Long-term Outcomes of Submacular Perfluorocarbon Liquid Removal with Internal Limiting Membrane Peeling and Transretinal Aspiration.

BACKGROUND: An important complication associated with perfluorocarbon liquid (PFCL) use during pars plana vitrectomy (PPV) is its retention in the submacular area. The aim of this study was to present the long-term outcomes of the surgical method used in this study to remove submacular PFCL and to shed light on the advantages and disadvantages compared to other methods. MATERIAL AND METHODS: This is a retrospective, single-center, observational study. Patients who underwent surgical intervention due to submacular PFCL were included in this study. The surgical procedural includes internal limiting membrane (ILM) peeling, transretinal aspiration of submacular PCFL with a 25/27-gauge soft-tipped cannula, then perfluoropropane (C3F8) gas tamponade, and facedown positioning for 5 days. The long-term anatomical and functional outcomes were evaluated with an ophthalmological examination and optical coherence tomography (OCT). OUTCOMES: A total of 15 patients with submacular PFCL were included in this study, and the mean age of the patients was 64.33 ± 10.36 years (47 - 83). The localization of submacular PFCL was subfoveal in nine patients (60.00%), non-subfoveal in four patients (26.67%), and both subfoveal and non-subfoveal in two patients (13.33%). The mean time of submacular PFCL diagnosis was 4.86 ± 1.02 weeks (2 - 8) and the mean time of the surgery was 9.80 ± 1.17 weeks (8 - 14). Complete removal of submacular PFCL was achieved in all cases (100%) and no significant treatment-associated complications were observed. The mean follow-up time was 37.60 ± 14.00 months (18 - 60) and the best-corrected visual acuity was significantly improved (p = 0.001). At the end of the follow-up time, prominent ellipsoid zone disruption was observed in six patients (40.00%), while in nine patients (60.00%), there was no prominent ellipsoid zone disruption. CONCLUSIONS: The surgical procedural for submacular PFCL removal is a reasonable option and improves visual acuity in the long term without any significant treatment-associated complications.

Assessment of the Retinal Nerve Fibre Layer, Retina, and Choroid in Osteogenesis Imperfecta.

BACKGROUND: Osteogenesis imperfecta (OI) is a genetic disorder in which there are problems in tissues containing type I collagen, predominantly the cornea and sclera in the eye. Although there are many studies on problems with the anterior segment of the eye in patients with OI, studies on posterior structures are limited. Involvement of the sclera may affect the retinal nerve fibre layer (RNFL), which is indirectly related to intraocular pressure. In addition, the retina and choroid containing type I collagen may be affected. The aim of the study was to compare the posterior segment structures of the eye, including the RNFL, retina, and choroid, in patients with OI to those of healthy control subjects. METHODS: This cross-sectional study recruited 19 patients with OI, as well as 22 age- and gender-similar healthy control subjects. Measurements of the RNFL, retina, and choroid were obtained with optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering, Heidelberg, Germany). RESULTS: Patients with OI (mean age 14.32 ± 5.08 years) and the control group (mean age 13.73 ± 3.56 years) had similar age, refractive error, and intraocular pressure values (p > 0.05). There was no difference between groups in terms of RNFL thickness, including the superonasal, nasal, inferonasal, inferotemporal, temporal, and superotemporal sectors, retinal thickness, and choroidal thickness from five different locations (p > 0.05, for all). CONCLUSION: According to these results, OI does not clinically affect the RNFL, retina, and choroid in childhood.

Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch.

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved ≥10 letters gain and ≥10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of ≥20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 ± 0.38, RNB: 0.61 ± 0.36, RNB to AFB: 0.61 ± 0.38), at checkpoints, or at the final visit (AFB: 0.46 ± 0.38, RNB: 0.5 ± 0.37, RNB to AFB: 0.53 ± 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 ± 129.6 µm) when compared to the AFB (450.5 ± 122.6 µm) and RNB (442 ± 116 µm) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost ≥10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated ≥20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments.

A comparative study on the knowledge levels of artificial intelligence programs in diagnosing ophthalmic pathologies and intraocular tumors evaluated their superiority and potential utility.

