The Effect of Robotic Rehabilitation on Hand Functions and Quality of Life in Children with Cerebral Palsy: A Prospective Randomized Controlled Study

OBJECTIVE

This study aimed to examine the impact of robotic hand rehabilitation on hand function and quality of life in children with cerebral palsy.

DESIGN

Children with cerebral palsy aged 7-16 years were divided into robotic rehabilitation (n = 9) or conventional rehabilitation (n = 10) groups for hand rehabilitation of 30 sessions. The primary outcomes were the Fugl-Meyer Assessment for Upper Extremity, and Box and Block Test. The secondary outcomes were the Manual Ability Classification System, Modified Ashworth Scale, hand grasp and finger strengths, ABILHAND-Kids, Functional Independence Measure for Children, and PedsQL Quality of Life Inventory-CP Module.

RESULTS

In the robotic rehabilitation group, a significant improvement was found in all parameters after treatment (p < 0.05), except for the Functional Independence Measure (p = 0.081). In the conventional rehabilitation group, there was significant improvement after treatment in the Modified Ashworth Scale, Fugl-Meyer Assessment for Upper Extremity, hand grasp strength, Box and Block Test, ABILHAND-Kids, and PedsQL Quality of Life Inventory-CP Module (p < 0.05). Before and after treatment, all outcome parameters in the groups were similar (p > 0.05).

CONCLUSIONS

Robotic hand rehabilitation is effective in improving motor function, manual dexterity, spasticity and quality of life in children with cerebral palsy. However, it was not demonstrated to be superior to conventional rehabilitation.

Evaluation of finger strength and spasticity in hemiplegic patients using hand-finger robotic device: A validity and reliability study

We aimed to investigate the validity, reliability, and clinical relevance of Amadeo hand-finger robotic rehabilitation system measurements for evaluating spasticity and strength in hemiplegic patients. In total, 161 participants (107 hemiplegic patients and 54 sex- and age-matched healthy controls) were included in this study. Spasticity was evaluated using the Modified Ashworth Scale, hand motor functions were evaluated using the Fugl-Meyer Assessment Hand Subscale, and hand grip and pinch strength were evaluated using the Jamar hand grip and pinch dynamometer. The Amadeo (Tyromotion) hand-finger robotic rehabilitation system was used to evaluate finger spasticity and strength of the participants. A statistically significant difference was found between the median values of the Modified Ashworth Scale (both clinical and robotic evaluation results) and the mean values of hand flexor and extensor strength measured with the robotic device in patients compared to healthy subjects (P < .01). Statistically, excellent agreement was obtained between the clinical and robotic test-retest results of the scale (P < .01) (intra-class correlation coefficient, ICC = .98-.99; ICC = .98-.99, respectively). There was a statistically significant positive correlation between the clinical and robotic device results of the Modified Ashworth Scale (r = .72; P < .01). There was a statistically significant positive correlation between the hand strength values measured with the robotic device, Jamar grip, pinch, and Fugl-Meyer Assessment Hand Subscale scores (P < .01) in the patient group. Hand finger spasticity and strength measurements of the Amadeo hand-finger robotic rehabilitation system were valid, reliable, and clinically correlated in stroke patients.

Results of anti-VEGF treatment for neovascular AMD in eyes with different baseline visual acuity in Turkish population-based on real life data-Bosphorus Retina Study Group

BACKGROUND

To investigate the anatomical and visual outcomes of the patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF), according to the baseline best-corrected visual acuity (BCVA) based on the multicenter real-life data.

METHODS

Five-hundred-ninety patients who had taken the Pro Re Nata (PRN) treatment regimen with three loading doses and at least one year of follow-up were included. The patients were divided into three groups according to the baseline BCVA: Group 1 (BCVA ≥1.3 Logmar), Group 2 (1.3 Logmar > BCVA ≥0.3 Logmar), and Group 3 (BCVA ≤0.2 Logmar). BCVA, central macular thickness (CMT), and the number of injections and visits were evaluated.

RESULTS

There were 175, 322, and 93 patients in Group 1, Group 2, and Group 3, respectively. The number of visits and injections in the 1st year was not different between the groups (p = 0.58 and p = 0.08) and was 7.09 and 4.41 (Group 1), 6.59 and 5.58 (Group 2), 6.77 and 4.08 (Group 3). There was a significant difference in CMT between the baseline and 12^th month in Group 1 and Group 2 (p<0.001, p<0.001, respectively) but not in Group 3 (p = 0.84). BCVA was significantly better in the 12th month in Group 1 (p<0.001), slightly worse in Group 2 (p = 0.79), and significantly worse in Group 3 (p<0.001).

