Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches.

INTRODUCTION: Open globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity. MATERIALS AND METHODS: We reviewed three hundred patients with open globe injuries receiving treatment at Khatam-Al-Anbia Hospital in Iran from 2020 to 2022. Age, sex, type of trauma, initial VA grade, relative afferent pupillary defect (RAPD), zone of trauma, traumatic cataract, traumatic optic neuropathy (TON), intraocular foreign body (IOFB), retinal detachment (RD), endophthalmitis, and ocular trauma score (OTS) grade were the input features. We calculated univariate and multivariate regression models to assess the association of different features with visual acuity (VA) outcomes. We predicted visual acuity using ten supervised machine learning algorithms including multinomial logistic regression (MLR), support vector machines (SVM), K-nearest neighbors (KNN), naïve bayes (NB), decision tree (DT), random forest (RF), bagging (BG), adaptive boosting (ADA), artificial neural networks (ANN), and extreme gradient boosting (XGB). Accuracy, positive predictive value (PPV), recall, F-score, brier score (BS), Matthew correlation coefficient (MCC), receiver operating characteristic (AUC-ROC), and calibration plot were used to assess how well machine learning algorithms performed in predicting the final VA. RESULTS: The artificial neural network (ANN) model had the best accuracy to predict the final VA. The sensitivity, F1 score, PPV, accuracy, and MCC of the ANN model were 0.81, 0.85, 0.89, 0.93, and 0.81, respectively. In addition, the estimated AUC-ROC and AUR-PRC of the ANN model for OGI patients were 0.96 and 0.91, respectively. The brier score and calibration log-loss for the ANN model was 0.201 and 0.232, respectively. CONCLUSION: As classic and ensemble ML models were compared, results shows that the ANN model was the best. As a result, the framework that has been presented may be regarded as a good substitute for predicting the final VA in OGI patients. Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries.

Clinical characteristics and management outcome of acute infectious endophthalmitis.

PURPOSE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. CONCLUSION: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.

Macular vessel density reduction in patients recovered from COVID-19: a longitudinal optical coherence tomography angiography study.

BACKGROUND/AIMS: To quantify the longitudinal changes of the macular microvasculature and the foveal avascular zone (FAZ) parameters in patients recovered from coronavirus disease-2019 (COVID-19) using optical coherence tomography angiography (OCTA) analysis. METHODS: This observational, longitudinal study was performed on patients recovered from COVID-19. The OCTA images were recorded at baseline and after 1 and 3 months at the follow-up examination. Vessel density (VD) of the retinal superficial (SCP) and deep capillary plexus (DCP), as well as the area of the FAZ of patients who had recovered from COVID-19, were measured. RESULTS: In total, 36 eyes of 18 patients (62.2% female) with a mean age of 34.5 ± 7.5 years old were included. Regarding SCP, while the VDs of the whole image, fovea, and parafovea were comparable at different time points, the mean VDs in inferior hemifield, as well as superior and inferior regions of perifovea, underwent significant reductions at month 3, compared to the baseline. In DCP, the mean of VD in the whole image was 54.3 ± 2.7 at the first visit which significantly decreased to 52.1 ± 3.8(P = 0.003) and 51.4 ± 2.7(P = 0.001) after 1 and 3 months, respectively. The VDs in all regions of parafovea and perifovea revealed a significant reduction after 1 and 3 months, compared to the first visit. The mean FAZ area was 0.27 ± 0.08 mm2, 0.26 ± 0.08 mm2, and 0.27 ± 0.08 mm2 at the baseline, month 1, and month 3, respectively (P > 0.05). CONCLUSION: Based on the results, the patients who had recovered from COVID-19 had a progressive decrease of VD at the follow-up visit 3 months after COVID-19 infection.

Acute effects of coffee consumption on the microcirculation of macula and optic nerve head.

