Evaluation of ocular symptoms in COVID-19 subjects in inpatient and outpatient settings.

PURPOSE: Evaluation of subtle ocular involvement and clinically significant conjunctivitis symptoms in a group of patients with COVID-19 in outpatient and inpatient settings. METHOD: Overall, 1083 patients infected with SARS-CoV-2 were recruited as subjects. Patients were divided into inpatients (group 1, n = 371) and outpatients (group 2, n = 712). Demographical and general medical data included age, sex, and comorbidities. Patients whose diagnosis was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR) were called by phone, and their chronic ocular disease, previous ocular surgery, ocular medication, contact lens wear and ocular irritation symptoms were queried during the active disease period. RESULTS: The mean age of the patients was 44.2 ± 16.5 (19-97) years; 635 (58.6%) were male, and 448 (41.4%) were female. Comorbidity, chronic ocular disease, ophthalmic medication and previous ocular surgery rates were significantly higher in group 1 (p < 0.05), while contact lens wear was not significantly different between groups. The main complaints received from patients were sore eye or burning sensation, foreign body sensation, itching and red eye and were significantly higher in group 1. Clinically significant conjunctivitis symptoms, such as red eye, ocular discharge and eyelid edema, were observed in 28 patients (2.6%), with 14 (3.8%) patients in group 1 and 14 (2%) patients in group 2. CONCLUSION: Clinically significant conjunctivitis symptoms were detected in 28 subjects in the inpatient and outpatient groups. As systemic findings of COVID-19 intensify.

Corneal Wavefront Aberrations After Primary and Recurrent Pterygium Surgery.

PURPOSE: To evaluate the effect of primary and recurrent pterygium surgery on corneal wavefront aberrations. METHODS: This prospective and interventional study included the 47 eyes of 47 patients with primary pterygium (primary group) and 41 eyes of 41 patients with recurrent pterygium (recurrent group). All patients underwent pterygium excision with conjunctival autograft transplantation. Corneal wavefront aberrations were measured using Sirius corneal topography and aberrometry system (Costruzione Strumenti Oftalmici, Florence, Italy) before surgery and at 3 and 12 months after surgery. The main outcome measures were root mean square values of total wavefront error (WFE), higher-order aberrations (HOAs), coma, trefoil, and spherical aberrations. RESULTS: Corneal wavefront aberrations were not significantly different between the primary and recurrent groups at baseline (P>0.05). Total WFE, HOA, trefoil, and coma decreased significantly in both primary and recurrent groups at postoperative 3 and 12 months compared with preoperative measurements (P<0.05). The mean spherical aberration was not significantly changed at 3 and 12 months compared with preoperative measurements (P>0.05). Total WFE, HOA, trefoil, and coma were significantly higher in the recurrent group than in the primary group at postoperative 3 and 12 months (P<0.05). CONCLUSIONS: Pterygium surgery can significantly reduce corneal wavefront aberrations, including total WFE, HOA, trefoil, and coma in eyes with primary or recurrent pterygium. However, postoperative corneal aberrations were higher in the recurrent group than in the primary group.

Risk Factors for Ocular Complications and Visual Loss in Patients with Juvenile Idiopathic Arthritis-associated Uveitis at a Turkish Tertiary Ophthalmology and Pediatric Rheumatology Referral Center.

PURPOSE: To investigate the rates of ocular complications and visual loss and their risk factors in patients with juvenile idiopathic arthritis (JIA) -associated uveitis. METHODS: Medical records of 51 patients were reviewed. RESULTS: The incidence of visual loss to the 20/50 or worse was found to be 0026/ eye-year (EY) in the present study. Cataract and ocular hypertension occurred during the follow-up period and were significantly associated with visual acuity loss to 20/50 or worse (p = .008, HR 11.932, 95% CI 1.915-74.355; p = .03, HR 7.323, 95% CI 1.216-44.110, respectively). Anti-TNF therapy was initiated in 88.2% of our cases and 93.3% of them achieved uveitis inactivity. CONCLUSION: The risk of vision loss is higher in patients with JIA-associated uveitis who had complications at presentation. We attribute the lower complication rates and better visual outcomes in our study to the early and frequent use of biologic agents.