PURPOSE: This study aimed to test the knowledge levels of ChatGPT, Bing, and Bard artificial intelligence chatbots, which have been released by three different manufacturers, about ophthalmic pathologies and intraocular tumors, to test their usability and to investigate the presence of superiority to each other. METHODS: Thirty-six questions were obtained from the American Academy and Ophthalmology 2022-2023 Basic and Clinical Science Course Ophthalmic Pathology and Intraocular Tumor study questions section. Each question was asked separately for the ChatGPT, Bing, and Bard artificial intelligence programs. Answers to the questions were categorized as correct or incorrect. The statistical relationship between the correct and incorrect response rates of the artificial intelligence programs was determined. RESULTS: From the artificial intelligence chatbots, ChatGPT gave the correct answer to 58.6% of the questions asked, Bing gave the correct answer to 63.9%, and Bard gave the correct answer to 69.4%. No statistical significance was found between the rates of correct answers to the questions in all 3 artificial intelligence programs (p = 0.705, Pearson Chi-square test). CONCLUSION: Artificial intelligence chatbots can be used to access information related to ophthalmic pathologies and intraocular tumors. However, in the evaluation of the data, it should be noted that not all questions can be answered correctly. Care should be taken when examining the answers.

Non-damaging retinal laser therapy in chronic central serous chorioretinopathy.

PURPOSE: To investigate the functional and anatomical outcomes of non-damaging retinal laser therapy (NRT), in cases with chronic central serous chorioretinopathy (CSCR). METHODS: Twenty-three eyes of 23 treatment-naïve chronic CSCR patients were included in this study. The irradiation of 577 nm yellow light was conducted on the serous detachment area after switching over to the NRT algorithm. Anatomical and functional changes after treatments were investigated. RESULTS: The mean age of the subjects was 48.68 ± 5.93 years (41-61). The mean best-corrected visual acuity (BCVA) and the mean central macular thickness (CMT) values were 0.42 ± 0.12logMAR (0.20-0.70) and 315.69 ± 61.25 µm (223-444) before NRT; and 0.28 ± 0.11logMAR (0.10-0.50) and 223.26 ± 60.91 µm (134-336) at the 2nd month follow-up visit (p < 0.001, for both). At the 2nd-month follow-up visit after NRT, complete resorption of subretinal fluid was observed in 18 eyes (78.3%) and incomplete resorption in five eyes (21.7%). Worse values of BCVA and CMT before NRT were found as increased risk for incomplete resorption (p = 0.002 and ρ = 0.612 for BCVA, and p < 0.001 and ρ = 0.715 for CMT). CONCLUSION: Significant functional and anatomical improvements can be observed in the early period after NRT in patients with chronic CSCR. Patients having worse baseline BCVA and CMT have increased risk for incomplete resorption.

Assessment of changes in macular structural retinal layers in patients with pathological myopia.

Background/aim: This study aimed to examine changes in the thickness of individual macular retinal layers in eyes with pathological myopia (PM) and to compare the thickness of each retinal layer between the PM and control groups to gain insights into retinal perfusion. Materials and methods: The study included 51 eyes in the PM group and 51 eyes in the control group. Optical coherence tomography (OCT) was used to measure the thickness of each retinal layer in the central fovea, parafoveal, and perifoveal regions. Optical coherence tomography angiography (OCT-A) was used to evaluate the retinal capillary density. Results: In the PM group, the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) were thicker than in the control group (p = 0.004, p = 0.027, p = 0.020, and p < 0.001, respectively), whereas the outer nuclear layer (ONL) and photoreceptor layer (PRL) were thinner (p = 0.001 and p = 0.003, respectively). In other regions, the RNFL was thicker in the myopic group, whereas the GCL, IPL, INL, and ONL were thinner. OCT-A did not reveal any significant difference between the groups in terms of radial capillary plexus density (p = 0.381); however, the densities of the other plexuses were lower in the PM group. Conclusions: The results showed alterations in the thickness of retinal layers and capillary plexus density in PM. Thus, assessment of the thickness of individual retinal layers may serve as an indicator of vascular diseases that affect the circulation of the retina and choroid.

