86 (11-18) in sickle cell anemia patients and 13.15± 2.69 (10-18) in the healthy control group. Of the patients, 56.6% (n=17) of Group 1 and 44.4% (n=20) of Group 2 were male. Choroidal measurements made in the subfoveal, N1, N2, N3, T1, T2 and T3 quadrants showed that the choroid was thinner in 6 quadrants in SCA patients compared to the healthy group (p = 0.003, p = 0.039, p = 0.035, p = 0.595, p = 0.006, p = 0.005, p = 0.047, respectively). In RNFL measurements, there was significant thinning in the temporal, inferotemporal, and nasal quadrants of SCA patients compared to the healthy group. Changes in other quadrants were not significant. CONCLUSIONS: SD-OCT is a useful imaging method in the diagnosis and screening in patients with SCA without retinopathy. Early diagnosis of retinopathy during subclinical disease will prevent visual loss in these patients.

Evaluation of changes in lens optical densitometry using Pentacam HR after renal transplantation: A prospective study.

BACKGROUND: To compare the optical densitometric changes in the lens of patients with renal transplantation with those of a healthy group using Pentacam HR. METHODS: Twenty-four right eyes of 24 healthy patients (Group 1) were compared with 24 right eyes of 24 kidney transplant recipients. Kidney transplant recipients were evaluated thrice (preoperatively: Group 2a, postoperative 1st month: Group 2b, postoperative 12th month: Group 2c). Corneal endothelial cell count, intraocular pressure, and central corneal thickness of all participants were measured. Lens optical densitometry was measured with Pentacam HR using 3D scanning mode. The optical density of the lens was analyzed by taking the corneal apex as the center and analysing the 12 mm diameter area. (Zone 1: 2.0 mm, Zone 2: 4.0 mm, and Zone 3: 6.0 mm). RESULTS: Corneal endothelial cell count was 2571.2±106.7 cells/mm2 in Group 1 and 2462.8±127.6 cells/mm2 in Group 2a (p=0.001). For lens optical densities, significant differences were observed between the groups in Zone 1 and Zone 3, but the difference in Zone 2 was not significant (p=0.003, p=0.164, p=0.009, respectively). There was a positive correlation between dialysis time and preoperative lens optical densitometry in Zone 1, Zone 2, and Zone 3 (r= 0.496, r= 0.131, r= 0.463, respectively). CONCLUSIONS: Although a decrease in lens transparency was observed after kidney transplantation, steroids may cause an increase in lens transparency in the postoperative period. Patients with renal transplantation should be followed closely for possible lens changes in the post-transplant period.

Solar retinopathy from sun gazing under the influence of ecstasy: A longitudinal analysis of OCT and OCTA findings.

This report presents the clinical and optical coherence tomography (OCT) and OCT angiography (OCTA) findings from a case of acute and chronic solar retinopathy (SR) caused by sun gazing while under the influence of the hallucinogenic drug methylenedioxymethamphetamine, which is commonly known as ecstasy. This retrospective and observational case report involves a 16-year-old male patient who developed disruption of all foveolar layers two days after using ecstasy and subsequently gazing at the sun. The patient underwent visual acuity testing, dilated fundus examination, visual field analysis, OCT, and OCTA imaging. He exhibited visual recovery with the permanent disruption of the photoreceptor outer layers, and demonstrated enlargement in the deep foveal avascular zone areas during later follow-up periods, from one month to two years. This report aims to draw attention to SR that may occur after sun gazing while using hallucinogenic drugs and the importance of OCT and OCTA imaging in follow-up exams in such cases.

Evaluation of corneal densitometry changes in patients with lichen planus.