Bevacizumab simultaneous combined with dexamethasone implant for treatment of neovascular serous retinal pigment epithelial detachment secondary to neovascular age-related macular degeneration.

PURPOSE: To evaluate the add-on effect of simultaneous intravitreal dexamethasone implant to bevacizumab for treatment of neovascular serous retinal pigment epithelial detachment (PED) secondary to neovascular age-related macular degeneration (nAMD). METHODS: A 72-year-old male patient was previously treated with intravitreal bevacizumab and aflibercept for neovascular serous PED secondary to nAMD. Because of the recurrences in neovascular PED patient was treated with simultaneous intravitreal injection of bevacizumab and dexamethasone implant. RESULTS: At the initial visit, the patient's the best corrected visual acuity (BCVA) in the left eye was 20/800. His left eye had neovascular serous PED with a height of 1100 µm and a largest linear diameter of 3953 µm accompanied by subretinal fluid. He received four intravitreal bevacizumab and five intravitreal aflibercept injections. Although there was a decrease in PED sizes from time to time during the 16-month treatment period, PED height was 926 µm and PED greatest linear diameter was 5820 µm at the end of 16th month. Later, the patient could not have an injection for 3 months (he could not come to his controls during the pandemic period), and when he arrived 3 months later, the PED height was 910 µm and the greatest linear diameter was 5830 µm. With a single simultaneous intravitreal injection of bevacizumab and dexamethasone implant, the PED regressed to 168 µm in height after 3 months. The BCVA increased to 20/200. Any clinical toxic effects did not occur and intraocular pressure did not rise for 3 months after injection. CONCLUSION: Simultaneous intravitreal bevacizumab and dexamethasone implant injection effectively and safely treated treatment-resistant neovascular serous PED. This therapy may be a novel alternative therapy for treatment resistant neovascular serous PED secondary to nAMD. However, further studies are required to understand its effectiveness and safety.

Efficacy of Intravitreal Dexamethasone After Combined Phacoemulsification and Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachments.

Purpose: To evaluate the efficacy and complications of intravitreal dexamethasone with simultaneous silicone tamponade after combined phacoemulsification and pars plana vitrectomy (PPV) in severe diabetic tractional retinal detachments (TRDs). Methods: In this single center, prospective, randomized, and open labeled 2 parallel group study, patients who applied to our clinic due to diabetic TRD involving the macula with grade-3 and 4 cataracts were randomized to receive either simultaneous silicone tamponade and intravitreal dexamethasone (Group-1) or only silicone tamponade (Group-2). Primary outcome measurements were the incidence rate of retinal re-detachment and, proliferative vitreoretinopathy (PVR) at sixth month, and anterior segment inflammation and posterior iris synechia at first and at sixth months. Results: We operated 22 eyes of 22 patients in Group-1 (PPV with dexamethasone implant) and 21 eyes of 21 patients in Group-2 (PPV without dexamethasone implant). The rate of re-detachment and PVR were significantly higher in the Group-2 compared with in Group-1 at sixth month (Group-1, 0/22, Group-2, 6/21 28.6%, P = 0.038). Anterior chamber fibrin exudation at first month was significantly superior in the Group-2 (Group-1, 0/22, Group-2, 8/21 38.0%, P = 0.021). Posterior iris synechia was more observed in the Group-2 at sixth month (Group-1, 0/22, Group-2, 7/21 33.3%, P = 0.029). Conclusions: Dexamethasone implant at the end of combined phacoemulsification and PPV with silicon oil tamponade in patients with diabetic TRD reduces retinal re-detachment, anterior chamber fibrin exudation and posterior iris synechia. This approach can be an alternative option in the treatment of diabetic TRD with coexisting cataracts.

Add-On Effect of Simultaneous Intravitreal Dexamethasone to Intravitreal Bevacizumab in Patients with Macular Edema Secondary to Branch Retinal Vein Occlusion.

