Evaluation of Retinal Layers in Individuals with Pseudoexfoliation Syndrome and Ocular Hypertension.

PURPOSE: To analyze the thickness of the peripapillary retinal nerve fiber layer (RNFL) and eight macular layers using optical coherence tomography (OCT) in eyes with ocular hypertension (OHT) and pseudoexfoliation syndrome (PXS) and healthy eyes and to evaluate between-group differences. MATERIALS AND METHODS: In a prospective study, the macular segmentation of retinal layers in 120 eyes of 120 participants was performed automatically using current Heidelberg Spectralis OCT software, which provides measurements for eight retinal layers. Thickness maps divided into nine subfields (i.e., 1, 3, and 6 mm) were extracted from the software for each retinal layer and compared between groups. RESULTS: The thinnest macular layers appeared in the ocular hypertensive PXS, normotensive PXS, and OHT groups, in that order. In the inner retinal layers (macular retinal nerve fiber layer, ganglion cell layer, inner plexiform layer), statistically significant differences emerged between the PXS and control groups in all quadrants of the 3 and 6 mm areas. No significant difference between the OHT group and control group appeared except in the 6 mm temporal quadrant of the inner plexiform layer (IPL). Receiving operating characteristic (ROC) analysis revealed quadrants with high area-under-the-curve (AUC) values at 3 and 6 mm in macular segments in all three groups compared with the control group. CONCLUSION: In macular segment analysis, the inner retinal layers showed the most thinning in patients with ocular hypertensive PXS. According to ROC curve analysis, examinations performed 6 mm inferior to the IPL, as the quadrant with the highest AUC in all three groups, are critical for the early diagnosis of glaucoma.

Excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication.

Aim: Trabeculectomy is the gold standard surgery for achieving target intraocular pressure (IOP) in glaucoma. Besides the efficiency of trabeculectomy, intraoperative or postoperative complications such as, suprachoroidal hemorrhage, vitreous loss, malignant glaucoma, flat anterior chamber, hypotony, choroidal detachment, endophthalmitis, are also quite important. We present the management of excessive conjunctival and scleral retraction during trabeculectomy: an unusual intraoperative complication. Case report: A 66-year-old woman was referred to our glaucoma unit with progression of primary open angle glaucoma. No known systemic disease was observed in her history except hypertension. The best-corrected visual acuity was 20/ 63 in the right eye and 20/ 20 in the left eye. IOP was 27 mmHg and 19 mmHg (with bimatoprost timolol fixed combination and brimonidine tartrate) in the right and left eyes, respectively. We planned trabeculectomy with mitomycin C for the right eye of the patient. Excessive conjunctival and scleral retraction occurred during surgery. Autograft conjunctival tissue was prepared to cover for bare sclera area. No complications were observed in postoperative period. Seronegative spondyloarthropathy (HLA-B27-negative) was diagnosed postoperatively as a result of consultations. Discussion: Conjunctival retraction is observed as a postoperative complication after trabeculectomy. Postoperative conjunctival retraction can cause bleb leakage and hypotony, as well as predispose to infection. Nowadays, micro invasive glaucoma surgery (MIGS) is gaining popularity, especially because of its reduced complication rate compared to trabeculectomy. However, considering the IOP reduction rates, MIGS has been indicated in mild and moderate glaucoma. Conclusions: We presented the management of excessive conjunctival and scleral retraction during trabeculectomy, which has not been reported earlier. Conjunctival autograft transplantation is useful to manage this complication.

Afibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion / Tratamento com afibercepte para edema macular devido à oclusão da veia retiniana do ramo com e sem descolamento seroso da retina

ABSTRACT Purpose: To evaluate the effectiveness of intravitreal aflibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion. Methods: Thirty-seven eyes with branch retinal vein occlusion treated with intravitreal aflibercept injection for macular edema were evaluated retrospectively. The patients were divided into two groups according to whether they showed serous retinal detachment on spectral domain optical coherence tomography. Pro re nata regimen was applied after 1 dose of intravitreal aflibercept injection. After the initial injection, control treatments were administered at months 1, 2, 3, 6, and 12. The best-corrected visual acuity and central macular thickness were measured. Results: Fifteen patients had serous retinal detachment, and 22 with macular edema only (non-serous retinal detachment). The central macular thickness was significantly greater in the group with than in the group without serous retinal detachment (811.73 ± 220.68 µm and 667.90 ± 220.68 µm, respectively, p=0.04). The difference between the groups disappeared from the third month. The central macular thickness was similar between the two groups at the last control treatment (407.27 ± 99.08 µm and 376.66 ± 74.71 µm, p=0.66). The best-corrected visual acuity increased significantly in both groups. No significant difference was found between the two groups in terms of the best-corrected visual acuities at baseline and the final control. Conclusion: The intravitreal aflibercept treatment was highly effective in improving best-corrected visual acuity and central macular thickness in patients with branch retinal vein occlusion-induced macular edema independent of serous retinal detachment.

RESUMO Objetivo: Avaliar a eficácia do tratamento com aflibercepte intravítreo para edema macular devido à oclusão de um ramo da veia retiniana, com e sem descolamento seroso da retina. Métodos: Foram analisados retrospectivamente 37 olhos com oclusão de um ramo da veia retiniana, tratados com injeção intravítrea de aflibercepte para edema macular. Os pacientes foram divididos em dois grupos, de acordo com a presença ou ausência de um descolamento seroso de retina na tomografia de coerência óptica (SD-OCT). Um regime pro re nata foi seguido após 1 injeção intravítrea de aflibercepte. Após a injeção, foram realizadas consultas de acompanhamento nos meses 1, 2, 3, 6 e 12. Foram medidas a melhor acuidade visual corrigida e a espessura macular central. Resultados: Houve 15 pacientes com descolamento seroso de retina e 22 pacientes com apenas edema macular (descolamento não seroso de retina). A espessura macular central foi significativamente maior no grupo com descolamento seroso de retina do que no grupo com descolamento não seroso de retina (respectivamente, 811,73 ± 220,68 µm e 667,90 ± 220,68 µm; p=0,04). A diferença desapareceu a partir do terceiro mês. A espessura macular central foi semelhante nos dois grupos na última consulta (407,27 ± 99,08 µm e 376,66 ± 74,71 µm, p=0,66). A melhor acuidade visual corrigida aumentou significativamente em ambos os grupos. Não houve diferença entre os dois grupos quanto à melhor acuidade visual corrigida inicial e final. Conclusão: O tratamento com aflibercepte intravítreo foi altamente eficaz em melhorar a acuidade visual corrigida e a espessura macular central no edema macular induzido pela oclusão de um ramo da veia retiniana, independentemente da presença ou não de um descolamento seroso da retina.

Afibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion.

PURPOSE: To evaluate the effectiveness of intravitreal aflibercept treatment for macular edema with and without serous retinal detachment due to branch retinal vein occlusion. METHODS: Thirty-seven eyes with branch retinal vein occlusion treated with intravitreal aflibercept injection for macular edema were evaluated retrospectively. The patients were divided into two groups according to whether they showed serous retinal detachment on spectral domain optical coherence tomography. Pro re nata regimen was applied after 1 dose of intravitreal aflibercept injection. After the initial injection, control treatments were administered at months 1, 2, 3, 6, and 12. The best-corrected visual acuity and central macular thickness were measured. RESULTS: Fifteen patients had serous retinal detachment, and 22 with macular edema only (non-serous retinal detachment). The central macular thickness was significantly greater in the group with than in the group without serous retinal detachment (811.73 ± 220.68 µm and 667.90 ± 220.68 µm, respectively, p=0.04). The difference between the groups disappeared from the third month. The central macular thickness was similar between the two groups at the last control treatment (407.27 ± 99.08 µm and 376.66 ± 74.71 µm, p=0.66). The best-corrected visual acuity increased significantly in both groups. No significant difference was found between the two groups in terms of the best-corrected visual acuities at baseline and the final control. CONCLUSION: The intravitreal aflibercept treatment was highly effective in improving best-corrected visual acuity and central macular thickness in patients with branch retinal vein occlusion-induced macular edema independent of serous retinal detachment.