PURPOSE: To investigate the corneal topography and densitometry changes in patients with lichen planus (LP). METHODS: Anterior segment parameters and corneal densitometry of patients with LP and age- and gender-matched individuals with healthy eyes were evaluated using Scheimpflug corneal topography. A 12 mm corneal area was divided into 4 annular zones and 3 regions-in-depth anterior, central and posterior-for densitometry evaluation. RESULTS: The study included 45 patients with LP and 50 individuals with healthy eyes. The two groups were similar in age and gender, and they showed no significant differences in anterior segment corneal topography parameters. Schirmer's I test results were significantly lower in the patients with LP than in the control group (P Ë‚ .001). The total corneal densitometry was higher in patients with LP than in the control group (P = .030). The anterior, central and posterior corneal densitometry in the 0-2 mm and 2-6 mm annular zones was higher in the LP group than in the control group. Correlation analysis between disease duration and corneal densitometry values showed a strong positive correlation in the anterior segment and a moderate positive correlation in the central and posterior segments (r = 0.632, P Ë‚ .001; r = 0.572, P Ë‚ .001; and r = 0.562, P Ë‚ .001, respectively). CONCLUSIONS: Corneal densitometry values were higher in patients with LP than in individuals with healthy eyes, even if the patients had a clinically transparent cornea. More studies are needed to evaluate the changes that may occur in corneal transparency in patients with LP and other autoimmune dermatologic diseases that may affect the eye.

Investigation of corneal topographic and densitometric properties of Wilson's disease patients with or without a Kayser-Fleischer ring.

BACKGROUND: To investigate the topographic measurements and densitometry of corneas in Wilson's disease (WD) patients with or without a Kayser-Fleischer ring (KF-r) compared to healthy individuals. METHODS: This cross-sectional study included 20 WD patients without a KF-r (group I), 18 WD patients with a KF-r (group II), and 20 age-matched controls (group III). The Pentacam high resolution imaging system is used to determine corneal topographic measurements and densitometry. RESULTS: Mean age for groups I, II and III was 25.40 ± 6.43 years (14-36 years), 25.38 ± 6.96 years (16-39 years), 23.60 ± 6.56 years (17-35 years), respectively (P = 0.623). There was no significant difference between the groups in terms of the anterior corneal densitometry values (P > 0.05), while the 6-10 mm and 10-12 mm mid stroma and the 2-6 mm, 6-10 mm, and 10-12 mm posterior corneal densitometry values in group II were significantly higher than those in groups I and III (for all values, P <  0.05). However, the 10-12 mm posterior corneal densitometry values in group I were also significantly higher than those in group III (P = 0.038). The central corneal thickness (CCT), thinnest corneal thickness (tCT), and corneal volume (CV) values in groups I and II were significantly lower than those in group III (for CCT values, P = 0.011 and P = 0.009; for tCT values, P = 0.010 and P = 0.005; for CV values, P = 0.043 and P = 0.029). CONCLUSION: In WD patients with a KF-r, corneal transparency decreased in the peripheral posterior and mid stromal corneal layers; for these patients, corneal transparency may be impaired not only in the peripheral cornea but also in the paracentral cornea.

Evaluation of Infectious Uveitis at a Tertiary Referral Center in Turkey: A 31-year Retrospective Study.

OBJECTIVES: The aim of this study was to examine the demographic and clinical characteristics of patients with infectious uveitis over time. METHODS: The records of a total of 2032 patients treated for uveitis were retrospectively analyzed and 369 eyes of 324 patients diagnosed with infectious uveitis were included in the study. The patients were divided into 2 groups according to the date of presentation. The first group comprised patients seen between January 1988 and August 2009, and patients who presented between September 2009 and April 2019 were classified in the second group. RESULTS: The prevalence of infectious uveitis was 15.1% in the first group and 16.8% in the second group. A statistically significant decrease was observed in the number of toxoplasmosis patients in the second group (p=0.031). There was no significant difference in the number of patients with herpetic anterior uveitis (HAU) (p=0.215). A significant increase was recorded in the number of patients with tuberculosis and acute retinal necrosis (ARN) (p=0.006 and p=0.041, respectively). While there were no patients diagnosed with cytomegalovirus (CMV) anterior uveitis in the first group, 19 patients were diagnosed with the disorder in the second group. There was a decrease in the rate of legal blindness among the patients who were treated in the second period compared with the first period; however, this difference was not statistically significant (p=0.069). CONCLUSION: Toxoplasmosis and HAU were the 2 most common causes of infectious uveitis. The incidence of CMV anterior uveitis, tuberculosis-related uveitis, and ARN increased over the period studied.