Purpose: To report the effect of simultaneous dexamethasone and bevacizumab combination treatment in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: Treatment-naive patients who had a macular edema secondary to BRVO with a duration of less than 1 month were treated either with intravitreal bevacizumab (Group-1) or intravitreal bevacizumab simultaneously combined with dexamethasone intravitreal implant (Group-2). In both groups, patients received monthly bevacizumab injection during the first 3 months. Between months 3 and 12, all patients were allowed to receive pro-re-nata bevacizumab. In Group-2, the first dexamethasone implant injection was simultaneously received with first bevacizumab injections. The patients were evaluated for re-treatment after 6 months and 11 months for second and third dexamethasone simultaneously with intravitreal bevacizumab. Results: In Group-1, 35 eyes of 35 patients and in Group-2, 32 eyes of 32 patients were treated. The mean gains in BCVA were +10.7 letters in the Group-1 and +21.3 letters in the Group-2 (P = 0.021) at month 12. The mean reduction in Central Macular Thickness (CMT) from the baseline were -173.74 µm in the Group-1 and -257.97 µm in the Group-2 (P = 0.0018). In Group-1, the mean intravitreal bevacizumab injection number was 7.18 ± 1.05. In Group-2, the mean intravitreal bevacizumab and dexamethasone injection number was 5.15 ± 1.24. There was a significant difference in mean injection numbers between 2 groups (P = 0.044). Conclusion: In the early period of macular edema adding dexamethasone to bevacizumab therapy does improve visual acuity and CMT, and reduce the injection frequency more than bevacizumab alone.

Choroidal Thickness in Eyes with Fuchs Uveitis Syndrome.

PURPOSE: This study measured the macular thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, subfoveal choroidal thickness (SFCT), and ganglion cell complex (GCC) thickness in eyes with Fuchs uveitis syndrome (FUS). METHODS: In total, 25 patients with unilateral FUS were enrolled. The diagnosis of FUS was based on the presence of several of the following clinical features: absence of acute symptoms and ciliary injection; small to medium-sized and stellate keratic precipitates (KP) diffusely scattered on the entire corneal endothelium; chronic low-grade anterior chamber inflammation; iris stromal atrophy with or without heterochromia; lack of posterior synechiae; iris nodules; and vitreous cells and debris. Spectral domain optical coherence tomography (SD-OCT; RTVue-100 OCT) was used to obtain the measurements. The SFCT, RNFL thickness, macular retinal thickness, and GCC thickness of the eyes with FUS were measured and compared with those of the uninvolved fellow eyes. A paired samples t-test was used for statistical analyses. A value of p<0.05 was considered to be statistically significant for all analyses. RESULTS: The mean age of the patients was 35.2 ± 4.8 years. Fifteen patients (60%) were male, and 10 (40%) were female. Small- to medium-sized stellate KPs and mild anterior chamber reactions were seen in all patients. Heterochromia was observed in 24% of the eyes, iris nodules in 36% of the eyes, lens opacity in 44% of the eyes, and vitreous cells and debris in 88% of the eyes. The mean SFCT was significantly thinner in eyes with FUS (296.47 ± 32.29 µm) than in the fellow eyes without FUS (324.47 ± 26.73 µm; p = 0.001). The mean average GCC thickness was found to be 101.09 ± 5.46 µm in eyes with FUS and 103.80 ± 6.65 µm in eyes without FUS (p = 0.023). There were no significant differences in the mean RNFL and macular thickness values. CONCLUSIONS: We detected subfoveal choroidal thinning in eyes with FUS when compared with the uninvolved fellow eyes. In our opinion, thinning of the SFCT in FUS might be associated with autoimmune responses and chronic inflammatory processes.

Evaluation of the Ganglion Cell Complex and Retinal Nerve Fiber Layer in Low, Moderate, and High Myopia: A Study by RTVue Spectral Domain Optical Coherence Tomography.