CONCLUSION

This study provides evidence that an inadequate number of injections cannot protect vision. Moreover, it can cause vision loss, especially in the eyes with good vision.

Based on the Real-Life Data of Türkiye; Comparison of Anatomical and Functional Outcomes of Phakic and Pseudophakic Patients in Wet Type Age-Related Macular Degeneration

Objectives

The aim of the study was comparison of wet-type age-related macular degeneration in phakic and pseudophakic patients in terms of anatomical and functional success based on the real-life data of Türkiye.

Methods

The multicenter retrospective real-life study data of the. retinal study group were used in this study. Among 867 eyes of 867 patients were included in the study. Patients were divided into two groups according to the status of the lens; phakic group and pseudophakic group. The follow-up period of the two groups, the number of injections at the 1st, 2nd, and 3rd years, and changes in the central macular thickness (CMT, μ) and visual acuity (VA, logMAR) of the patients at the beginning, 6th, 12th, 24th, and 36th months were examined.

Results

In our study, the number of injections in the 1st, 2nd, and 3rd years, respectively, was 4.2±2.0, 1.8±1.9, and 1.0±1.7 in the phakic group, and 3.9±2.0, 1.7±1.9, and 0.8±1.4 in the pseudophakic group. When the two groups were compared in terms of the number of injections, there was a statistically significant difference in the 1st year, but there was no significant difference in the 2nd and 3rd years (p=0.001, p=0.350, and p=0.288, respectively). There was no statistically significant difference between the groups in terms of CMT in the baseline, 6th, 12th, 24th, and 36th months (p=0.991, p=0.327, p=0.652, p=0.599, and p=0.873, respectively). Although there was no difference in VA between groups at the beginning (p=0.052), the phakic group showed statistically better VA in controls at 3rd, 6th, 12th, 24th, and 36th months (p=0.001, p=0.001, p=0.000, p=0.000, and p=0.003, respectively).

Conclusion

Differences in the number of injections and visual results between phakic and pseudophakic patients in wet type AMD may necessitate the creation of different treatment and follow-up protocols.

Two-color pulse compounds in waveguides with a zero-nonlinearity point

We study incoherently coupled two-frequency pulse compounds in waveguides with single zero-dispersion and zero-nonlinearity points. In such waveguides, supported by a negative nonlinearity, soliton dynamics can be obtained even in domains of normal dispersion. We demonstrate trapping of weak pulses by solitary-wave wells, forming nonlinear-photonics meta-atoms, and molecule-like bound-states of pulses. We study the impact of the Raman effect on these pulse compounds, finding that, depending on the precise subpulse configuration, they decelerate, accelerate, or are completely unaffected. Our results extend the range of systems in which two-frequency pulse compounds can be expected to exist and demonstrate further unique and unexpected behavior.

Evaluation of macular vascular density and foveal avascular zone changes by optical coherence tomography angiography (OCT-A) after intravitreal dexamethasone implant in diabetic macular edema resistant to Anti-VEGF treatment

PURPOSE

Analysis of foveal avascular zone (FAZ) width and vascular density (VD) changes before and after intravitreal dexamethasone implant (IDI) treatment in diabetic macular edema (DME) patients resistant to anti-VEGF treatment.

METHODS

In this retrospective study, patients who were regularly treated with at least 5 doses of intravitreal Anti-VEGF (bevacizumab, ranibizumab or aflibercept) for DME and whose DME continued were considered resistant to Anti-VEGF and were treated with IDI for the first time. Thirty-four eyes of 34 patients were included in the study. FAZ and VD values of optical coherence tomography angiography (OCT-A) scans at 0, 1 and 3 months were examined.

RESULTS

In OCT-A measurements, the pre-IDI superficial plexus FAZ (SFAZ) area (0.350 ± 0.120 mm²) was decreased at 1 (0.292 ± 0.132 mm², p < 0.001) and at 3 months (0.311 ± 0.153 mm², p = 0.017). Pre-IDI deep plexus FAZ (DFAZ) area (0.651 ± 0.313 mm²) was decreased at 1-month post-IDI (0.481 ± 0.247 mm², p < 0.001) while no significant change was observed at 3 months (0.575 ± 0.259 mm², p = 0.197). There was no significant change in the mean post-IDI total VD rate in both superficial (pre 39.2% ± 2.4; 1st month 39.2% ± 2.6%; 3rd month 39.5% ± 3.4%) and deep retinal plexus (pre 43.3% ± 2.6%; 1st month 43.5 ± 2.8%; 3rd month 43.6% ± 4.6%) (p = 0.408 and p = 0.607, respectively).