The Effect of Chalazion Excision on Corneal Aberrometric and Densitometric Values.

OBJECTIVES: The aim of this study was to investigate the effect of chalazion excision on corneal aberrations and corneal densitometry. METHODS: Thirty-six patients with a chalazion in 1 eyelid and 40 healthy subjects were included in the study. Corneal aberration parameters of total root mean square (RMS), RMS high-order aberration (HOA), horizontal trefoil, oblique trefoil, horizontal coma, vertical coma, and spherical aberration values were measured using Scheimpflug corneal topography (Pentacam HR; Oculus Optikgeräte GmbH, Wetzler, Germany). Corneal densitometry values measured from 4 regions of the cornea (0-2, 2-6, 6-10, and 10-12 mm) and 4 corneal depths (anterior, central, posterior, and total) were recorded. Preoperative measurements of the patients (Group 1), postoperative first-month measurements (Group 2), and control group (Group 3) measurements were compared. RESULTS: The total RMS measurement was 1.64±0.48 µm in Group 1, 1.35±0.32 µm in Group 2, and 1.17±0.38 µm in Group 3 (Group 1-2: p=0.007, Group 1-3: p<0.001, Group 2-3: p=0.173). The mean spherical aberration value was 0.183±0.057 µm in Group 1, 0.157±0.048 µm in Group 2, and 0.144±0.050 µm in Group 3 (Group 1-2: p=0.104, Group 1-3: p=0.004, Group 2-3: p=0.781). The total corneal densitometric measurement was 15.95±1.80 gray scale units (GSU) in Group 1, 14.76±1.76 GSU in Group 2, and 14.33±1.49 GSU in Group 3 (Group 1-2: p=0.01, Group 1-3: p<0.001, Group 2-3: p=0.804). CONCLUSION: It was observed that some corneal aberration and corneal densitometry values were higher in patients with a chalazion compared with those of healthy individuals, and there was a decrease in corneal aberration and densitometry values after surgical excision.

Corneal and lens densitometry with Pentacam HR in children with vernal keratoconjunctivitis.

CLINICAL RELEVANCE: Corneal and lens densitometry measurements provide clinically important information for the evaluation and monitoring of corneal and lens health in patients with vernal keratoconjunctivitis. BACKGROUND: To compare the corneal and lens densitometry values between paediatric patients with vernal keratoconjunctivitis (VKC) and healthy individuals. METHODS: This study included 72 eyes of 72 patients with VKC (25 with mild VKC [Group 1], 22 with moderate VKC [Group 2], and 25 with severe VKC [Group 3]), and 25 eyes of 25 healthy subjects (Group 4). Corneal and lens densitometry values were measured using Pentacam HR as follows: for corneal densitometry in two different corneal zones (0-2 and 2-6-mm) and four different corneal depths (at the total thickness, anterior, central, and posterior layers), and lens densitometry in three different lens zones (Zone 1: 2.0-mm, Zone 2: 4.0-mm, and Zone 3: 6.0-mm). RESULTS: In the 0-2-mm corneal zone for the total thickness and all three layers, corneal densitometry values in Group 3 were significantly higher than those in Groups 1, 2, and 4 (for all values p < 0.012). There was no significant difference in the mean corneal densitometry values between Groups 1 and 2 (for all values p > 0.05). In these groups, the mean corneal densitometry values were significantly higher than those in Group 4 for the anterior layer in the 0-2 and 2-6-mm corneal zones (for all values p < 0.012). The mean values for Zone 3 and average lens densitometry values in Groups 2 and 3 were significantly higher than those in Group 4 (p = 0.001 and p = 0.001, respectively). CONCLUSION: The current study showed corneal clarity changes in patients with mild, moderate, and especially severe VKC. An increase in the lens densitometry values was also observed in patients with moderate and severe VKC than in healthy individuals.