The Effects of an Increased Workload in Cataract Surgery Since the Pandemic in a Tertiary Care Clinic.

Objective: To evaluate the progress of cataract surgery in a training institution providing tertiary care since the removal of pandemic restrictions. To evaluate ocular and demographic characteristics of cataract cases in a tertiary care teaching institution since the lifting of pandemic restrictions. Methods: Patients who underwent cataract surgery in our clinic in the pre-pandemic period September 2019-March 2020 (group 1, n=353) and in the post-pandemic period September 2021-March 2022 (group 2, n=459) were retrospectively screened. The cases were operated by two educator ophthalmologists and residents. The main parameters evaluated were cataract morphology, surgical parameters, and posterior capsular rupture complications. Results: The case rate increased by 30% in group 2 once pandemic restrictions were relaxed. Preoperative best corrected visual acuity (BCVA) in groups 1 and 2 was 0.840±0.63 and 1.26±0.75 log MAR, respectively (p<0.001). The percentage of mature cataracts was 15.3% in group 1 and 31.2% in group 2 (p<0.001). Significantly higher cumulative dissipated energy (CDE), total aspiration time, and fluid amount (p<0.001 for all) were found in group 2. During the training phase, 25.2% of the cases in group 1 and 24.6% in group 2 were performed by resident doctors (p=0.870). Residents in groups 1 and 2 had mature cataract case rates of 6.7% and 13.3%, respectively (p<0.001). The incidences of posterior capsule rupture in the instances of residents was 3.4% in group 1 and 4.4% in group 2 (p=0.498). A negative correlation (r=-0.424, p<0.001) between CDE and BCVA and a positive correlation (r=0.40, p<0.001) between cataract hardness and CDE were both found. Conclusions: The number of cataract surgeries increased after the COVID-19 pandemic. Poor vision and increasing rates of mature cataracts are other effects of this backlog. Residents have to deal with challenging cases. Our results are just the tip of the iceberg. Urgent planning is needed to deal with the remaining cases. Abbreviations: COVID-19 = coronavirus infection, PCR = posterior capsular rupture, BCVA = best corrected visual acuity, IOP = intraocular pressure, CDE = cumulative dissipated energy, TAT = total aspiration time, ZD = zonular separation.

Objective evaluation of changes in lens clarity after repeated injections of ranibizumab in patients with neovascular age-related macular degeneration.

PURPOSE: To objectively evaluate changes in lens densitometry in eyes with neovascular age-related macular degeneration (n-AMD) treated with repeated intravitreal ranibizumab injections during a 12-month period and to compare the results with those in untreated healthy fellow eyes and healthy control eyes. METHODS: In this prospective study, the 36 treated eyes and the 37 untreated fellow eyes of 38 patients with n-AMD and the 32 control eyes of 32 healthy individuals were analyzed. Lens densitometry was evaluated using the Scheimpflug imaging. All data in both groups regarding lens densitometry were recorded at baseline and 12 months. RESULTS: The mean densitometry of zone 1 in the treated eyes of patients had increased significantly at 12 months compared with the baseline (baseline: 9.3 ± 1.5, 12 months: 11.9 ± 1.7, p = .004) and was significantly greater than those measurements in the fellow eyes (9.8 ± 1.6 p = .02) and control eyes (9.6 ± 1.9, p = .01) at 12 months as well. There were no significant differences in terms of densitometry values between the fellow and control eyes at baseline and 12 months (for all, p > .05). CONCLUSIONS: Our results objectively demonstrate early nuclear lens density changes using with Scheimpflug images in eyes with n-AMD that were treated with repeated ranibizumab injections for 12 months.

How Reliable and Popular are Trabeculectomy Videos on Youtube?