Evaluation of off-label anti-vascular endothelial growth factor and steroid implant medication uses in macular edema due to retinal vein occlusion in Turkey.

WHAT IS KNOWN AND OBJECTIVE: Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs, ranibizumab and aflibercept, and corticosteroid implants are approved treatment options for RVO-related macular edema (ME) in Turkey. To the best of our knowledge, there is no data regarding the off-label use of these drugs for RVO in English literature. We aimed to evaluate the clinical and demographic characteristics of off-label drug use applications in Turkey for RVO. METHODS: Applications made to the Turkish Medicines and Medical Devices Agency between January 1 and December 31, 2018, for the use of off-label drugs (ranibizumab, aflibercept, dexamethasone implant) for the diagnosis of RVO from hospitals across Turkey were retrospectively analysed. Data of the applications, such as demographic characteristics, previous treatment regimens, reasons for applications, applicant hospitals and their regions, were recorded. RESULTS: There were 291 approved applications for RVO. The mean age of the patients was 64.88 ± 10.78 years, 48.8% were male, and 51.2% were female. Of these applications, 44.7% were for aflibercept, 35.7% for ranibizumab and 19.6% for dexamethasone implant. No application was made for bevacizumab since it could be used without needing for an application. The most common reasons for applications were due to dose limitations, failure to complete loading doses, and glaucoma, respectively. In terms of the distribution of the applicant hospitals, public university hospitals ranked first with 72.5%, training and research hospitals ranked second with 14.7% and foundation university hospitals ranked third with 13.1% rates. WHAT IS NEW AND CONCLUSION: The practice of drug use in RVO in Turkey has changed as of the beginning of 2019. Stepwise therapy has been accepted by the drug regulatory agency Turkish Medicines and Medical Devices Agency. Utilization of licensed drugs, aflibercept, ranibizumab and dexamethasone has been allowed only after administration of 3 doses of intravitreal bevacizumab. After 3 doses of bevacizumab, the physician may continue either with bevacizumab again or a dexamethasone implant. If there is a reason such as the presence of glaucoma, the physician may skip dexamethasone and switch to aflibercept and ranibizumab, but in this case, dexamethasone cannot be administered to the patient for life. The evaluation of the off-label treatments of RVO, which is one of the most frequently followed diseases in retina clinics, not only contributes to the literature but also provides information regarding the most frequently applied treatments and the physicians' off-label drug preferences for RVO.

Anti-vascular endothelial growth factor therapy in diabetic macular edema: real-life outcomes from a multicenter study in Turkey over 36 months.

PURPOSE: This study aimed to report the visual and anatomical outcomes of intravitreal anti-VEGF treatment for diabetic macular edema (DME) in a real-world clinical setting from Turkey over 36 months. METHODS: This is a retrospective, multicenter (7 sites) study. The medical records of 1072 eyes (both previously treated and naive eyes) of 706 consecutive patients with visual impairment due to center-involving DME treated with intravitreal anti-VEGF injections between April 2007 and February 2017 were reviewed. The eyes were divided into mutually exclusive three groups based on the duration of follow-up (12, 24, or 36 months). Primary outcome measures were changes in visual acuity (VA) and central macular thickness (CMT) from baseline to final visit in each cohort, frequency of visits and intravitreal anti-VEGF injections. As secondary endpoints, VA outcomes were assessed in subgroups stratified by baseline VA [<70 ETDRS letters and ≥70 ETDRS letters] and loading dose status of anti-VEGF injections. RESULTS: VA increased by a mean of 8.2 letters (12-month cohort, p < 0.001), 5.3 letters (24-month cohort, p < 0.001), and 4.4 letters (36-month cohort, p = 0.017) at final visits. The eyes with <70 VA letters achieved more significant VA improvement at final visits in all cohorts compared with eyes with >70 VA letters (p < 0.001). The mean decreases in CMT from baseline to last visits at 12-, 24-, and 36- month cohorts were -100.5 µm, -107.7 µm, and -114.3 µm, respectively (p < 0.001). The mean number of injections given were 4.6, 2.3, and 1.8 during years 1 to 3, respectively. Patients who received loading dose showed greater VA gains than those who did not in all follow-up cohorts. CONCLUSION: Our study revealed that anti-VEGF treatment improved VA and CMT over a follow-up of 36 months. Although these real-life VA outcomes following anti-VEGF therapy for DME were similar to other real-life studies, they were inferior to those noted in randomized controlled trials, mainly due to undertreatment.

Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study.

PURPOSE: To investigate the prognostic factors associated with functional and anatomical outcomes and to assess the longitudinal course of visual acuity and retinal morphology after vitreoretinal surgery for idiopathic epiretinal membrane (ERM). METHODS: This multicenter, retrospective study included a total of 634 eyes who underwent surgery for idiopathic ERM in 22 academic centers nationwide in Turkey. Data on best-corrected visual acuity (BCVA) and optical coherence tomography features (central foveal thickness (CFT), ERM and foveal contour morphology, ellipsoid zone (EZ) integrity) were collected and compared at baseline, 6-month, 12-month, and 24-month follow-ups. Prognostic factors for functional (having ≥ 20/25 Snellen BCVA) and anatomical (having normal/shallow foveal contour) recoveries after surgery were investigated by means of multivariate regression analyses. A cutoff value of preoperative BCVA optimizing functional recovery was calculated using receiver operating characteristic curve analysis. RESULTS: At a median follow-up of 24 months, 37.4% of the eyes achieved ≥ 20/25 BCVA and 54% regained normal or shallow foveal contour. Functional recovery was more likely in eyes with better baseline BCVA and intact EZ (R2 = 0.356, p < 0.001). The cutoff baseline BCVA value for good visual prognosis was 0.35 logarithm of the minimum angle of resolution (Snellen 20/44) (sensitivity 60%, specificity 85%, p < 0.001). Anatomical recovery was negatively associated with advanced age, higher baseline CFT, foveal herniation-type ERM morphology, and internal limiting membrane (ILM) peeling (R2 = 0.225, p < 0.001). The negative effect of ILM peeling on anatomical recovery was not significant after the first postoperative year (p = 0.05). Mean BCVA values and foveal morphology progressively improved at each visit. Cases with convex baseline foveal contour continued to change towards normal foveal depression over 24 months of follow-up, which took longer than the eyes with shallow/flat contoured cases. One-third of eyes with severe baseline EZ defects showed recovery at follow-up and achieved significantly greater visual acuity gains than the remaining eyes with persistent defects (p < 0.001). CONCLUSIONS: Functional and anatomical restoration of the eyes appears to be a slow process after ERM surgery. This process may take much longer in eyes with worse foveal morphology at baseline. Although photoreceptor disruption may be reversible in some eyes, full functional recovery is unlikely when it persists.

Nondamaging retinal laser therapy in recurrent diabetic macular edema after antiVEGF injections.

BACKGROUND: Subthreshold yellow nondamaging retinal laser therapy (NRT) could provide a greater safety profile when compared to conventional laser methods. NRT may also improve diabetic macular edema (DME). This study aims to assess whether the severity of DME affects the efficacy of subthreshold yellow NRT. METHODS: The study included 70 eyes that had previously been treated with ranibizumab for DME and then developed recurrent macular edema, which was treated with NRT once. The central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were evaluated retrospectively 2 months following the NRT. The eyes in the study were divided into 4 different groups according to the baseline CFT values. The initial CFT was 250-300 µm in Group 1 (n = 26), 301-400 µm in Group 2 (n = 24), and >401 µm in Group 3 (n = 20). Group 4 (n = 20) included control subjects with 250-300 µm CFT, diagnosed with DME, and not previously treated. The alterations in the BCVA and CFT were measured. RESULTS: In the study, it was determined that 45 right eyes and 45 left eyes were involved. Statistically significant decrements (42.84 m reduction) in CFT were detected only in the Group 1 (p = 0.01). There was no significant improvement in CFT within Group 2, 3 and 4 (p = 0.29, p = 0.73, p = 0.22, respectively). Solely Group 1 had statistically significant improvement (from 0.54 to 0.39 LogMAR) in BCVA (p = 0.01), while groups 2, 3 and 4 had no improvement at all (p = 0.74, p = 0.96, p = 0.66 respectively). DISCUSSION: Based on the results, NRT provided an improvement in BCVA and CFT in eyes with CFT less than 300 µm at the shortterm follow-up. However, CFT and BCVA outcomes after NRT were inferior to those achieved after previous ranibizumab treatment. No positive effect of NRT was not observed in patients with moderate and severe macular edema in DME treatment.

