Fluorescent and Biocompatible Nitrogen and Sulfur Co-Doped Carbon Nanodot as an Ocular Fundus Angiography Imaging Agent.

The florescence characteristics and the toxicities of carbon nanodots (CDs) are directly related to their elemental compositions. Fluorescent and non-toxic agent for imaging of biological systems was aimed. Sulfur and nitrogen co-doped CDs (S/N-CDs) was hydrothermally produced in an average size of 8 nm. S/N-CDs showed blue fluorescence under UV-light with an excitation wavelength of 365 nm. After 24 h, S/N-CDs was non-cytotoxic in HUVEC and L929 cells. S/N-CDs have a great potential to act as an alternative material for commercial fluorescent materials with its 85.5% of quantum yield. S/N-CDs was approved in vitro as an imaging agent for an ocular fundus angiography of rats.

The evolution of the changes in the clinical course: a multicenter survey-related impression of the ophthalmologists at the peak of the COVID-19 pandemic in Turkey.

PURPOSE: The coronavirus disease-2019 (COVID-19) has become a difficult pandemic to control worldwide. The high transmission risk and mortality rates of COVID-19 cause serious concerns in ophthalmologists and may cause disruptions in clinical functioning. This study aims to identify changes in the clinical approaches of ophthalmologists, understand their anxiety levels, and exhibit how patients' follow-up processes progress during the pandemic. METHODS: A questionnaire that including demographic information, ophthalmology clinical activity scale, and Beck anxiety scale was sent to ophthalmologists in Turkey. Google Forms was used as a survey platform in this study. RESULTS: A total of 121 ophthalmologists participated in the study. The participants stated that they could not continue routine interventional diagnosis and treatment practices during the outbreak. It was clearly stated that there were changes in their clinical approach and decreased patient examination quality. For this reason, 14.9% of physicians said to missed the diagnosis in this process. Physicians who encounter infected patients state that it is more difficult to provide ophthalmological services and their clinical approaches are affected more negatively. Anxiety levels of physicians who could access personal protective equipment (PPE) and show positive solidarity with their colleagues in the process were found to be lower. CONCLUSION: Our study revealed that ophthalmologists, like other healthcare professionals, were severely affected by the COVID-19 outbreak. Accordingly, healthcare managers should provide adequate PPE for ophthalmologists, organize the clinical operation, and support the mental health of ophthalmologists.

Needling with 5-fluorouracil for encapsulated blebs after Ahmed glaucoma valve implantation.

Objective: To evaluate the efficacy of 5-fluorouracil (5-FU) needling of encapsulated blebs (EBs) after Ahmed glaucoma valve (AGV) implantation in patients with medically uncontrolled secondary glaucoma. Methods: Thirty-eight eyes of 37 patients who underwent AGV implantation due to secondary glaucoma with EB were recruited in this retrospective non-randomized study. 5-FU needling (0.1 mL of 50 mg/mL) was performed for the restore of the aqueous outflow. Success after needling was defined as last intraocular pressure (IOP) ≤21 mmHg or ≥6 mmHg (with or without the use of antiglaucoma medication) without loss of light perception. Results: The mean follow-up time was 14.5 ± 8.5 (5-36) months after needling. The mean interval between the AGV implantation and the needling was 10.2 ± 7.5 (2-32) weeks. Patients were examined after needling at the 2nd hour, 1st week, 1st month, 3rd month, 6th month, and at the final visit. The success rates were 84.2%, 94.7%, 94.7%, 86.8%, 83.3%, and 71.1%, respectively. The Kaplan-Meier survival analysis revealed 96.4%, 77.4%, and 60.3% cumulative predictive success rates for the 6th, 12th, and 24th months, respectively. The mean IOP before needling was 28 ± 8.4 mmHg. At the final visit, the mean IOP was 18.1 ± 7.5 mmHg (p ≤ 0.001). Complications after needling included Seidel without hypotony (three eyes, 7.9%), hyphema (one eye, 2.6%), and decompression retinopathy (one eye, 2.6%). Neovascular glaucoma was the only factor that affected efficacy of treatment negatively (p = 0.003). Conclusions: Bleb needling with 5-FU seems to be a safe and effective method in patients with EB formation after AGV implantation in secondary glaucoma cases.

Evaluation of the Reliability and Quality of YouTube Videos on Congenital Nasolacrimal Duct Obstruction.