PURPOSE: To assess the effect of low, moderate, and high myopia on the thickness of the retinal nerve fiber layer (RNFL) and Ganglion cell complex (GCC) measured by Spectral Domain Optical Coherence Tomography (SD-OCT) in non-glaucomatous subjects. METHODS: The subjects were divided into three groups: low (n = 81, 35.6%), moderate (n = 79, 34.8%), and highly myopic eyes (n = 67, 29.5%). The RNFL thickness profile, including the average, superior, nasal, inferior, and temporal quadrant and each of the eight directional thicknesses, was measured. GCC parameters, including the average, superior, and inferior values, the focal loss volume (FLV), and the global loss volume (GLV), were measured. The correlation between the OCT measurements and the axial length was evaluated. RESULTS: The average, superior, inferior, and nasal RNFL thicknesses of low and moderate myopic eyes were found to be significantly higher than those of highly myopic eyes. The temporal RNFL thicknesses were not different among the three groups. The average, superior, and inferior ganglion cell complex values of low and moderate myopic eyes were significantly higher than those of highly myopic eyes. The FLV and GLV of low and moderate myopic eyes were significantly higher than those of highly myopic eyes (p = 0.001 for all). In the moderate and high myopia groups, the average RNFL thickness and GCC thickness were both negatively correlated with the axial length. CONCLUSION: Highly myopic subjects tend to have thinner RNFL and GCC thicknesses than subjects with low and moderate myopia.

Clinical Features and Prognosis of Herpetic Anterior Uveitis.

OBJECTIVE: To evaluate clinical features, complications, visual outcomes and treatment modalities in patients clinically diagnosed with herpetic anterior uveitis (AU). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 67 patients seen at the Umraniye Training and Research Hospital, Ophthalmology Clinic, Uveitis and Cornea Department from January 2009 to June 2013. RESULTS: Thirty-seven patients (55.2%) were female and 30 (44.7%) patients were male. The average follow-up period was 12.9 ± 10.6 months (range: 1-45 months). The most common ocular findings were granulomatous keratic precipitates (KPs) (82.2%), corneal involvement (62.6%), iris atrophy (41.7%) and transient elevated intraocular pressure (IOP) (40.2%). Recurrences were observed in 46.2% of the eyes and the median recurrence rate was 1.0 during the follow-up period. Topical steroids and oral antiviral (acyclovir) therapy were applied to all patients during active episodes. Long-term oral acyclovir was used in 29.8% of the patients. Recurrence rates were significantly lower in patients who used oral acyclovir for more than 6 months, whereas complications rates and final visual acuity did not show any difference between groups. Final visual acuity was better than 20/40 in 61.1% of eyes, and visual impairment was due to corneal scarring or cataract formation. CONCLUSION: Herpetic AU can present with or without corneal involvement. Granulomatous KPs, iris atrophy and elevated IOP are important clinical findings for the diagnosis of cases without corneal involvement. Long-term oral acyclovir treatment (more than 6 months) and is important to decrease recurrence rates and possible complications. Visual prognosis is favorable in cases without corneal scarring.

Intravitreal Bevacizumab for Treatment of Central Serous Chorioretinopathy.

PURPOSE: To compare the outcomes of treatment with intravitreal bevacizumab (IVB) versus observation in central serous chorioretinopathy (CSCR). METHODS: In a retrospective comparative study, records of 45 patients with CSCR were reviewed. Twenty-two patients received IVB (1.25 mg/0.05 ml) while 23 subjects were observed. All subjects underwent measurement of best corrected visual acuity (BCVA) and intraocular pressure (IOP), dilated fundus examination and optical coherence tomography (OCT) imaging at baseline and follow up visits. Outcome measures included central macular thickness (CMT) and BCVA in logarithm of minimum angle of resolution (logMAR) notations. RESULTS: Mean age was 44.1 ± 9.3 (range: 24 to 64) years and mean follow-up period was 10.4 ± 11.2 (range: 3 to 43; median: 6) months. All patients demonstrated resolution of neurosensory detachment and improvement in visual acuity. At final visit, there was no significant difference in mean CMT between the IVB and observation groups (275 vs 284 µm, P> 0.05). Mean baseline logMAR visual acuity was 0.38 ± 0.24 in the IVB group which improved to 0.24 ± 0.31 at final follow-up (P = 0.011); mean baseline logMAR visual acuity was 0.42 ± 0.28 in the observation group and improved to 0.12 ± 0.18 (P = 0.001). Visual improvement was more marked in the observation group (0.30 vs 0.14 logMAR, P< 0.05) and mean final visual acuity was also significantly better (P = 0.05). CONCLUSION: There was no significant difference between IVB injection and observation in terms of anatomical outcomes of treatment for CSCR. In terms of visual outcomes, observation was superior to IVB injection.

