The treatment of a hypertrophic bleb after XEN gel implantation with the "Drainage Channel with sutures" method: a case report.

BACKGROUND: The placement of a XEN gel stent is an ab-interno, minimally invasive glaucoma surgery which provides a subconjunctival drainage pathway and decreases intraocular pressure (IOP). CASE PRESENTATION: A 75-year-old male patient who had undergone XEN45 gel implantation after phacoemulsification and intraocular lens implantation appealed to the clinic. A filtration bleb was seen that extended through the nasal 180 degrees of the eye which caused ectropion of the lower eyelid. The value of the IOP was 12 mm Hg (mmHg). By the "Drainage Channel with Sutures" method this complication was effectively treated. As with every new method, there is a lack of knowledge about long-term outcomes in terms of effectiveness, technique and complications. CONCLUSION: The "Drainage Channel with Sutures" method has not been described in the literature yet. By this minimal invasive method, hypertrophic bleb complication of XEN gel implant has been successfully treated.

Assessment of the Quality and Readability of Online Resources on Corneal Transplantation.

PURPOSE: The aim of this study is to evaluate the quality and readability of corneal transplant websites. METHODS:  We examined internet resources related to corneal transplantation. The search terms "cornea transplantation," "keratoplasty," "keratoprothesis," and "eye transplantation" were searched on www.google.com. A total of 200 websites were scanned, with 50 websites for each search term. In the final evaluation, 113 websites were included in the study. DISCERN and the Journal of the American Medical Association (JAMA) scales were used to evaluate the websites' quality. The Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG) were used to evaluate the readability of the information. The presence of the Health On the Net Foundation Code of Conduct (HONCode) certification on websites was examined in terms of quality. RESULTS: The total DISCERN score was 42.47 ± 17.06, and the score for the JAMA was 1.58 ± 1.52. The FKGL and SMOG scores were found to be 9.19 ± 2.08 and 8.20 ± 5.23, respectively. Most of the websites we examined related to corneal transplantation were profit websites. These websites had low JAMA and DISCERN scores but relatively high readability levels. They were sites that provided low-quality information and had more financial bias and conflict of interest. Journal and book websites were found to have higher readability scores. Journal and book-sourced websites with higher FKGL and SMOG scores were more difficult to read. CONCLUSION: Most of the websites exhibit financial bias, and as a result, they contain low-quality information. Online information must be more regulated for patients to easily access accurate, high-quality information.

Evaluation of retinal and choroidal vascular structures in obsessive-compulsive disorder.

PURPOSE: To evaluate the optical coherence tomography-angiography (OCT-A) findings and choroidal vascularity index (CVI) of patients followed with a diagnosis of obsessive-compulsive disorder (OCD) by comparing them with the healthy control group (HCG). METHODS: This prospective study included 33 patients diagnosed with OCD and 32 HCG patients who followed up for at least 3 months. OCT-A images were obtained to evaluate the microvascular circulation, and enhanced HD line images were obtained for the CVI calculation of all patients. RESULTS: Statistical analysis results revealed that the rates of superficial vascular density in the fovea region and deep vascular density in the parafovea region decreased in the OCD group compared to the HCG group ( P = 0.003 and P = 0.010, respectively). Subfoveal choroidal thickness values of the OCD group were lower than those of the HCG group ( P = 0.008). While total choroidal area and lumen area values were lower in the OCD group than in the HCG group ( P < 0.001 and P < 0.001, respectively); CVI values were similar in both groups ( P = 0.436). CONCLUSION: The use of the OCT-A device, which is a non-invasive method for detecting retinal and choroidal changes in OCD cases, may provide insight into the pathogenesis of the disease.

Co-assessment of OCT-A and choroidal vascularity index data in multiple sclerosis patients.

OBJECTIVE: To evaluate optical coherence tomography-angiography (OCT-A) findings and choroidal vascular index (CVI) in patients with multiple sclerosis (MS). METHODS: 113 patients, including multiple sclerosis patients with optic neuritis attack (MSON+) and no optic neuritis attack (MSON-) and healthy control group (HCG), participated in this cross-sectional study. OCT-A images of all patients were taken and CVI was calculated. RESULTS: Superior flow (SF), deep flow (DF), foveal, and parafoveal superior vascular density (sVD) were decreased in the MSON+ group compared to HCG (p < 0.05). Optic disk flow (ODF) and optic disk head density (ONHD) values decreased in the MS group (p < 0.05). CVI was decreased in the MSON+ group compared to HCG (p < 0.05). There is a correlation between CVI and foveal and parafoveal sVD. CONCLUSION: Non-invasive diagnostic tools such as OCT-A and CVI can be used for early diagnosis and follow-up of microvascular pathologies in inflammatory diseases such as MS.