Purpose: This study aimed to evaluate the acute changes in retinal vasculature following coffee consumption. Methods: This is an interventional case series. The subjects were 22 healthy young adults. They were asked to rest in a silent room for 15 min; then, their heart rate, blood pressure, and arterial oxygen saturation pressure were measured with a single patient monitoring system. Optical coherence tomography (OCT) and OCT angiography (OCT-A) imaging of the disc and macula were performed for both eyes of the subjects. These measurements were repeated 45 min after drinking a cup of 450 ml of coffee containing a standard dose of 130 mg of caffeine. Macular and optic nerve head neurovasculature changes were assessed. Results: The results of our study did not show a significant change in peripapillary retinal nerve fiber layer thickness and neural structural and vascular parameters of the optic nerve head. Although assessments of macular vasculature showed a significant decrement in superficial (p = 0.01) and deep vessel density (p = 0.05) at parafovea, vessel densities (VDs) at the fovea, and deep capillary plexus at perifovea showed no significant change. Conclusion: Consuming one cup of coffee (150 mg caffeine) statistically changes central foveal thickness and parafoveal blood flow but likely does not have a clinical impact in healthy young adults.

Efficacy of systemic diclofenac sodium on intravitreal concentration.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs), as an alternative, are replacing corticosteroids in ocular inflammatory diseases. Diclofenac has been used mainly topically, and recent focus has been on intravitreal delivery. Both of these methods have been shown to have complications in long-term application. PURPOSE: To assess the efficacy of slow release oral diclofenac sodium on intravitreal concentration in experimental model of chemically injured eyes. METHODS: In an experimental double-masked clinical trial, right eyes of 24 albino rabbits were chemically injured by 1 N NaOH. One hour after chemical injury, 10 cc suspension gavage containing 100 mg slow release diclofenac sodium was administered in all cases. 2, 4, 6, 12, 24, 48 h after gavage, vitreous samples were obtained in all cases. Intravitreal concentration of diclofenac sodium was evaluated in all samples using high-performance liquid chromatography (HPLC) method. RESULTS: Intravitreal diclofenac levels by oral intake were enhanced by the inflammation in all the measurements. In inflamed eyes, diclofenac concentration was ten times more than control eye (2.658 ± 0.344 vs. 0.242 ± 0.0279 and 1.617 ± 0.527 vs. 0.148 ± 0.095; in 2 and 4 h, respectively). After 6 h, diclofenac concentration was statistically different, although it reduced below 1 µg/ml. CONCLUSION: Diclofenac is delivered to the inflamed eye more than healthy eye. It seems that by oral diclofenac consumption, it is possible to make a significant intravitreal concentration.

Endothelial cell changes after photorefractive keratectomy with graded usage of mitomycin C.

PURPOSE: To compare differences in the endothelial cells before and after photorefractive keratectomy (PRK) for myopia with refractive error graded mitomycin C (MMC) application. METHODS: In a prospective randomized clinical trial, forty-eight myopic patients referred to Khatam-al-Anbia Eye Hospital, Mashhad, Iran, for PRK. Patients were treated with PRK by a Bausch and Lomb Technolas 217z excimer laser (Bausch and Lomb, Rochester, NY). MMC was applied after PRK 5 s for each diopter of spherical equivalent myopic refractive error corrected. The manifest refraction, visual acuity, MMC treatment length, corneal pachymetry and specular microscopy were evaluated preoperatively and at 1 and 6 months postoperatively. RESULTS: A total of 48 cases (96 eyes, 68.75% female) were treated, with a mean age of 26.70 ± 4.89 years (range, 18-34 years). Postoperative cell density, cell size and polymegathism did not significantly change. On the other hand, standard deviation (SD) of cell size (P = 0.008), pleomorphism (P = 0.003) and coefficient of variation (CV) (P = 0.016) were significantly increased. None of these parameters was related to the length of MMC application. Corneal thickness decreased significantly after the operation but it increased 6 months postoperatively compared with the first month (P < 0.001). CONCLUSION: MMC application for PRK in myopia can affect the endothelial cells, but in early follow-ups, it does not affect the cell density or size. Cell size was changed but it was obvious not in mean cell size, but in SD and CV. MMC time below the 30 s was not significant on endothelial cell changes.