Clinical characteristics of intermediate uveitis in adult Turkish patients.

AIM: To describe the clinical characteristics of Turkish patients with intermediate uveitis (IU) and to investigate the effect of clinical findings and complications on final visual acuity (VA). METHODS: We retrospectively analyzed the medical records of patients with IU who had at least 6mo of follow-up and were older than 16y. RESULTS: A total of 78 eyes of 45 patients were included in the study and the mean follow-up period was 19.4mo. The mean age at the time of presentation was 42.9s. Systemic disease associations were found in 17.7% of cases; sarcoidosis (8.8%) and multiple sclerosis (6.6%) were the most common diseases. Recurrence rate (odds ratio=45.53; 95%CI: 2.181-950.58), vitritis equals to or more than 3+ cells (odds ratio=57.456; 95%CI: 4.154-794.79) and presenting with VA less than 20/40 (odds ratio=43.81; 95%CI: 2.184-878.71) were also found as high risk factors for poor final VA. At the last follow-up examination, 67.9% of eyes had VA of 20/40 or better. CONCLUSION: IU is frequently seen at the beginning of the fourth decade of life. The disease is most commonly idiopathic in adult Turkish patients. Patients with severe vitritis at presentation and patients with frequent recurrences are at high risk for poor visual outcome.

Evaluation of corneal stromal demarcation line after two different protocols of accelerated corneal collagen cross-linking procedures using anterior segment optical coherence tomography and confocal microscopy.

Purpose. To evaluate the depth of corneal stromal demarcation line using AS-OCT and confocal microscopy after two different protocols of accelerated corneal collagen cross-linking procedures (CXL). Methods. Patients with keratoconus were divided into two groups. Peschke CXL device (Peschke CCL-VARIO Meditrade GmbH) applied UVA light with an intended irradiance of 18.0 mW/cm(2) for 5 minutes after applying riboflavin for 20 minutes (group 1) and 30 minutes (group 2). One month postoperatively, corneal stromal demarcation line was measured using AS-OCT and confocal microscopy. Results. This study enrolled 34 eyes of 34 patients (17 eyes in group 1 and 17 eyes in group 2). The mean depth of the corneal stromal demarcation line was 208.64 ± 18.41 µm in group 1 and 240.37 ± 18.89 µm in group 2 measured with AS OCT, while it was 210.29 ± 18.66 µm in group 1 and 239.37 ± 20.07 µm in group 2 measured with confocal microscopy. Corneal stromal demarcation line depth measured with AS OCT or confocal microscopy was significantly deeper in group 2 than group 1 (P < 0.01). Conclusion. The group in which riboflavin was applied for 30 minutes showed significantly deeper corneal stromal demarcation line than the group in which riboflavin was applied for 20 minutes.

Effects of polyquaternium- and benzalkonium-chloride-preserved travoprost on ocular surfaces: an impression cytology study.

PURPOSE: To compare the toxicity effect of polyquaternium (PQ) and benzalkonium chloride (BAK) preservation of travoprost on the ocular surface. METHODS: This prospective study included 44 eyes of 44 patients with newly diagnosed glaucoma. Twenty-two patients used PQ-preserved travoprost (PQ group) and 22 patients used BAK-preserved travoprost (BAK group). To investigate the effect on the ocular surface, conjunctival impression cytology (IC) was performed at baseline and the 1- and 6-month follow-up visits. Additionally, the ocular surface disease index (OSDI) questionnaire, Schirmer I test, and tear break-up time (TBUT) measurement were administered at baseline, and at 1-, 3-, and 6-month follow-up visits. RESULTS: While both groups showed statistically significant IC grade increases at 1 and 6 months when compared with baseline measurements, IC grades were significantly higher for patients using PQ-preserved travoprost compared with patients using BAK-preserved travoprost. The Schirmer I test and TBUT scores were not statistically significant between group 1 and BAK group at baseline and at 1-, 3-, and 6-month visits (P>0.05). OSDI scores did not statistically differ at baseline and the 1-month measurements between the 2 groups (P>0.05), but the 3- and 6-month OSDI scores were significantly higher for BAK group (P=0.001). Differences in OSDI and Schirmer I test scores were statistically significant at 1, 3, and 6 months in both groups as compared with baseline values (P<0.05). Statistically significant differences in the TBUT scores were seen for both groups at 3 and 6 months, while BAK group, but not PQ group, had insignificant score differences at 1 month as compared with baseline values of PQ group (P=0.083). CONCLUSION: PQ-preserved travoprost was found to be safer and better-tolerated than BAK-preserved travoprost. PQ-preserved travoprost provided better ocular surface comfort, and therefore a better patient experience, which would likely result in higher treatment compliance.