Evaluation of the subfoveal choroidal and outer retinal layer thickness in obese women.

CLINICAL RELEVANCE: Obesity has become one of the most important health problems of today with its increasing prevalence. With the development of retinal imaging systems, obesity has been observed to be associated with changes in outer retinal layers and choroid in women. BACKGROUND: The aim of this study was to examine retinal layer parameters and their relationship with body mass index in obese women. METHODS: The study included 197 eyes of 197 women, of whom 44 were normal-weight, 40 were overweight, 40 were class 1 obese, 38 were class 2 obese, and 35 were morbidly obese. The thickness of the choroid was measured manually using an enhanced-depth imaging optical coherence tomography scanning program. RESULTS: The mean choroidal thickness values in five locations were lower than those of normal-weight, overweight, class 1, and class 2 obese women, in morbidly obese women (p < 0.05 for all). Subfoveal outer retinal layer thickness and specific sublayer thickness of the photoreceptor layer values were significantly lower in morbidly obese women than in normal-weight women, but there were no statistically significant differences between the groups in retinal pigment epithelium thickness and Bruch's membrane thickness (p = 0.001, p < 0.001, p = 1.00, and p = 0.101, respectively). Furthermore, there were significant negative relationships between body mass index and subfoveal choroidal thickness, subfoveal outer retinal layer thickness, and specific sublayer thickness of the photoreceptor layer values (r = -0.327, p < 0.001; r = -0.259, p < 0.001; and r = -0.281, p < 0.001, respectively). CONCLUSIONS: Morbid obesity was associated with a thinner choroid, subfoveal outer retinal layer, and specific sublayer thickness of the photoreceptor layer in women. Furthermore, retinal hypoxia associated with morbid obesity may be related to a decrease in photoreceptor layer thickness. Thinning of the outer retinal layer may also lead to atrophy of the cone sheath.

Evaluation of corneal safety in systemic lupus erythematosus patients undergoing long-term hydroxychloroquine treatment.

PURPOSE: The aim of this study was to examine the effects of long-term use of hydroxychloroquine (HQ) on the pachymetric, aberrometric, and densitometric values of the cornea and corneal endothelium in lupus patients. METHOD: Twenty-two eyes (study group) of 22 patients using HQ for treatment of lupus and 25 eyes (control group) of 25 healthy individuals were included in this prospective study. A specular microscopy was used to measure corneal endothelial cell density (ECD), percentage of hexagonal cells (HEX%), coefficient of variation of the cell size (CV). Then, a Pentacam® HR corneal tomography system was used to measure central corneal thickness (CCT), corneal aberrometry values in 6-mm pupil diameters and corneal densitometry values in 6-mm corneal zones (0-2 mm and 2-6 mm). RESULTS: While ECD was significantly lower in the study group than in the control group (p = 0.034), CCT was significantly higher in the study group (p = 0.032). The higher-order aberrations values and the anterior corneal densitometry values in the 0-2 mm and 2-6 mm corneal zones in the study group were found to be significantly higher than the control group (p = 0.021, p = 0.007 and p = 0.013). CONCLUSION: Prolonged use of HQ may cause some changes in the cornea. In the follow-up of these cases, detailed examination of the cornea as well as the macula may be important for the protection of corneal health.

Ocular findings in patients with coronavirus disease 2019 (COVID-19) in an outbreak hospital.