Closantel; a veterinary drug with potential severe morbidity in humans.

BACKGROUND: Closantel is a halogenated salicylanilide with a potent anti parasitic activity. It is widely used in management of parasitic infestation in animals, but is contraindicated in humans. CASE PRESENTATION: A 34-year-old man with depression was referred to our center with progressive loss of vision in both eyes 10 days after unintentional ingestion of three 500 mg tablets of Closantel. On fundus examination, left optic disc margin was blurred. His bilateral visual acuity was no light perception (NLP) despite prescribed IV erythropoietin injections 20,000 units daily for 3 days and 1gr intravenous methylprednisolone acetate for 3 days followed by 1 mg/kg oral prednisolone. On macular optical coherence tomography (OCT), a disruption in outer retina was observed. Electroretinogram and visual evoked potential tests showed visual pathway involvement. CONCLUSIONS: Destruction of neurosensory retina and visual pathways after accidental Closantel use is related to severe visual loss. This case alerts us about the destructive effect of this drug on humans even in low dosage which necessitates preventive efforts to reduce the chance of this morbid side effect.

Sulfur Mustard Exposure and Non-Ischemic Central Retinal Vein Occlusion.

A 41-year-old man was referred with a complaint of visual loss in his left eye and his best corrected visual acuity was 20/80. Slit lamp examination showed arborizing conjunctival vessels and dry eye. Fundus examination and fluorescein angiography revealed a non-ischemic central retinal vein occlusion. Cardiovascular, rheumatologic, and hematologic work up showed no abnormal findings. An ascertained history of exposure to sulfur mustard during the Iran-Iraq war was documented in his medical history. Four sessions of intravitreal bevacizumab injections were done as needed. After two-year follow-up, visual acuity in his left eye improved to 20/25 and macular edema was resolved without any need for further interventions. We conclude that sulfur mustard gas exposure may be considered as a predisposing factor for central retinal vein occlusion, as was found in our patient (an Iranian war veteran) by excluding all yet known etiologies and predisposing factors.

Higher titers of anti-Chlamydia pneumoniae IgG in diabetic retinopathy: a cross-sectional study.

BACKGROUND: Chronic inflammation has a role in the pathogenesis of diabetic retinopathy. Infection with intracellular organisms may incite chronic inflammation. This study was conducted to investigate the association between previous infection with Chlamydia pneumoniae (an intracellular microorganism) and diabetic retinopathy. METHODS: Patients with type 2 diabetes mellitus (30-60 years old) and age-matched normal controls were recruited. Patients with history of cardiovascular or cerebrovascular disease, recent pulmonary infection and the presence of age-related macular degeneration were excluded from the study. Complete ophthalmic examinations were performed. Fasting blood sugar and haemoglobin levels were measured in diabetic patients and controls, and HgbA1c , blood urea nitrogen, creatinine and 24-h urine protein were measured in diabetic patients. Anti-C. pneumoniae IgG (enzyme-linked immunosorbent assay) was measured in the sera of all participants. RESULTS: A total of 215 type 2 diabetic patients and 243 normal healthy controls were included. Anti-C. pneumoniae IgG titers were higher in patients affected by diabetic retinopathy than participants without retinopathy (74.78 ± 33.38 vs 66.18 ± 31.40, p = 0.028). Diabetic patients with diabetic retinopathy also had higher titers than diabetic patients without diabetic retinopathy (74.78 ± 33.38 vs 66.11 ± 33.41, p = 0.042). Of different variables including age, body mass index, haemoglobin level, glycated haemoglobin level, fasting blood sugar, mean arterial pressure and blood urea nitrogen, only age (r = 0.17; p = 0.001) and body mass index (r = 0.15; p = 0.003) were correlated with anti-C. pneumoniae IgG levels. In regression analysis, the presence of diabetic retinopathy was still a determinant of the antibody level (p = 0.03). CONCLUSION: Anti-C. pneumoniae IgG titers were higher in patients with diabetic retinopathy, which may indicate a role of this infection in the pathogenesis of diabetic retinopathy.