Evaluation of pachymetric measurements with scheimpflug photography-based system and optical coherence tomography pachymetry at different stages of keratoconus.

The aim of this study was to compare the central and peripheral pachymetric measurements determined with Sirius system and Visante OCT and evaluate the agreement between them at different stages of keratoconus. Measurements were not significantly different in all patients and subgroups and showed high correlation for the corneal thicknesses of the entire cornea in different stages of keratoconus.

The safety and efficacy of brinzolamide 1%/timolol 0.5% fixed combination versus dorzolamide 2%/timolol 0.5% in patients with open-angle glaucoma or ocular hypertension.

PURPOSE: The aim of this study was to compare the intraocular pressure (IOP) lowering efficacy and to determine patient preference based on ocular discomfort with fixed combination brinzolamide/timolol and fixed combination dorzolamide/timolol in patients with open-angle glaucoma or ocular hypertension who required a change in therapy due to elevated IOP while receiving IOP-lowering medication. METHODS: This was a 3-month, randomized, double-blinded, active-controlled, parallel-group trial. Patients had open-angle glaucoma or ocular hypertension, which could not be controlled with monotherapy and were randomized to twice daily therapy with either brinzolamide 1%/timolol 0.5% or dorzolamide 2%/timolol 0.5%. IOP assessments were taken at 8 AM, 10 AM, and 4 PM at week 2 as well as at months 1, 2, and 3. Patients completed ocular discomfort assessments (based on stinging, burning, feeling of heat or warmth, or sharp pain) on their current IOP lowering therapy at baseline. RESULTS: Of the 114 patients enrolled, 57 received Brinz/Tim and 57 received Dorz/Tim twice daily. Both medications produced statistically relevant IOP reductions, which were similar in both groups at each visit. The IOP reductions with Brinz/Tim ranged from 6.42 to 9.74 mmHg (26.09%-37.46%), whereas Dorz/Tim produced mean IOP reductions ranging from 8.16 to 12.41 mmHg (31.19%-41.44%) (P>0.05). Brinz/Tim showed significantly less ocular irritation (0.5% vs. 15.7%, respectively; P=0.0004) than Dorz/Tim. CONCLUSIONS: Both Brinz/Tim and Dorz/Tim showed similar significant and clinically relevant IOP-lowering efficacy, whereas Brinz/Tim provided superior outcomes in terms of ocular comfort.

Ipsilateral rotational autokeratoplasty for the management of traumatic corneal scar.

A 40-years-old male patient with a corneal scar secondary to perforating eye injury had undergone ipsilateral rotational autokeratoplasty in our clinics. The corneal scar involved the pupillary area. The patient had a preoperative visual acuity of counting fingers. The patient's cornea was trephined with a 0.5 mm temporal decentration. The 8.0 mm autograft was rotated approximately 180° to relocate the scar to the temporal aspect of the cornea. The final position of the corneal scar was temporal of the visual axis and central area was clear. The visual acuity at 1-, 3-, and 6-months followups was better than the first visual acuity in the patient. Ipsilateral rotational autokeratoplasty has many advantages over conventional keratoplasty. There is no risk of immunological rejection of the graft, postoperative corticosteroids are not needed as frequently, and donor cornea is not required. A rotational autograft can be a powerful alternative to conventional keratoplasty for some patients with traumatic corneal scars.