Postoperative eccentric macular holes after surgery for vitreomacular interface diseases.

PURPOSE: To assess the incidence, clinical characteristics, and outcome of postoperative eccentric macular hole (ECMH) after epiretinal membrane (ERM), macular hole (MH), and idiopathic vitreomacular traction (VMT) surgery and discuss the underlying possible mechanisms. METHODS: A retrospective study was carried out for 711 eyes of 711 consecutive patients who underwent 25-gauge pars plana vitrectomy (PPV) with ERM (396 eyes), MH (268 eyes), and VMT (47 eyes) surgery between 2010 and 2016. Mean follow-up time was 19 months. RESULTS: Eight patients developed ECMH (1.12%). Four of the patients were ERM, three patients were idiopathic full thickness MH, and one patient was ERM and lamellar pseudohole. There was no ECMH in patients with VMT. The average time of hole formation after vitrectomy was 7.25 weeks with a range from 2 to 15 weeks. Three patients developed 2 ECMH, and others had 1 ECMH. The location of the ECMH was mostly in the temporal of fovea. All patients were asymptomatic. No retinal detachment or choroidal neovascularization occurred in any patient and no additional intervention was attempted in the postoperative period in any case. CONCLUSION: Postoperative ECMH may be seen after vitreomacular interface surgery. They are mostly asymptomatic, usually do not require additional intervention and often located in the parafoveal area. ILM peeling-induced muller cell damage, residual ILM contraction, and iatrogenic trauma may play a role as the underlying cause in our case series.

The impact of central foveal thickness on the efficacy of subthreshold micropulse yellow laser photocoagulation in diabetic macular edema.

To evaluate the efficacy of short-term subthreshold micropulse yellow laser photocoagulation (SMYLP) on eyes with diabetic macular edema (DME) with different central foveal thicknesses (CFT). Eighty eyes of 40 patients who had previously undergone ranibizumab treatment for DME and who subsequently had recurrent macular edema were included to the study. The study subjects were divided into four groups according to their initial CFT values (group 1, 250-300 µm; group 2, 301-400 µm; group 3, > 401 µm; group 4, 250-300 µm untreated control subjects). Patients were treated with SMYLP for one session and followed for 6 months. All patients underwent complete ophthalmologic evaluation. The alteration from baseline in CFT and the best corrected visual acuity (BCVA) were measured. Patients with a pretreatment CFT ≤ 300 µm experienced the statistically significant reduction in CFT and gain in BCVA at 2 months (p < 0.05), whereas patients with baseline CFT > 300 µm experienced no significant change (p > 0.05). Hyperautofluorescence lesions, that were not previously described, were detected in fundus autofluorescence imaging in the early period after SYMLP laser and these lesions were regressed with time. Our study indicates that the SYMLP provides a statistically significant improvement in BCVA and a reduction in CFT in the patients with a pretreatment CFT of 300 µm or less in DME and can be safe and effective in mild DME treatment.

The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value.

PURPOSE: To assess the impact of symptom duration on the recurrence of rhegmatogenous retinal detachment (RRD) and to determine the threshold symptom duration for recurrence. PATIENT AND METHODS: In this non-comparative, observational case series, a retrospective evaluation was made of the records of patients with RRD at baseline and during the postoperative follow-up period, in respect of postoperative anatomic outcome, prognostic factors for recurrent retinal detachment and the cutoff value of symptom duration. RESULTS: Recurrent retinal detachment was detected in 33 (17.8%) of 185 patients following primary retinal detachment surgery. The surgery type in phakic patients and preoperative symptom duration had a significantly high odds ratio for evidence of surgical failure. According to the ROC analysis, the threshold preoperative symptom duration was 20.5 days. CONCLUSION: Our results showed that early reattachment surgery is necessary to lower the risk of retinal redetachment. The threshold at which RRD recurrence significantly increases is 20.5 days.