Investigation of Retinal Vascular Parameters and Choroidal Vascular Index in Patients Developing Hyphema After Unilateral Blunt Trauma.

BACKGROUND: To evaluate retinal and choroidal vascular changes in cases with hyphema after blunt ocular trauma that did not cause globe rupture or any retinal pathology. METHODS: This cross-sectional study included 29 patients who developed hyphema after unilateral blunt ocular trauma (BOT). The other healthy eyes of the same patients were evaluated as the control group. Optical coherence tomography-angiography (OCT-A) was used for imaging. In addition, choroidal parameters were compared by calculating the choroidal vascular index (CVI) and using choroidal thickness measurements by two independent researchers. RESULTS: Superior and deep flow values were significantly decreased in the traumatic hyphema group compared to the control group (p<0.05). Parafoveal deep vascular density (parafoveal dVD) values were decreased in traumatized eyes compared to control eyes (p=0.000). Vascular density values were similar other than that. In addition, there was a significant decrease in optic disc blood flow (ODF) and optic nerve head density (ONHD) values compared to the control group (p<0.05). In addition, no significant difference was observed between the groups in terms of mean CVI values (p>0.05). CONCLUSION: Non-invasive diagnostic tools such as OCTA and EDI-OCT can be used to detect and monitor early changes in retinal and choroidal microvascular flow in cases of traumatic hyphema.

Investigation of changes in retinal vascular parameters and choroidal vascular index values during the early recovery period of COVID-19: The COVID-OCTA study.

BACKGROUND: COVID-19 effects microvasculature in many tissues. This study investigated whether the choroidal structure is also affected. METHODS: This cross-sectional study included 80 patients with COVID-19 and the same number of age- and gender-matched healthy individuals. All participants' right eye measurements were examined. Optical coherence tomography angiography (OCTA) was used for imaging. Otherwise, two independent researchers used the Choroidal vascular index (CVI) for choroidal parameters calculation. RESULTS: Superior and deep flow values were lower in the COVID-19 group than in the control group, and vascular density (VD) values were lower in all regions in this group. Except for the superior mean VD, there was no statistically significant difference (p = 0.003). However, the COVID-19 group had significantly lower subfoveal choroidal thickness (SFChT) measurements than the control group (p = 0.001). In addition, no significant difference was observed between the groups in evaluating mean CVI values (p>0.05). CONCLUSION: Noninvasive diagnostic tools such as OCTA and EDI-OCT can be used to monitor early changes in diseases affecting microvessels, such as from COVID-19.

Comparing the effects of serum GPER-1 and oxidant/antioxidant levels on retinopathy in patients with diabetes and healthy individuals: a pilot study.

PURPOSE: This study aimed to determine the effect of serum G receptor-mediated protein-1 levels on the development of retinopathy in patients with diabetes in comparison with healthy individuals. METHODS: The study enrolled patients with diabetic retinopathy (Group 1), patients without diabetic retinopathy (Group 2), and healthy individuals (Group 3). Levels of serum progesterone, serum G receptor-mediated protein-1, estradiol, oxidant/antioxidants, and thyroid-releasing hormones were analyzed and compared among the groups. Post-hoc analysis was performed to compare the subgroups in which significant differences were found. RESULTS: Groups 1, 2, and 3 each included 40 patients. A significant difference was found among all groups in terms of serum G receptor-mediated protein-1, oxidant/antioxidant, and estradiol levels (p<0.01), but no significant difference was found in terms of thyroid-releasing hormone or progesterone (p=0.496, p=0.220, respectively). In the post-hoc analysis of the groups with significant differences, another significant difference was found among all groups for serum G receptor-mediated protein-1 and oxidant/antioxidant levels (p<0.05). Serum G receptor-mediated protein-1 and oxidant levels were positively correlated, whereas serum G receptor-mediated protein-1 and antioxidant levels were negatively correlated (r=0.622/p<0.01, r=0.453/p<0.01, r=0.460/p<0.01, respectively). The multiple regression analysis showed that increased levels of serum G receptor-mediated protein-1 may help prevent diabetic retinopathy. CONCLUSIONS: Serum G receptor-mediated protein-1 levels, which were the highest in the diabetic retinopathy Group, increased as the oxidant/antioxidant balance changed in favor of oxidative stress. This appears to be a defense mechanism for preventing neuronal damage.

Correlation of Demarcation Line Depth With Medium-Term Efficacy of Different Corneal Collagen Cross-Linking Protocols in Keratoconus.