Effect of topical diclofenac on postoperative photorefractive keratectomy pain: a randomized, controlled trial.

BACKGROUND: A major disadvantage of photorefractive keratectomy is postoperative pain and discomfort. This study aims to evaluate whether topical diclofenac 0.1% therapy adds any extra benefit to systemic diclofenac in controlling pain after photorefractive keratectomy. DESIGN: Prospective randomized, double-masked clinical trial applied in the Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. PARTICIPANTS: Sixty-eight individuals (age range, 18-35 years) having bilateral photorefractive keratectomy for myopic correction with or without astigmatism. METHODS: All patients received 100 mg of extended-release oral diclofenac two times (12-h interval) before photorefractive keratectomy surgery. Postoperatively, patients were randomized into the case and control groups. Case group was administered the diclofenac 0.1% drop, one drop 2 h preoperatively and four times daily postoperatively for 3 days, whereas the control group was given artificial tears instead. MAIN OUTCOME MEASURES: Pain level, photophobia and functional activity were evaluated by the patient after operation. RESULTS: Two days after surgery, no statistically significant difference in pain level was noted between both groups. In addition, photophobia and functional activity was not different between the case and control groups. Eyelid oedema and conjunctival injection levels were significantly higher in the control group (P < 0.001). CONCLUSIONS: Administration of topical diclofenac to a standardized postoperative pain regime did not alleviate post-photorefractive keratectomy pain, although it is effective in local signs like eyelid oedema and conjunctival injection. It can be concluded that oral diclofenac is sufficient in the management of post-photorefractive keratectomy pain and addition of the topical diclofenac is unnecessary.

Angle kappa changes after photorefractive keratectomy for myopia.

The goal of this study was to compare differences in the mean angle kappa and its intercepts before and after photorefractive keratectomy (PRK) for myopia. In a prospective controlled study, myopic patients were treated with aspheric wavefront-guided (personalized) PRK with a Bausch & Lomb Technolas 217z excimer laser. The manifest refraction, visual acuity, and angle kappa were evaluated preoperatively and at 1 and 6 months postoperatively. The same operator performed all angle kappa measurements using Orbscan IIz. A total of 48 cases (96 eyes, 68.75 % female) with a mean age of 26.70 ± 4.89 years (18-34 years) were treated. The preoperative and postoperative mean angle kappa values were not significantly different (4.97 ± 1.24 vs 4.99 ± 1.10 at 6 months). The average horizontal distance (x-intercept) between the visual axis and pupillary axis intersection on the corneal surface measured before surgery (-0.562 ± 0.074 mm) did not significantly differ from the values measured at 1 and 6 months after surgery (-0.559 ± 0.048 and -0.554 ± 0.055 mm, respectively). Similarly, the average vertical distance (y-intercept) values did not differ before and at 1 and 6 months after surgery (0.156 ± 0.225, 0.142 ± 0.040, and 0.149 ± 0.33 mm, respectively). No differences in the angle kappa or its corneal intercepts were observed between pre- and post-PRK. This finding implies that PRK does not change the corneal vertex locations.

Anterior and posterior corneal curvature: normal values in healthy Iranian population obtained with the Orbscan II.