Aqueous humor IL-8, IL-10, and VEGF levels in Fuchs' uveitis syndrome and Behçet's uveitis.

PURPOSE: This study investigated the levels of interleukin (IL)-8, IL-10, and vascular endothelial growth factor (VEGF) in the aqueous humor (AqH) of patients with Behçet's uveitis (BU) and Fuchs' uveitis syndrome (FUS) during an inactive period and compared these levels with those in the AqH of noninflammatory healthy control subjects. METHODS: This prospective and case-control study included 33 patients (16 patients with BU and 17 patients with FUS) and 35 control subjects. IL-8, IL-10, and VEGF levels in the AqH were quantified by performing sandwich enzyme-linked immunosorbent assay. Kruskal-Wallis test was used to compare the cytokine levels in the different groups, and statistical significance was set at p < 0.05. RESULTS: IL-8 levels were significantly higher in the AqH of patients with BU and FUS than in the AqH of control subjects (p < 0.001 and p < 0.001, respectively). IL-10 levels were significantly lower in the AqH of patients with BU than in the AqH of patients with FUS and of control subjects (p = 0.001 and p < 0.001, respectively). Although VEGF levels were higher in the AqH of patients with FUS than in the AqH of patients with BU and of control subjects, the difference was significant only between patients with FUS and control subjects (p < 0.001). CONCLUSIONS: We observed a significant decrease in IL-10 levels in the AqH of patients with BU and a significant increase in VEGF levels in the AqH of patients with FUS compared to controls. IL-8 and VEGF levels showed no significant difference among uveitis patients.

Quantitative analysis of the optic nerve head parameters in patients with age-related macular degeneration

Background/aim: To evaluate the topographic parameters of the optic disc of patients with age-related macular degeneration (AMD) by performing confocal scanning laser ophthalmoscopy. Materials and methods: This prospective study included 41 eyes of 41 patients with neovascular AMD, 56 eyes of 56 patients with nonneovascular AMD, and 48 eyes of 48 healthy control subjects. Images of the optic nerve head of all of the participants were obtained using Heidelberg retinal tomography III software 3.1. The following stereometric parameters were measured for each participant: disc area, cup area, rim area, cup volume, rim volume, cup-to-disc ratio, mean cup depth, maximum cup depth, cup shape, and mean retinal nerve fiber layer thickness. Results: The cup shape values of the patients with neovascular and nonneovascular AMD were significantly different from those of the control subjects (P = 0.002 and P < 0.001, respectively). The cup-to-disc ratio was significantly higher in the patients with nonneovascular AMD when compared with the control subjects (P = 0.013), but no difference was found between the patients with neovascular AMD and the control subjects (P > 0.05). No significant differences were observed among the 3 groups with respect to the other optic disc parameters (P > 0.05). Conclusion: These data showed that the deterioration of the cup shape was an important finding in patients with AMD. Because AMD manifests with progressive ocular damage, including the optic nerve head, examination of the cup shape may be important during the follow-up of these patients.

Branch retinal vein occlusion associated with platelet activation

Background/aim: The aim of this study is to study subclinical platelet activation by detecting three important platelet activation parameters of mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with branch retinal vein occlusion (BRVO) in comparison to those in healthy control subjects. Materials and methods: This prospective study included 43 patients with BRVO (Group 1)and 40 control subjects (Group 2). The levels of MPV, PDW, and PCT were measured in both of the studied groups Results: The mean serum level of MPV value was 7.64 ± 0.64 in Group 1 and 7.39 ± 0.42 in Group 2. Mean serum level of PDW was 15.01 ± 1.56 in Group 1 and 14.43 ± 1.03 in Group 2. Mean serum PCT value was 0.19 ± 0.05 in Group 1 and 0.16 ± 0.04 in Group 2. MPV, PDW, and PCT levels were significantly increased in BRVO patients (P < 0.05). Conclusion: Subclinical platelet activation reflected by MPV, PDW, and PCT may have an impact on the genesis of vessel occlusion in BRVO. The results may be important for the clinical management of patients with BRVO

CORRELATION BETWEEN CENTRAL FOVEAL THICKNESS AND VISUAL ACUITY IN PATIENTS WITH IDIOPATHIC VITREOMACULAR TRACTION.