PURPOSE: The aim of this study was to investigate the ocular findings observed in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 and to present the relationship between ocular involvement, systemic findings, and laboratory results. MATERIAL AND METHODS: This cross-sectional study was carried out between 1 May and 30 June 2020. The study included 359 patients diagnosed with COVID-19 and assessed by clinical evaluation, nasopharyngeal polymerase chain reaction, and lung computed tomography. RESULTS: One hundred ninety-seven (54.9%) of the patients were male and 162 (45.1%) were female. The mean age of the patients was 58.5 years (20-91). Two hundred ninety-four (81.9%) patients were treated in the inpatient clinic and 65 (18.1%) patients were treated in the intensive care unit. Various ocular diseases were observed in 16 (4.5%) of the patients. Although the rate of ocular disease was 12 out of 294 (4.1%) in patients followed up in the inpatient clinic, this rate was 4 out of 65 (6.2%) in intensive care patients. There was no systemic problem in one patient, in whom conjunctival hyperemia was the first and only reason for admission to the hospital. Four patients followed up in the inpatient clinic had conjunctivitis at the time of admission, and conjunctivitis occurred in three patients during hospitalization. Subconjunctival hemorrhage occurred in five patients and vitreous hemorrhage in one patient. CONCLUSION: Ocular diseases are uncommon in COVID-19 patients but may occur during the first period of the disease or during follow-up. Ocular diseases may be the initial or only sign of COVID-19 infection.

Changes in choroidal thickness after vitamin D supplementation in patients with vitamin D deficiency.

OBJECTIVE: To determine the relationship between vitamin D (vit D) deficiency and choroidal thickness and to investigate changes in choroidal thickness after vit D treatment. METHODS: Sixty-five patients diagnosed with vit D deficiency (group 1) and 60 healthy individuals with normal vit D levels (group 2) were included in the study. The choroidal thickness in the subfoveal, nasal, and temporal regions of the fovea were measured manually using enhanced depth imaging optical coherence tomography. The choroidal thickness in the patients in group 1 was re-evaluated after treatment with vit D. RESULTS: The groups were similar in terms of age and sex (p = 0.138 and p = 0.198, respectively). The subfoveal, temporal (500 and 1.500 µm), and nasal (500 and 1.500 µm) choroidal thickness values in group 1 were statistically significantly lower than those in group 2 (p < 0.001 for all). After vit D replacement therapy, there was a significant increase in the choroidal thicknesses compared with the pretreatment measurements (p < 0.001 for all). There was a positive correlation between vit D values and subfoveal, temporal (500 and 1.500 µm), and nasal (500 and 1.500 µm) choroidal thickness values (r = 0.558 and p < 0.001, r = 0.415 and p < 0.001, r = 0.352 and p < 0.001, r = 0.349 and p < 0.001, and r = 0.294 and p = 0.001, respectively). CONCLUSION: The choroidal thickness decreased in patients with vit D deficiency. The choroidal thickness values increased after vit D replacement therapy. Serum vit D levels should be assessed in studies evaluating choroidal thickness.

Central serous chorioretinopathy associated with high-dose follistatin-344: a retrospective case series.

PURPOSE: To present 11 bodybuilding athletes who developed central serous chorioretinopathy (CSCR) following high-dose subcutaneous follistatin-344, a peptide-based performance and image enhancing drug, injections to increase muscle mass. METHODS: This is a retrospective case series from one institution. Demographic and clinical data of 11 patients who were admitted to our clinic with decreased visual acuity after high-dose follistatin-344 injections and optical coherence tomography (OCT) findings consistent with CSCR were analyzed. RESULTS: All 11 patients were male, and the mean age was 36.8 ± 8.1 years. All patients had a history of injecting complete 1 mg vials of follistatin-344 subcutaneously in the abdomen. There was a history of a single previous high-dose follistatin-344 injection in eight patients and multiple previous injections in three patients. At the time of diagnosis, ten patients had unilateral CSCR findings and one had bilateral CSCR findings. In all eight patients with a history of only one injection, subretinal fluid completely disappeared after an average of 2.3 ± 0.7 months and symptoms regressed. Recurrent CSCR developed in three patients with a history of multiple follistatin-344 injections. CONCLUSION: Follistatin-344 injection can be considered as a risk factor for CSCR. To take medical history from CSCR patients including follistatin-344 use may be important to reveal the CSCR etiology.

Retinal nerve fiber layer, retinal pigment epithelium, and choroidal thickness in vitiligo patients.