The objective of study was to determine the normative values of anterior and posterior best fit sphere (A-BFS and P-BFS) measured with Orbscan II Topography System. In this cross-sectional study, patients (age range: 18-40 years) referred to the Khatam Eye Hospital (Mashhad, Iran) were put in an observational cross-sectional study. The A-BFS and P-BFS were measured with the Orbscan II. The differences between genders, between right and left eyes, and age-related changes were evaluated. A total of 977 healthy participants consisted of 614 female and 363 male subjects aged 18-35 years participated. The average A-BFS in our study population was recorded as 43.060 ± 1.541 D (median: 43.00 D, mode: 43.10 D, range: 38.80-55.80 D). The average P-BFS in our study population was recorded as 52.702 ± 2.190 D (median: 52.60 D, mode: 53.10 D range: 46.9-62.20 D). The A-BFS and P-BFS were respectively 42.753 ± 1.629 and 52.327 ± 2.376 D in males and 43.242 ± 1.457 and 52.924 ± 2.041 D in females, which were statistically different between the genders (P < 0.001). However, A-BFS and P-BFS were not statistically different between right and left eyes (P = 0.649 and P = 0.688 respectively). In addition, A-BFS and P-BFS were not correlated with the age (r = 0.038, P = 0.096 and r = -0.142, P = 0.178 respectively). Considering 95 % confidence interval, A-BFS less than 43.13 D and greater than 42.99 D and P-BFS less than 52.80 D and greater than 52.60 D would be considered abnormal. Detailed description and analysis of A-BFS and P-BFS with Orbscan demonstrated that the obtained average value of BFS were higher in male than female and did not change with increasing age.

In-situ forming biodegradable implants for sustained Fluocinolone acetonide release to the posterior eye: In-vitro and in-vivo investigations in rabbits.

Delivering medication to the posterior segment of the eye presents a significant challenge. Intravitreal injection has emerged as the preferred method for drug delivery to this area. However, current injectable non-biodegradable implants for fluocinolone acetonide (FA) require surgical removal after prolonged drug release, potentially affecting patient compliance. This study aimed to develop an in-situ forming biodegradable implant (ISFBI) optimal formulation containing PLGA504H and PLGA756S (50:50 w/w%) with the additive NMP solvent. The goal was to achieve slow and controlled release of FA over a two-month period with lower burst release, following a single intravitreal injection. Through morphology, rheology, stability and in-vitro release evaluations, the optimal formulation demonstrated low viscosity (0.12-1.25 Pa. s) and sustained release of FA at a rate of 0.36 µg/day from the third day up to two months. Furthermore, histopathology and in-vivo studies were conducted after intravitreal injection of the optimal formulation in rabbits' eye. Pharmacokinetic analysis demonstrated mean residence time (MRT) of 20.02 ± 0.6 days, half-life (t1/2) of 18.80 ± 0.4 days, and clearance (Cl) of 0.29 ± 0.03 ml/h for FA in the vitreous humor, indicating sustained and slow absorption of FA by the targeted retinal tissue from vitrea over the two-month period and eliminating through the anterior section of the eye, as revealed by its presence in the aqueous humor. Additionally, FA exhibited no detection in the blood and no evidence of systemic side effects or damage on the retinal layer and other organs. Based on these findings, it can be concluded that in-situ forming injectable biodegradable PLGA implants can show promise as a long-acting and controlled-release system for intraocular drug delivery.

Evaluation of Macular Neurovasculature and Choroidal Blood Flow Following Inferior Oblique Myectomy Using Optical Coherence Tomography Angiography.