CONCLUSION

The study showed that IDI caused a significant decrease in the FAZ area without any change in VD in patients with DME resistant to the anti-VEGF agents. IDI might be related to a decrease in the macular ischemia secondary to diabetic retinopathy.

Wave-Shape-Tolerant Photonic Quantum Gates

Photons, acting as "flying qubits" in propagation geometries such as waveguides, appear unavoidably in the form of wave packets (pulses). The actual shape of the photonic wave packet as well as possible temporal and spectral correlations between the photons play a critical role in successful scalable computation. Currently, unentangled indistinguishable photons are considered a suitable resource for scalable photonic circuits. Here we show that using so-called coherent photon conversion, it is possible to construct flying-qubit gates which are not only insensitive to wave shapes of the photons and temporal and spectral correlations between them but which also fully preserve these wave shapes and correlations upon the processing. This allows the use of photons with correlations and purity in a very broad range for a scalable computation. Moreover, such gates can process entangled photonic wave packets even more effectively than unentangled ones.

Incoherent two-color pulse compounds: publisher's note

This publisher's note contains corrections to Opt. Lett.46, 5603 (2021)OPLEDP0146-959210.1364/OL.440567.

Incoherent two-color pulse compounds

We study the dynamical evolution of two-frequency pulse compounds, i.e., intriguing bound-states of light, kept together due to their incoherent interaction. A special class of solutions of such compounds is found to be describable in terms of a simplified model. They entail generalized dispersion Kerr solitons and yield their corresponding metasolitons. We use these solutions to study when the interaction of their constituent pulses is independent of their phase. These results are relevant to understand the complex collision dynamics of quasi-group-velocity-matched solitons across a vast frequency gap.

Crossover from two-frequency pulse compounds to escaping solitons

The nonlinear interaction of copropagating optical solitons enables a large variety of intriguing bound-states of light. We here investigate the interaction dynamics of two initially superimposed fundamental solitons at distinctly different frequencies. Both pulses are located in distinct domains of anomalous dispersion, separated by an interjacent domain of normal dispersion, so that group velocity matching can be achieved despite a vast frequency gap. We demonstrate the existence of two regions with different dynamical behavior. For small velocity mismatch we observe a domain in which a single heteronuclear pulse compound is formed, which is distinct from the usual concept of soliton molecules. The binding mechanism is realized by the mutual cross phase modulation of the interacting pulses. For large velocity mismatch both pulses escape their mutual binding and move away from each other. The crossover phase between these two cases exhibits two localized states with different velocity, consisting of a strong trapping pulse and weak trapped pulse. We detail a simplified theoretical approach which accurately estimates the parameter range in which compound states are formed. This trapping-to-escape transition allows to study the limits of pulse-bonding as a fundamental phenomenon in nonlinear optics, opening up new perspectives for the all-optical manipulation of light by light.

Prognostic factors affecting macular hole closure types

Purpose

In this study, we aimed to evaluate the relationship between macular hole closure types assessed by optical coherence tomography (OCT) and the preoperative prognostic factors.

Materials and methods

In total, 183 patients who underwent pars plana vitrectomy and internal limiting membrane peeling for idiopathic macular hole between August 2014 and August 2019 were reviewed retrospectively. The preoperative measurements of the macular hole including minimum linear diameter (MLD), basal hole diameter (BHD) and hole height (HH) were measured on OCT images. The patients were divided into two closure types on the basis of postoperative OCT findings (type 1 closure: retinal edges were flat and there was no defect of the neurosensory retina on the fovea; type 2 closure: retinal edges were flat and there was a defect of the neurosensory retina on the fovea). The difference of prognostic factors such as age; duration of symptoms; preoperative best-corrected visual acuity (BCVA); preoperative macular hole measurements, including MLD, BHD and HH; and rate of reopening between two types were statistically analysed.