Introduction Congenital nasolacrimal duct obstruction (CNLDO) causes excessive eye tearing or mucoid discharge. Twenty percent of one-year-olds globally have CNLDO. There are many sources that offer information to parents. This study evaluates the quality and accuracy of CNLDO-related YouTube videos. Methods The first 100 videos that appeared after typing "congenital nasolacrimal duct obstruction" in the YouTube search engine were evaluated. These videos were also analyzed and scored using the DISCERN, Journal of the American Medical Association (JAMA), and Global Quality Scoring (GQS) systems. Results Forty videos met the inclusion criteria. The mean DISCERN score was 47.3 ± 9.15, JAMA was 1.72 ± 0.87, and GQS was 3.1 ± 0.81. The duration of the videos uploaded by the non-physician group was significantly longer (p = 0.04). In addition, the JAMA score of the videos uploaded by the physician group was significantly higher than that of the other group (p = 0.03). Theoretical videos were longer than surgical videos (p = 0.02). DISCERN, JAMA, and GQS scores were statistically higher in the theoretical video group (p = 0.002, p = 0.04, and p = 0.03, respectively). Conclusion According to our research, the quality of YouTube videos about congenital nasolacrimal duct obstruction is average. This information source can be improved by making videos with more detailed information about the disease and theoretical information, as well as by having health professionals look over the content that has been uploaded.

An Association Between the Intestinal Permeability Biomarker Zonulin and the Development of Diabetic Retinopathy in Type II Diabetes Mellitus.

Objectives: Increased intestinal permeability (IP) and gut microbiota dysbiosis have been implicated in low-grade chronic inflammation, which is an important factor in the pathogenesis of diabetic retinopathy (DR). This study aims to demonstrate the relationship between the IP biomarker zonulin and DR in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: This study was conducted with a total of 89 T2DM patients, including 33 non-DR, 28 with non-proliferative DR (NPDR), and 28 with proliferative DR (PDR), and 32 healthy controls. Zonulin levels were determined from blood samples using an enzyme-linked immunosorbent assay kit. Results: There was no difference between the four groups in terms of age (p=0.236), gender (p=0.952), and body mass index (p=0.134) of the participants. Zonulin levels were significantly higher in the PDR group compared to the other three groups, as well as in the non-DR and NPDR groups compared to the control group. In multivariate logistic regression analysis, zonulin was found to be an independent predictor of DR (odds ratio: 1,781, 95% confidence interval: 1,122-2,829, p=0.014). Conclusion: Our study showed that elevated zonulin levels may play a significant role in the development of DR, particularly during the transition to the proliferative stage. This suggests that regulation of IP could be one of the targets of DR treatment. More studies are needed to determine whether a eubiotic gut microbiota and IP have a direct relationship with DR.

Evaluating scientific research barriers by gender and other characteristics from the perspective of ophthalmologists in Turkey: A multicenter survey study.

BACKGROUND/AIM: The ever-increasing population and life expectancy worldwide increase the prevalence of ophthalmic diseases, and the need for ophthalmic research expands accordingly. In our study, we aimed to evaluate many aspects of the barriers, especially gender disparities, confronting ophthalmologists who aspire to conduct scientific research (SR). MATERIALS AND METHODS: In this descriptive quantitative study, we distributed an online questionnaire to ophthalmologists in Turkey with 21 questions presented on a five-point Likert scale and two open-ended questions. The survey was prepared with Google forms. Participants were recruited via e-mail and social networks. A multicenter survey was conducted between January 29 and February 20, 2021, and a total of 210 valid responses were recorded. RESULTS: Participants' responses were grouped into four types of barriers: motivation, time constraints, research support, and competence. Participants' motivation to conduct research was above average (3.54±0.96), but most stated that they have time constraints (3.74±0.97). Participants did not agree that there is adequate support for research (2.35±0.76), and they self assessed their level of the required competence to be average (2.87±1.08). Women were more motivated to do SR than men (p = 0.008), but there were no statistically significant differences between women and men in terms of time constraints, research support, and level of competence (p = 0.853, p = 0.482, and p = 0.558, respectively). Although there is no statistically significant difference between men and women regarding time constraints, female physicians mentioned more about the barriers arising from their personal responsibilities (p = 0.038). CONCLUSIONS: Our study revealed that ophthalmologists are enthusiastic about doing SR but encounter obstacles with regard to time availability and research support. In addition, there is a need to reinforce competence in SR. Although female physicians are more motivated than men, they must deal with competing domestic responsibilities.

Evaluation of macular and choroidal thickness in healthy residents living at high altitude.