PURPOSE: To evaluate the short-term effects of inferior oblique myectomy on the retinal neurovasculature, choroidal thickness, and choroidal vascularity index at the macula. METHODS: Patients older than 5 years who were candidates for inferior oblique muscle myectomy surgery participated in the study. Patients with any systemic or ocular disease that could affect the macular neurovasculature were not included in the study. After recording demographic data, including age and gender, and conducting a complete ophthalmic examination, macular optical coherence tomography (OCT), enhanced depth imaging OCT, and OCT angiography imaging (AngioVue software (V.2017.1.0.151; Optovue, Inc) were performed before (1 day to 1 week) and in the specific time intervals (1 week, 1 month, and 3 months) after the surgery for all participants. RESULTS: Eighteen patients (13 male and 5 female) who underwent inferior oblique muscle myectomy, with a mean ± standard deviation age of 24.22 ± 18.14 years, were included in this study. The baseline mean ± standard deviation of subfoveal choroidal luminal area and subfoveal total choroidal area were 0.390 ± 0.03 and 0.539 ± 0.04 mm2, respectively. The changing pattern of the subfoveal choroidal vascularity index and subfoveal choroidal luminal area was statistically significant (P = .013 and .035, respectively). CONCLUSIONS: Inferior oblique myectomy can lead to changes in choroid hemodynamics in the short term. However, these changes seem to be temporary. [J Pediatr Ophthalmol Strabismus. 2024;61(4):235-244.].

Optic nerve head alterations after COVID-19: an optical coherence tomography angiography-based longitudinal study.

OBJECTIVE: To evaluate longitudinal changes in peripapillary vessel density (VD) following coronavirus disease 2019 (COVID-19) using optical coherence tomography angiography. METHODS: As part of a prospective longitudinal observational study, we studied healthy individuals with a history of mild COVID-19 confirmed via real-time polymerase chain reaction. After recovery, we used the Optovue RTVue XR Avanti machine to perform optic nerve head (ONH) imaging. We also assessed the VD of all vessels and of small vessels in the disc and the radial peripapillary capillary (RPC) network at 1 and 3 months post-recovery. RESULTS: We included 17 patients (34 eyes; mean age: 36.9 ± 10.2 years, range: 24-62 years) who had recovered from COVID-19. No changes were observed in the ONH parameters. However, there was a noticeable trend of increased small vessel VD values in the RPC. These increases were significant for the peripapillary whole, superior hemifield, inferior-temporal, temporal-superior, and superior-temporal small vessels. Moreover, the evaluation of all vessel VD values in the RPC revealed a significant decrease in the inside disc and a significant increase in a grid-based inferior region. CONCLUSION: COVID-19 may affect VD of the RPC in the ONH, and should be considered in ONH evaluations.

Evaluating the Efficacy and Safety of Aflibercept Biosimilar (P041) Compared with Originator Product in Patients with Neovascular Age-Related Macular Degeneration.

OBJECTIVE: To assess the noninferiority of biosimilar aflibercept (P041, CinnaGen) to the originator aflibercept (AFL, Regeneron) in terms of efficacy, safety, and immunogenicity. DESIGN: This was a phase Ш, 52-week, multicenter, randomized, double-masked, and active control trial involving eyes in a 1:1 ratio. SUBJECTS: Patients with active subfoveal choroidal neovascularization secondary to age-related macular degeneration randomized into the 2 groups of P041 and AFL. METHODS: Patients received an injection of aflibercept every 4 weeks for 3 doses, followed by administration every 8 weeks up to week 48. MAIN OUTCOME MEASURES: The primary outcome was the noninferiority analysis of eyes maintaining vision at week 52. Secondary outcomes included the changes in visual acuity and retinal thickness, safety evaluation, and immunogenicity during the study. RESULTS: In total, 168 eyes of 168 patients were included. At week 52, the proportion of patients maintaining vision was 94.44% in the P041 group compared with 94.52% in the AFL group. The 95% confidence interval (CI) for the difference of maintaining vision from baseline did not exceed the predefined noninferiority margin of 10% (difference, -0.0008; 95% CI, -0.074 to 0.074; P = 0.98). Secondary outcomes indicated similar results in both arms (all P > 0.05). Safety measured outcomes and immunogenicity were similar between the 2 study groups. CONCLUSIONS: Biosimilar aflibercept was noninferior to AFL in eyes with neovascular age-related macular degeneration. Other efficacy and safety findings also indicated the similarity of 2 products. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Macular retinal and choroidal thickness profile in patients with thyroid-associated orbitopathy compared to healthy individuals: A cross-sectional study.