Results

The mean age of patients was 66.33 ± 8.09 years (range: 48-88 years). According to OCT imaging, 117 eyes (63.9%) were classified into the type 1 closure group, and 66 eyes (36.1%) were classified into the type 2 closure group. There were no significant differences between two groups in age, duration of symptoms and preoperative BCVA (p = 0.694, p = 0.092 and p = 0.15). MLD and BHD were significantly larger, and reopening was significantly more common in type 2 group (p < 0.05, p = 0.04 and p < 0.005); however, there was no significant difference in HH between two groups (p = 0.239).

Conclusion

Preoperative horizontal measurements of macular hole may help to determine postoperative visual expectations and anatomical success, and predict the possibility of reopening.

Morphological assessment of lamina cribrosa in idiopathic intracranial hypertension

Purpose:

Technological development of optic coherence tomography has enabled a detailed assessment of the optic nerve and deeper structures and in vivo measurements. The aim of this study was to compare the lamina cribrosa morphology of the optic nerve in idiopathic intracranial hypertension (IIH) and healthy individuals.

Methods:

The lamina cribrosa morphology of optic nerve in 15 eyes with IIH and 17 eyes of healthy individuals were compared. Four parameters such as Bruch membrane opening (BMO), lamina cribrosa thickness (LCT), prelaminar tissue thickness (PTT), and anterior lamina cribrosa surface depth (ALCSD) were retrospectively evaluated.

Results:

By enhanced depth imaging-optic coherence tomography (EDI-OCT), PTT and BMO were found to be significantly greater (574,35 ± 169,20 μm and 1787,40 ± 140,87 μm, respectively) in IIH patients than healthy individuals (187,18 ± 132,15 μm and 1632,65 ± 162,58 μm, respectively), whereas ALSCD was found to be significantly less in IIH patients (234,49 ± 49,31 μm) than healthy individuals (425,65 ± 65,23 μm). There was not a statistically significant difference regarding LCT between the IIH patients (238,59 ± 17,31 μm) and healthy individuals (244,96 ± 15,32 μm).

Conclusion:

Increased intracranial pressure causes morphological changes in lamina cribrosa. Assessment of lamina cribrosa with EDI-OCT is important for diagnosis and follow-up of patients with IIH. EDI-OCT is objective, reproducible, and cost-effective assistive imaging tool in IIH patients.

Correction: Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience

PURPOSE

The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE).

METHODS

Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded.

RESULTS

Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected.

CONCLUSION

This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.

Dynamics of localized dissipative structures in a generalized Lugiato-Lefever model with negative quartic group-velocity dispersion

We study localized dissipative structures in a generalized Lugiato-Lefever equation, exhibiting normal group-velocity dispersion and anomalous quartic group-velocity dispersion. In the conservative system, this parameter-regime has proven to enable generalized dispersion Kerr solitons. Here, we demonstrate via numerical simulations that our dissipative system also exhibits equivalent localized states, including special molecule-like two-color bound states recently reported. We investigate their generation, characterize the observed steady-state solution, and analyze their propagation dynamics under perturbations.

Choroidal vascularity index as an indicator of vascular status of choroid, in eyes with nanophthalmos

PURPOSE

To investigate choroidal vascular index (CVI) in eyes with nanophthalmos (NO) with the use of optical coherence tomography (OCT).

METHODS

Macular enhanced depth imaging OCT scans of 25 eyes of 25 patients with NO and age-gender-matched 25 eyes of 25 control subjects were analysed. Images were binarized using the ImageJ software, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were acquired. The main outcome measure was CVI, defined as the ratio of LA to TCA.

RESULTS

Twenty-five eyes of 25 patients with NO and age-gender-matched control subjects were enrolled. The mean TCA, SA and LA were found to be significantly higher in patients with NO (2.51 ± 0.44 vs. 1.91 ± 0.35 mm², P < 0.001; 0.86 ± 0.17 vs. 0.63 ± 0.13 mm², P < 0.001; and 1.65 ± 0.29 vs. 1.27 ± 0.23 mm², P < 0.000, respectively). On the contrary, CVI did not significantly differ between the two groups (65.72, 67.68, P = 0.099).

CONCLUSION

As a novel OCT-based marker, CVI could be used to assess vascular status of the choroid in eyes with NO and can provide better understanding of the pathogenesis of this disease.

Comparison of two different treatment regimens' efficacy in neovascular age-related macular degeneration in Turkish population-based on real life data-Bosphorus RWE Study Group

AIM

To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients.

METHODS

Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3^th, 6^th and 12^th months, and in central macular thickness (CMT) at 6^th and 12^th months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately.