Purpose: Assessment of long-term effects of high altitude on choroidal thickness. Methods: This prospective cross-sectional study included 88 and 79 age- and sex-matched healthy individuals who were living at sea-level (SL group) and high-altitude (HA group), respectively. Participants were required to have resided in the same place for at least 10 years. Spectral-domain optical coherence tomography (SD-OCT) scans were conducted in two different and were performed within the same time (08:00 am to 10:00 am). Central macular thickness (CMT) and choroidal thickness were measured at five different points (i.e., at the central fovea and 1 mm and 2 mm temporal and nasal of the fovea). Blood hemoglobin (Hb), red blood cell (RBC), hematocrit (Htc) levels, blood oxygen saturation, heart rate, and body mass index (BMI) were compared between groups statistically. Results: The HA group had a mean age of 47.5 ± 13.3 years, whereas the SL group was 48.7 ± 13.4 years (P = 0.57). There was no significant difference between the groups in terms of CMT. Subfoveal choroidal thickness (SCFT) was 282.73 ± 87.82 µm in the HA group and 310.49 ± 74.73 in the SL group (P = 0.02). The choroid was found to be thinner at all the measured locations in the HA group except the 2 mm nasal point of the fovea. However, only the difference at an SFCT was statistically significant. Furthermore compared with the SL group statistically significant higher Hb, RBC, Htc levels were determined in the HA group. In the multiple linear regression model analysis, age was found an only effective confounder factor for SCFT (P = 0.001, 95% CI 4.132-2.476). Conclusion: The systemic adaptive changes due to chronic high altitude exposure may cause structural changes in the choroidal vascular network. The current study results revealed significant thinning only at SFCT. Large-scale longitudinal studies are needed to obtain more definitive data on this subject.

Evaluation of the Effects of Intravitreal Aflibercept and Ranibizumab on Systemic Inflammatory and Cardiovascular Biomarkers in Patients with Neovascular Age-related Macular Degeneration.

Purpose: To investigate the effects of intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) on systemic inflammatory and cardiovascular biomarkers in treatment-naive patients with neovascular age-related macular degeneration (nAMD)Methods: This study included 24 eyes of 24 patients treated with 0.5 mg ranibizumab (IVR group) and 25 eyes of 25 patients treated with 2.0 mg aflibercept (IVA group). Complete blood count, C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), uric acid (UA), albumin, fibrinogen levels were measured in blood samples before and after the three-monthly loading dose treatment. Neutrophil/lymphocyte ratio (NLR), monocyte/HDL-c ratio (MHR), CRP/albumin ratio (CAR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR) were also calculated.Results: A statistically significant decline was determined in post-treatment CRP (P = .002), LDL-c (P < .001) levels, white blood cell (WBC, P = .001), neutrophil (P < .001), monocyte (P = .019) counts and NLR (P = .020), MHR (P = .042), CAR (P = .010) ratios comparing with pre-treatment values in the IVA group. No statistically significant change was found in any of the parameters evaluated in the study in the IVR group. Also, there was no significant change in fibrinogen, lymphocyte count, MLR, HDL-c, UA, PLR, and platelet count values in both groups.Conclusion: Compared to IVR, IVA treatment had a small but significant effect on systemic inflammatory and cardiovascular biomarkers.

Sequential tissue plasminogen activator, pneumatic displacement, and anti-VEGF treatment for submacular hemorrhage.

PURPOSE: To report the results of our sequential intravitreal (IV) tissue plasminogen activator (tPA), pneumatic displacement (PD), and IV anti-vascular endothelial growth factor (VEGF) treatment in patients with neovascular age-related macular degeneration (nAMD)-related submacular hemorrhage (SMH). METHODS: A total of 16 eyes of 16 patients with SMH of less than 15 days duration were included in this retrospective pilot study. The tPA was applied on the day of diagnosis, and PD was performed the following day. Patients received 3 consecutive monthly IV injections of ranibizumab starting from 15 days after PD. During the follow-ups, additional ranibizumab treatment was performed if persistent macular or recurrent subretinal or intraretinal fluid hemorrhage was observed. RESULTS: The mean central retinal thickness was 489 ± 92 µm (311-621 µm) at the time of diagnosis, 324 ± 56 µm (209-409 µm) at the first month, 262 ± 48 µm (197-364 µm) at 3 months, 248 ± 40 µm (190-334 µm) at 6 months, and 253 ± 41 µm (192-356 µm) at the last control (p<0.01). The mean best-corrected visual acuity was 2.08 ± 0.79 logMAR (0.7-3.0 logMAR) at baseline, 1.41 ± 0.70 logMAR (0.56-2.50 logMAR) at the first month, 1.21 ± 0.66 logMAR (0.3-2.0 logMAR) at 3 months, 1.14 ± 0.77 logMAR (0.2-2.50 logMAR) at 6 months, and 1.09 ± 0.73 logMAR (0.3-2.50 logMAR) at the last follow-up (p<0.01). CONCLUSIONS: Sequential IV tPA, PD, and IV anti-VEGF treatments for SMH in patients with nAMD is effective. However, further studies are needed to establish the best treatment algorithm for SMH in patients with nAMD.