PURPOSE: To evaluate the impact of preoperative central foveal thickness (CFT) on visual acuity after surgery in patients with idiopathic vitreomacular traction and to calculate a cut-off value in preoperative CFT. METHODS: Thirty-five patients with idiopathic vitreomacular traction were evaluated retrospectively. A complete ophthalmological examination including spectral domain optical coherence tomography was performed preoperatively and at 12 months after the surgery. Receiver operating characteristic analysis was used to determine the critical point for the CFT associated with improvement of 10 or more letters in visual acuity on the Early Treatment Diabetic Retinopathy Study. RESULTS: Among 35 patients, the mean CFT at postoperative 12 months was significantly decreased from baseline (P = 0.001). Preoperative CFT and visual improvement were not significantly correlated (r = -0.090, P = 0.605), whereas preoperative CFT and preoperative visual acuity were significantly correlated (r = 0.757, P < 0.001). Improvement in CFT and visual improvement were also correlated significantly (r = 0.449, P = 0.007). According to the receiver operating characteristic analysis, the threshold CFT was 471 µm. When 15 patients with CFT thickness under 471 µm were evaluated, preoperative CFT was significantly correlated with improvement in visual acuity after the surgery (r = 0.561, P = 0.030). CONCLUSION: Preoperative CFT is important for the visual prognosis of patients with vitreomacular traction. Preoperative CFT of these patients should be considered in surgical decisions.

Excessive serous retinal detachment during the use of isotretinoin.

PURPOSE: To report a case unilateral excessive subretinal fluid during the use of isotretinoin. METHOD: A case report. A patient who used isotretinoin orally for nodular-cystic acne vulgaris developed concurrent unilaterally excessive subretinal fluid and serous retinal detachment. RESULTS: Fluorescein angiography did not demonstrate the leakage points throughout the subretinal fluid. Spectral-domain optical coherence tomography showed the excessive subretinal fluid and serous retinal detachment at macula. Two weeks after presentation, visual acuity was partially increased and subretinal fluid was disappeared at macula. CONCLUSION: Isotretinoin may affect the functioning of the RPE and can cause the development of subretinal fluid and serous retinal detachment.

Comparison of Conjunctival Cytological Alterations following Conventional and Sutureless Sclerotomies.

PURPOSE: To assess the alterations in conjunctival impression cytology following 23-gauge transconjunctival sutureless versus conventional pars plana vitrectomy. PATIENTS AND METHODS: Sixty consecutive patients were enrolled in the study. Conjunctival impression cytology was performed on 30 eyes (of 30 subjects) with 23-gauge transconjunctival sutureless vitrectomy and on 30 eyes (of 30 subjects) with conventional vitrectomy. Conjunctival impression cytology was performed preoperatively on the 1st day and in the 3rd month after the surgery. Impression cytology specimens of each group were graded and scored using a range of 0-3 according to Nelson's method. RESULTS: In the conventional pars plana vitrectomy group, statistically significant alterations in the conjunctival impression cytology were detected on the 1st postoperative day (p = 0.001) and in the 3rd postoperative month (p = 0.001), whereas in the 23-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were observed on the 1st postoperative day. However, no significant changes were observed in the following 3 postoperative months (p = 0.08). CONCLUSION: The properties of impression cytology were altered in the early postoperative period after sutureless and conventional vitrectomy. These changes were improved in the sutureless vitrectomy group only. Sutureless vitrectomy also had an advantageous effect on the conjunctival cytological changes and conjunctival structure.