BACKGROUND: Vitiligo is one of the common pigmentary disorders affecting the ocular structures. AIM: To determine the retinal nerve fiber layer (RNFL), retinal pigment epithelium (RPE), and choroidal thickness (CT) in vitiligo patients and to evaluate the relationship between choroidal thickness and vitiligo subtypes. METHODS: The right eyes of 106 participants (51 vitiligo, 55 nonvitiligo) were included in the study. All of the participants underwent detailed eye examinations and spectral-domain optical coherence tomography (SD-OCT) examinations. CT was measured manually with enhanced depth imaging optical coherence tomography (Edi-OCT) (subfoveal [SubF], nasal n500 µm [N1], n1500 µm [N2]), and temporal (t500 µm [T1], t1500 µm [T2]). RESULTS: In vitiligo patients, CT values were significantly lower in the SubF, N1, N2, T1, and T2 areas compared to the control group (P = .001, P = .011, P = .002, P = .005, P Ë‚ .001, respectively). Periorbital involvement did not affect CT (P = .355, P = .746, P = .443, P = .633, P = .558, respectively). However, in patients with periorbital region involvement, the CT was significantly reduced if the lesion had a universal character (P Ë‚ .001, P = .001, P = .011, P Ë‚ .001, P = .002, respectively). It was observed that RPE thickness decreased in vitiligo, but this difference was not statistically significant (P = .140). RNFL thickness was unaffected in all quadrants. A positive correlation (r = .286, r = .280, respectively) was observed between the Vitiligo Area Severity Index (VASI) and age and disease duration. A negative correlation (r = -.360, r = -.316, r = -.315, r = -.313, respectively) was found in the CT of the SubF, N1, N2, T1, and T2 areas. CONCLUSION: Vitiligo patients should be closely monitored for possible posterior ocular segment disorders.

Successful Treatment of Conjunctival Kaposi Sarcoma in a Human Immunodeficiency Virus-Negative Kidney Transplant Recipient: A Case Report.

Kaposi sarcoma (KS) is the most common tumor in patients with human immunodeficiency virus (HIV), and its frequency is increasing after organ transplantation in HIV-negative patients. A 28-year-old woman had preemptive kidney transplantation from her 48-year-old mother. In the postoperative ninth month, an exophytic mass was found in the upper medial conjunctiva of the right eye. The lesion was excised under local anesthesia, and cryotherapy was applied to the surgical area. The biopsy result was reported as KS. Treatment with tacrolimus was switched to everolimus (EVO), but EVO was discontinued because of pneumonitis. The patient was followed without any recurrences after the excision of the conjunctival lesion. No local or systemic recurrence was observed in the 14th month after surgical excision and local cryotherapy. Local treatment and the reduction of immunosuppressive therapy may be effective in the treatment of conjunctival KS.

Is there an association between congenital nasolacrimal duct obstruction and cesarean delivery?

PURPOSE: The aim of this study was to research the relationship between types of birth and congenital nasolacrimal duct obstruction. METHOD: The study enrolled 665 infantile patients with prediagnosis of congenital nasolacrimal duct obstruction due to associated ophthalmic symptoms. Age, gender, family history, delivery type, and patient medical records were investigated. Patients were grouped and compared according to their birth type and whether it was the first birth. RESULTS: The number of the infants with and without congenital nasolacrimal duct obstruction was 227 (34.1%) and 438 (65.9%), respectively. Comparison of the congenital nasolacrimal duct obstruction and non-congenital nasolacrimal duct obstruction groups according to the first births showed that ratio of cesarean section was significantly higher in the congenital nasolacrimal duct obstruction group than the non- congenital nasolacrimal duct obstruction group (58.7% and 20.7%, respectively). Number with positive family history also was significantly higher in the congenital nasolacrimal duct obstruction group. CONCLUSION: Cesarean section in first birth and positive family history of congenital nasolacrimal duct obstruction appear to be important risk factors in the etiopathogenesis of congenital nasolacrimal duct obstruction.