PURPOSE: To compare demarcation line depth (DD) and topographic changes among different corneal collagen cross-linking (CXL) protocols and to evaluate the relation of DD with medium-term efficacy of CXL in halting progression of keratoconus. METHODS: The study included 124 patients (mean age 19 ± 4.8 years) with progressive keratoconus who underwent conventional (3 mW/cm/30 min), accelerated (18 mW/cm/5 min), or transepithelial (TE) CXL (3 mW/cm/30 min) and followed up for at least 2 years. Baseline and final corneal topographic parameters and DD determined with anterior segment optical coherence tomography 1 month after CXL were compared among the protocols and the correlation between DD and topographic changes at the end of 24 months was analyzed. P < 0.05 was considered as statistically significant. RESULTS: Mean DD was significantly higher in the conventional and accelerated groups (335.19 ± 71.13 µm and 304.97 ± 94.45 µm, respectively) compared with the TE group (239.92 ± 71.37 µm) (P < 0.001). After conventional and TE CXL, keratometric parameters improved remarkably, whereas accelerated CXL only lowered K1 and Kmax (P < 0.05). No correlation was found between DD and topographic changes (P > 0.05). Progression was detected in 3 eyes in the conventional group (4.1%), 3 in the accelerated group (7.7%), and none in the TE group. The use of either riboflavin D or M made no differences in terms of DD and topographic parameters (P > 0.05). CONCLUSIONS: In conventional and accelerated protocols, corneal stromal demarcation line is deeper compared with TE CXL; however, the DD has no correlation with topographic changes, which means that DD is not a direct measure for the efficacy of CXL.

Correlation of Corneal Endothelial Cell Density with Corneal Tomographic Parameters in Eyes with Keratoconus.

OBJECTIVES: To examine changes in corneal endothelial cell density (ECD) in different stages of keratoconus and evaluate its correlation with corneal tomographic parameters. MATERIALS AND METHODS: Two hundred six patients with keratoconus were enrolled in the study. Corneal topography was performed by Sirius (CSO, Italy), which has a rotating Scheimpflug camera and a Placido disc topographer. Automatic endothelial analysis was done with the non-contact endothelial microscope (20x probe) of Confoscan-4 (NIDEK, Japan). The eyes were classified into stages based on steepest keratometric value as follows: mild <45 D; moderate 45-52 D; severe >52 D and according to thinnest cornea thickness (TCT) as <400 µm, 400-450 µm, and >450 µm. Tomographic and endothelial cell parameters were compared among the groups using Kruskal-Wallis test and the correlations between them were analyzed using Spearman correlation. RESULTS: The study included 391 eyes of 100 male (24.29±7.7 years, range 11-47 years) and 106 female (26.26±7.5 years, range 13-45 years) patients (p=0.07). Mean ECD values were 2628±262 cells/mm2, 2541.9±260.4 cells/mm2, and 2414.6±384.3 cells/mm2 in mild, moderate, and severe keratoconus, respectively (p<0.001) and 2592.3±277 cells/mm2, 2502±307 cells/mm2 and 2348±296 cells/mm2 in corneas with TCT values >450 µm, 400-450 µm, and <400 µm, respectively (p<0.001). ECD showed significant negative correlation with keratometric and elevation parameters and positive correlation with pachymetric parameters (p<0.05). CONCLUSION: As endothelial cell numbers seem to decrease with the progression of keratoconus, specular/confocal microscopy screening should be carried out, especially in eyes with advanced stages and corneas with TCT <400 µm.

Spectral-Domain Optical Coherence Tomography Findings in Lipemia Retinalis.

Severe hypertriglyceridemia can give rise to a fundus appearance with whitish-colored retinal vessels called lipemia retinalis. A 52-year-old man with hypertriglyceridemia presented with a best-corrected visual acuity of 20/20 in both eyes and creamy-white retinal vessels on fundus. Spectral-domain optical coherence tomography (SD-OCT) revealed hyperreflective and engorged retinal vessels and white dots mainly accumulated in the inner nuclear and ganglion cell layer. Follow-up fundus examination after plasmapheresis sessions revealed normal retinal vessels. The hyperreflective appearance of the retinal vessels in OCT reversed rapidly 5 days after the treatment, whereas hyperreflective dots in retina disappeared slowly in 3 months. OCT is useful in demonstrating inner retinal changes associated with lipemia retinalis at histopathological level. The hyperreflective dots in inner retina associated with leakage from superficial retinal capillaries attested the correlation of their location with their origin. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:589-592.].