PURPOSE: Evaluating the quality, dependability, and popularity of YouTube videos about trabeculectomy. METHODS: A simulated user search for trabeculectomy videos on YouTube was conducted using the keywords "trabeculectomy, trabeculectomy surgery for glaucoma, and trabeculectomy surgery." Hundred out of the one hundred and fifty videos met the criteria and were analyzed. To assess quality and reliability, each video was evaluated by two independent reviewers using the DISCERN (scale, 1-5), Journal of the American Medical Association (JAMA; scale, 0-4), and Global Quality (GQ; scale, 1-5) criteria. The popularity of the videos was evaluated by Video Power Index (VPI). Videos were further classified into three groups based on the source of their upload. RESULTS: Of the 100 analyzed videos, 50 were uploaded to the system by doctors, 40 by health institutions and 10 by patients. Fifty-seven percent are videos with surgical content. The mean DISCERN score was 44.84 ± 8.14 the mean JAMA score was 2.08 ± 0.67, and the mean Global Quality score was 2.02 ± 0.72. Although some videos provided adequate information, the majority of the videos were rated as fair. While the DISCERN, JAMA, GQS scores were statistically higher in videos uploaded by doctors than in videos uploaded by patients (P < 0.01), VPI was higher in videos uploaded by patients (P = 0.003). Nonsurgical videos had the highest rate of likes and comments (P < 0.05). No substantial difference in scoring was observed between the 2 independent reviewers (P < 0.05). CONCLUSION: Videos with high popularity had low information quality and reliability. This situation presupposes video sharing in a more understandable language for patients.

Bilateral Intraoperative Floppy Iris Syndrome Associated with Silodosin Intake.

Intraoperative floppy iris syndrome (IFIS) is described by three characteristics: floppy iris that billows in reaction to intraocular fluid currents during phacoemulsification surgery, flaccid iris stroma that tends to prolapse through well-constructed surgical incisions, and progressive pupillary miosis despite preoperative pharmacologic dilatation. A 63-year-old man presented with decreased vision in both his eyes. Ophthalmic examination revealed bilateral nuclear cataract. He was prescribed silodosin for the management of benign prostatic hyperplasia a month ago. Consecutive cataract surgery was planned at a 2-week time interval. All features of IFIS were encountered in both eyes of the patient during phacoemulsification surgery. IFIS was successfully managed by the aid of an iris retractor, and a 20/20 final visual acuity was achieved postoperatively in both eyes of the patient. To the best of our knowledge, this is the first study about bilateral IFIS associated with silodosin intake. Ophthalmologists and urologists prescribing silodosin should be aware of this possible association.

Bacterial Conjunctivitis Accompanying Spontaneous Subconjunctival Abscess.

Subconjunctival abscess is a rare form of ocular infections. Subconjunctival abscesses often develop in the eyes with previous surgery or trauma. It is extremely rare in patients without surgery or trauma. In this study, we aimed to present a rare case of subconjunctival abscesses associated with spontaneous bacterial conjunctivitis. The patient was admitted to the hospital with complaints of redness, swelling and burning in two eyes. He said he used antibiotic drops for about a week, but his complaints did not decline. A subconjunctival abscess was detected in the right eye. There was no history of previous ocular surgery and trauma. Abscess drainage and subconjunctival antibiotic injection were performed. Oral and topical antibiotics were prescribed. There was no growth in culture. The third week was a complete recovery. In conclusion, spontaneous subconjunctival abscess formation should be considered in the differential diagnosis in unhealed eyes after bacterial conjunctivitis.

Reply to comment by De Bernardo and Rosa on "Evaluation of Goldmann applanation tonometry, rebound tonometry and dynamic contour tonometry in keratoconus" / Réplica al comentario de De Bernardo y Rosa a "Evaluación de la tonometría por aplanación de Goldmann, la tonometría de rebote y la tonometría de contorno dinámico en el queratocono"

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Retrospective analysis of the effect of aflibercept loading dose on the retinal vessel diameters in patients with treatment-naive neovascular AMD.