RESULTS

The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6^th month (48.5 vs 76.4; P<0.05) was statistically significant in favor of 3+PRN group. BCVA changed in 1+PRN group from 0.77 to 0.78, 0.75 and 0.75; in 3+PRN group from 0.81 to 0.69, 0.72, and 0.76 at months 3, 6, and 12, respectively. Visual gain was statistically better in 3+PRN group at 3^th month (-0.01 vs 0.12; P<0.001). In IVR group, CMT reduction was in greater in 3+PRN at 6^th (44 vs 72) and 12^th month (61 vs 84), but statistically insignificant. The 3+PRN group revealed statistically better visual results at 3^th month (-0.02 vs 0.11, P<0.05). In IVA group, although statistically insignificant, CMT reduction (61 vs 89, 6^th month; 85 vs 97, 12^th month) and visual gain (0.02 vs 0.16; 0.02 vs 0.14; 0.05 vs 0.11) was found in favor of 3+PRN group at all visits.

CONCLUSION

The loading dose of anti-VEGF treatments in nAMD leads to significantly better anatomical and functional results, regardless of the agent, specially in early follow-up interval.

Evaluation of Choroidal Thickness in Patients with Proliferative and Non-Proliferative Macular Telangiectasia Using Enhanced Depth Imaging Optical Coherence Tomography

Purpose: To compare subfoveal choroidal thickness (SFCT) in eyes with non-proliferative macular telangiectasia (MacTel) type 2 with or without subretinal neovascularization (SRNV) and healthy control eyes.Methods: Consecutive patients with non-proliferative and proliferative MacTel type 2 were included in the current study. For comparisons subjects with no ocular pathology were recruited and used as controls. Best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated. Since axial length (AL) may affect choroidal thickness, AL measurements were performed to avoid confusion in SFCT between the groups.Results: Of the 63 eyes of 38 MacTel type 2 patients, 38 eyes had only MacTel type 2 (group 1) and 25 eyes had SRNV caused by MacTel type 2 (group 2). Fourty eyes of 20 subjects served as controls (group 3). BCVA was found to be significantly higher in control group compared with group 1 and group 2 (p < .005). Whereas, no difference was detected between group 1 and group 2 (p = .75). No difference was noted in CMT between the groups (p = .35). Axial length measurement was very similar among all three groups (p = .62). After adjusting for age and axial length SFCT was significantly thinner in group 3 than the other groups (p < .001), but no statistically significant difference was found between group 1 and group 2.Conclusions: Choroidal thickness did not vary between eyes with MacTel type 2 with SRNV and without SRNV. Choroid was significantly thicker in MacTel type 2 with SRNV and without SRNV than healthy eyes.

Field enhancement in a doubly resonant optical parametric oscillator

Single-resonant and (signal/idler) double-resonant optical parametric oscillators differ fundamentally on the conversion efficiency back to the pump wave. The nonpresent idler in the single-resonant case allows for signal intracavity enhancement well beyond the pump power level. This paper answers the question, how the phase-matched back conversion in a doubly-resonant system can be overcome to reveal substantial power enhancement, and what parameters it depends on. In a degenerate double-resonant OPO (DROPO) pumped by a thin-disk oscillator, an enhancement up to a factor of four is shown experimentally. Support of a semianalytical theory is presented with exceptionally simple relations between enhancement and intracavity losses. Interestingly, our theory predicts no fundamental limit to the maximal field enhancement or conversion efficiency.

Surgical outcomes of Pars Plana Vitrectomy for recurrent retinal detachment in eyes previously treated with Pars Plana Vitrectomy or Scleral Buckling

PURPOSE

To report anatomical and functional outcomes of pars plana vitrectomy (PPV) for recurrent retinal detachment (RD) after failed scleral buckling (SB) or primary PPV.

METHODS

Retrospective analysis of 59 eyes with recurrent RD treated previously with SB or PPV was performed. All eyes underwent 23 gauge PPV. The primary outcome was single surgery success rate (SSSR) for retinal reattachment at the final visit. Secondary outcomes were visual acuity change and number of reoperations.

RESULTS

SSSR was 77.4 % in the SB group and 67.9 % in the PPV group (P=0.41). The mean change in visual acuity was not significantly different between the two groups (P=0.35). The mean number of reoperations was 1.2±0.5 and 1.4±0.6 in the SB and PPV groups, respectively (P=0.38).