Background and Aims: To evaluate the macular thickness profile and central subfoveal choroidal thickness in patients with thyroid-associated orbitopathy (TAO) compared to healthy subjects. Methods: We used the convenience sampling method and divided all participants into the patients and control groups. Based on the clinical activity score (CAS) in the first examination, the patient group was divided to two subgroups: the patients with CAS < 3 and the patients with CAS ≥ 3. Complete ophthalmologic examinations and optical coherence tomography imaging were performed for all participants. Results: The mean ± SD of central choroidal thickness was 277 ± 76.58 microns for the control and 326.07 ± 56.574 micron for the patient group which was statistically significant (p = 0.003). We also found that the parafoveal inner thickness is significantly lower in patients compared to healthy subjects (p = 0.02). A comparison of neuro-structural data between the two subgroups of patients showed a significant difference in central choroidal thickness (p = 0.05). Conclusion: This study showed that central choroidal thickness in patients with CAS ≥ 3 compared to those with CAS < 3 and also in the patient group compared to healthy individuals have a significantly increasing trend.

Macular microvasculature in patients with thyroid-associated orbitopathy: a cross-sectional study.

PURPOSE: The aim of this study was to evaluate macular blood flow in patients with thyroid-associated orbitopathy (TAO) as compared to healthy subjects. The inflammatory nature of the disease, as well as the vascular congestion caused by the increase in the volume of orbital soft tissue and extraocular muscles, rationalize the assessment of retinal blood flow changes in these patients. METHODS: This is a cross-sectional study with the convenience sampling method. Macular flow density was assessed using optical coherence tomography angiography (OCTA) and compared between patients with TAO and healthy individuals. We also compared macular flow density in two subgroups of patients based on clinical activity score (CAS). RESULTS: Eighty-five cases, including 30 healthy individuals and 55 patients with TAO, participated. The foveal avascular zone (FAZ) area was significantly larger in the patient group than in the control. Patients with active TAO with CAS 3 or more had significantly larger FAZ areas than those with CAS less than 3 (p = 0.04). CONCLUSION: We showed that the FAZ area is larger in active TAO patients and can be considered a possible candidate feature for monitoring disease activity and thyroid-associated vasculopathy.

Bilateral anterior ischemic optic neuropathy and choroidal ischemia in a patient with COVID-19 infection.

A 57-year-old male known case of diabetes mellitus presented with gradually bilateral decreased vision accompanied by ocular pain two weeks after diagnosis of SARS-CoV-2 infection. The results of examination and imaging were indicative of bilateral anterior ischemic optic neuropathy (AION) and massive choroidal ischemia, which may be associated with SARS-CoV-2-induced damages, including endothelial damage, hypercoagulable state, and hypoxia.

Uveitis including Vogt-Koyanagi-Harada syndrome following inactive covid-19 vaccination: a case series.

BACKGROUND: Currently, large populations have been vaccinated against COVID-19. The whole inactivated Sinopharm COVID-19 vaccine has been the main available COVID-19 vaccine in Iran. Ocular inflammatory reactions have been reported following vaccination. The present case reports aim to introduce four cases of uveitis after the Sinopharm vaccine administration. CASE PRESENTATION: Our first reported case is a 38-year-old woman with a positive medical history of inactive ulcerative colitis. Active uveitis had developed following the second dose of the COVID-19 vaccination. The remaining three cases were healthy individuals who developed the first episode of uveitis, after the COVID-19 vaccine administration. Vogt-Koyanagi-Harada syndrome was the final diagnosis in one of the aforementioned cases. All four patients demonstrated favorable responses to corticosteroid treatment. CONCLUSION: These observations are in line with incoming reports from all around the world and raise concerns about the possibility of post-vaccination uveitis development, especially in cases with a previous history of auto-immune systemic diseases or inactive uveitis.