BACKGROUND: To evaluate the effects of intravitreal aflibercept (IVA) on retinal vessel diameters in patients with neovascular age-related macular degeneration (AMD). DESIGN, SETTING, AND PARTICIPANTS: A retrospective study conducted at the Kutahya Dumlupinar University Faculty of Medicine included 15 eyes of 15 patients with treatment naive neovascular AMD. METHODS: All eyes received IVA injections once per month for 3 months; untreated contralateral eyes were used as controls. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR) values were measured using a computer-based program before the first IVA injection and 30 days after the first, second, and third injections. The main outcome measurements were the central macular thickness (CMT), best-corrected visual acuity (BCVA), choroidal thickness, CRAE, CRVE, and AVR. RESULTS: Significant vasoconstriction of the retinal arterioles was observed in all eyes treated with IVA when compared to baseline (p = 0.009). However, no significant differences were found for CRVE or AVR throughout the study period in treated eyes. In the control group, all parameters measured during each visit were similar to baseline measurements (p > 0.05). The mean BCVA significantly improved at the end of the loading dose of IVA, when compared to baseline (p = 0.006). After the IVA injections, the mean CMT and choroidal thickness were significantly reduced at all visits, compared to baseline (p < 0.001). CONCLUSIONS: The current study showed that IVA led to significant retinal arteriolar vasoconstriction and choroidal thinning, which may cause reduced retinal blood flow.

Investigation of dynamic thiol-disulphide homoeostasis in age-related cataract patients with a novel and automated assay.

PURPOSE: The aim of this study was to determine plasma thiol-disulphide homoeostasis in patients with age-related cataract (ARC) and compare the results of the patients with healthy subjects. Plasma malondialdehyde (MDA) levels and catalase (CAT) activity were also investigated. METHODS: The study included 53 cataract patients and 52 healthy volunteers. Native thiol-disulphide exchanges were determined using a novel and automated method. CAT activity was determined using the method described by Aebi, and MDA levels were calculated using the thiobarbituric acid method. RESULT: Native thiol and total thiol levels were significantly lower in the cataract patients compared with the controls (p < 0.001, p = 0.002, respectively). The disulphide levels of the cataract patients were significantly higher than the controls (p = 0.002). The ratios of disulphide/native thiol and disulphide/total thiol were statistically higher in the cataract patients compared with the control group (p < 0.001, p < 0.001, respectively). Furthermore, CAT activity was significantly lower in the cataract patient group compared with the control group (p < 0.001), and MDA levels were insignificantly higher in the patient group (p = 0.581). CONCLUSIONS: Our study showed that dynamic thiol-disulphide homoeostasis has shifted towards disulphide formation, as a result of thiol oxidation in ARC patients. The present study is the first to measure thiol-disulphide homoeostasis in ARC patients with a novel automated assay. This study supports the hypothesis that cataract is an oxidative disorder. Further studies are required in order to examine the relationship between oxidative stress and the development of cataract formation.

VEGF-A gene polymorphisms and responses to intravitreal ranibizumab treatment in patients with diabetic macular edema.

PURPOSE: To investigate the association between VEGF gene polymorphisms and the responses to treatment with intravitreal ranibizumab (IVR) in patients with diabetic macular edema (DME). METHODS: This prospective study, conducted at the Kutahya Dumlupinar University Faculty of Medicine, included 95 patients with DME that were treated with IVR and 32 patients without DME despite proliferative diabetic retinopathy (PDR). The participants were divided into three groups: DME with non-proliferative diabetic retinopathy, DME with PDR, and PDR without DME; patients with DME who were treated with IVR were further divided into two groups based on their response to the treatment. Each patient was genotyped for five single nucleotide variations (SNVs) in VEGF-A: rs2010963, rs2146323, rs10434, rs833069, and rs6921438. RESULT: There was a statistically significant difference in allelic distribution of VEGF-A rs833069 polymorphism in relation to the severity of diabetic retinopathy (DRP) (p = 0.031). The allelic distribution of VEGF-A rs2146323 polymorphism tended to be associated with the severity of DRP (p = 0.069). There were no statistically significant differences in the allelic distribution of the studied five SNVs in DME patients regarding the patients' responses to IVR therapy. CONCLUSIONS: There is no association between the studied VEGF-A SNVs and the responses to IVR therapy in DME. However, the VEGF-A rs833069 gene polymorphism has a clear association with the severity of diabetic retinopathy.