CONCLUSION

PPV was found to be an effective technique for the management of recurrent RD after SB and PPV surgeries. However, the small sample size and the retrospective design prevent any claims of advantages or disadvantages of one surgical technique over the other.

Unipolar subcycle pulse-driven nonresonant excitation of quantum systems

The interaction of subcycle pulses with quantum systems is considered when the pulse duration becomes much smaller than the timescales of electron oscillations. We show analytically that the interaction process in this case is governed by the electric pulse area. The efficient nonresonant excitation of quantum systems by subcycle pulses with a high degree of unipolarity is demonstrated. The results are confirmed by direct numerical solution of multilevel Bloch equations.

Real-World Outcomes of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration in Turkey: A Multicenter Retrospective Study, Bosphorus Retina Study Group Report No: 1

Objectives

To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients.

Materials and Methods

Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year.

Results

Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively.

Conclusion

The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Comparison of the effect of ranibizumab and dexamethasone implant on serous retinal detachment in diabetic macular edema

PURPOSE

To compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) on neurosensory retinal detachment (SRD) associated with diabetic macular edema (DME) in the early treatment period.

METHODS

This was a retrospective, interventional, case-control study. After three monthly loading doses of IVR or an initial IDI injection, the changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) on OCT, and presence and height of SRD were evaluated.

RESULTS

The IVR and IDI groups consisted of 101 and 35 eyes, respectively. The mean changes in CMT in the IVR and IDI groups were 204.4±176.6 and 311.4±163, respectively (P<0.001). The mean changes in SRD height in the IVR and IDI groups were 133.6±92.1 and 168.6±103.9μm, respectively. The decrease in SRD height was significantly greater in the IDI group than in the IVR group (P=0.002). The SRD resolved completely in 72.2% and 71.4% of the patients in the IVR and IDI groups, respectively (P=0.9).

CONCLUSION

The mean reduction in CMT and SRD height was greater in the IDI group than in the IVR group. There was a negative correlation between baseline best-corrected visual acuity (BCVA) and SRD height and also between BCVA and CMT.

Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies

Background

The prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated.

Methods

Patients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories.

Results

Twenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores.

Conclusion

OTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs.

Treatment of intravitreal bevacizumab combined with focal laser photocoagulation in the case of macular telangiectasia type 2 with retinal arterial macroaneurysm

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.

The real life data of ranibizumab use among the diabetic macular edema patients in Turkey: Documenting the improvement with clinical optimization during three consecutive years

Purpose

To report the 12 month real life outcomes of ranibizumab treated diabetic macular edema (DME) patients.

Methods

Treatment naïve DME patients treated with ranibizumab were included. Patients were divided into three groups according to their hospital admittance years (2013, 2014, and 2015) and were compared in regards to the treatment outcomes.

Results

The mean visual acuity change from baseline to month 12 was not statistically significant in 2013 at month 12. The mean BCVA change from baseline to month 12 was statistically better at month 12 in 2014 and 2015. There was a statistically significant difference among the three groups in regards to both mean visit and injection numbers. The mean visit number in 2013 and 2014 were both lower than 2015. The mean injection number in 2013 was lower than both 2014 and 2015.

Conclusions

It is effortful to obey the strict follow-up criteria of prospective studies in DME patients on a PRN regimen. However, optimizing the clinical processes of patient management may lead to improved clinical outcomes in real life.

Polarization control of terahertz radiation from two-color femtosecond gas breakdown plasma

We individually control polarizations of 800 and 400 nm beams, which form a two-color femtosecond plasma filament in air irradiating a linear-to-elliptical THz signal. We detected a threshold-like appearance of THz ellipticity at the angle of ∼85° between the fundamental and second-harmonic field polarization directions. The simulations confirm the abrupt change of THz polarization and reveal that the weak ellipticity of the second harmonic is sufficient to generate essentially elliptical THz radiation.

Symmetry Breaking and Strong Persistent Plasma Currents via Resonant Destabilization of Atoms

The ionization rate of an atom in a strong optical field can be resonantly enhanced by the presence of long-living atomic levels (so-called Freeman resonances). This process is most prominent in the multiphoton ionization regime, meaning that the ionization event takes many optical cycles. Nevertheless, here, we show that these resonances can lead to rapid subcycle-scale plasma buildup at the resonant values of the intensity in the pump pulse. The fast buildup can break the cycle-to-cycle symmetry of the ionization process, resulting in the generation of persistent macroscopic plasma currents which remain after the end of the pulse. This, in turn, gives rise to a broadband radiation of unusual spectral structure, forming a comb from terahertz to visible. This radiation contains fingerprints of the attosecond electron dynamics in Rydberg states during ionization.

Population density gratings induced by few-cycle optical pulses in a resonant medium

Creation, erasing and ultrafast control of population density gratings using few-cycle optical pulses coherently interacting with resonant medium is discussed. In contrast to the commonly used schemes, here the pulses do not need to overlap in the medium, interaction between the pulses is mediated by excitation of polarization waves. We investigate the details of the dynamics arising in such ultrashort pulse scheme and develop an analytical theory demonstrating the importance of the phase memory effects in the dynamics.

Generation of unipolar half-cycle pulses via unusual reflection of a single-cycle pulse from an optically thin metallic or dielectric layer

We propose a strikingly simple method to form approximately unipolar half-cycle optical pulses via reflection of a single-cycle optical pulse from a thin flat metallic or dielectric layer. Unipolar pulses in reflection arise due to specifics of one-dimensional pulse propagation. Namely, we show that the field emitted by the layer is proportional to the velocity of the oscillating charges in the medium, instead of their acceleration. Besides, the oscillation velocity of the charges can be forced to keep a constant sign throughout the pulse duration. That is, reflection of ultrashort pulses from broad-area layers with nanometer-scale thickness can be very different from the common reflection in the case of longer pulses and thicker layers. This suggests a possibility of unusual transformations of few-cycle light pulses in completely linear optical systems.

Efficacy of Intravitreal Bevacizumab in Treatment of Proliferative Type 2 Idiopathic Juxtafoveal Telangiectasia

Objectives:

To evaluate the effectiveness of intravitreal bevacizumab (IVB) in patients with subretinal neovascularization secondary to type 2 juxtafoveal telangiectasia.

Materials and Methods:

Ten eyes of 10 patients were included in this retrospective study. All cases were treated with IVB (1.25 mg bevacizumab). Visual acuity and slit-lamp anterior and posterior segment examinations were performed at each visit. Central macular thickness (CMT) and intraretinal/subretinal fluid were evaluated via spectral domain optical coherence tomography (OCT). Loss of a line in visual acuity chart and presence of fluid on OCT were defined as criteria for repeated treatment.

Results:

The mean age of patients was 66.0±7.0 years (56-75). The mean follow-up time was 54.7±16.0 month (24-72). The mean BCVA was 0.62±0.35 (0.00-1.00) logMAR at baseline and 0.54±0.35 (0.00-1.00) logMAR at final exam (p=0.03). The mean CMT was 251±25.4 µm at baseline and 239±39.3 µm at final exam (p=0.01). Patients received an average of 1.7±1.0 IVB injections during follow-up. At baseline, all cases had intraretinal/subretinal fluid. There was no fluid at final examination of all cases.

Conclusion:

IVB treatment may be effective in the treatment of subretinal neovascularization secondary to type 2 juxtafoveal telangiectasia.

Ultrafast creation and control of population density gratings via ultraslow polarization waves

In the regime of resonant coherent light-matter interaction, light pulses may interact with each other indirectly via a polarization wave created by the other pulse. We show that such interaction allows fast creation and erasing of high-contrast dynamic population density gratings, as well as control of their period in a few-cycle regime. Our scheme uses counter-propagating optical pulses, which do not cross each other in the medium. The mechanism is able to work with pulse durations up to the single-cycle limit. Somewhat surprisingly, ultrafast grating wave vector control requires the generation of polarization waves with the phase velocity much smaller than that of light.

Refractive lenticule extraction (ReLEx) through a small incision (SMILE) for correction of myopia and myopic astigmatism: current perspectives

Small-incision lenticule extraction (SMILE) is an alternative to laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for the correction of myopia and myopic astigmatism. SMILE can be performed for the treatment of myopia ≤−12 D and astigmatism ≤5 D. The technology is currently only available in the VisuMax femtosecond laser platform. It offers several advantages over LASIK and PRK; however, hyperopia treatment, topography-guided treatment, and cyclotorsion control are not available in the current platform. The working principles, potential advantages, and disadvantages are discussed in this review.

Comparison of Changes in Corneal Biomechanical Properties after Photorefractive Keratectomy and Small Incision Lenticule Extraction

Objectives:

To compare the postoperative biomechanical properties of the cornea after photorefractive keratectomy (PRK) and small incision lenticule extraction (SMILE) in eyes with low and moderate myopia.

Materials and Methods:

We retrospectively examined 42 eyes of 23 patients undergoing PRK and 42 eyes of 22 patients undergoing SMILE for the correction of low and moderate myopia. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with an Ocular Response Analyzer before and 6 months after surgery. We also investigated the relationship between these biomechanical changes and the amount of myopic correction.

Results:

In the PRK group, CH was 10.4±1.3 mmHg preoperatively and significantly decreased to 8.5±1.3 mmHg postoperatively. In the SMILE group, CH was 10.9±1.7 mmHg preoperatively and decreased to 8.4±1.5 mmHg postoperatively. CRF was significantly decreased from 10.8±1.1 mmHg to 7.4±1.5 mmHg in the PRK group whereas it was decreased from 11.1±1.5 mmHg to 7.9±1.6 mmHg in the SMILE group postoperatively. There was a significant correlation between the amount of myopic correction and changes in biomechanical properties after PRK (r=-0.29, p=0.045 for CH; r=-0.07, p=0.05 for CRF) and SMILE (r=-0.25, p=0.048 for CH; r=-0.37, p=0.011 for CRF).

Conclusion:

Both PRK and SMILE can affect the biomechanical strength of the cornea. SMILE resulted in larger biomechanical changes than PRK.

Effects of two commonly used mydriatics on choroidal thickness: direct and crossover effects

PURPOSE

To investigate the effect of 2 commonly used mydriatics on choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT).

METHODS

In this prospective study, 90 healthy subjects were enrolled. The participants were randomly divided into 3 groups based on the application of drops. One eye of each subject received a drop of tropicamide 1% in the tropicamide group (n=30), a drop of phenylephrine 2.5% in the phenylephrine group (n=30), and a drop of artificial tear in the control group (n=30). Drops were given thrice at 5 min intervals. Subfoveal choroidal thickness (SFCT) was measured using EDI-OCT before and at 45 min after drop application in both the dilated eye and nondilated contralateral eye.

RESULTS

The SFCT was significantly decreased after drop instillation in both the dilated eye and contralateral eye in the tropicamide group (P<0.001 and P=0.001, respectively) and in the phenylephrine group (P<0.001 and P=0.001, respectively). However, the SFCT did not significantly differ after drop instillation in either the dropped eye or contralateral eye in the control group (P=0.108 and P=0.695, respectively).

CONCLUSION

The findings of the present study revealed that tropicamide and phenylephrine cause a decrease in choroidal thickness.

Effect of orbital protrusion and vertical interpalpebral distance on pterygium formation

PURPOSE

To evaluate the risk factors in the development of pterygium in the Marmara region of Turkey as well as the efficacy of vertical interpalpebral distance, protrusion level and tear function in the development of pterygium.

MATERIALS AND METHODS

The cases were grouped in two as the research group consisted of patients with pterygium and the control group consisted of healthy people. A total of 294 patients with pterygium (108 bilateral, 186 unilateral) and 200 controls were included in the study. All patients and control group underwent a thorough ophthalmic examination, including tear function analysis using tear film breakup time measurement, protrusion level and vertical interpalpebral distance.

RESULTS

No statistically significant difference was found between the bilateral pterygium subgroup and control group in terms of vertical interpalpebral distance and protrusion value (p=0.733, p=0.625). When the pterygium eyes and the control group were compared in the unilateral pterygium subgroup, no significant difference was found in terms of vertical interpalpebral distance and protrusion value (p=0.533, p=0.209).

CONCLUSIONS

While UV efficiency in pterygium was obvious, protrusion value and vertical interpalpebral distance were not found to be a risk factor in the formation of pterygium.

Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy

PURPOSE

To report the postoperative results of full-tendon vertical rectus transposition (VRT) augmented with lateral fixation suture for the treatment of type 1 Duane syndrome and sixth nerve palsy and to determine whether there was a decrease in the effect of the Foster suture over time.

METHODS

This retrospective, consecutive case series included patients who underwent a full-tendon VRT transposition with lateral fixation for type 1 Duane syndrome or sixth nerve palsy. The primary outcome measures included deviation, abnormal head posture(AHP), abduction deficiency, and postoperative binocular single visual field (BSVF).

RESULTS

Eighty-seven patients (87 eyes: 40 eyes with Duane syndrome and 47 eyes with sixth nerve palsy) were included in this study. In Duane syndrome patients, the deviation was reduced by a mean of 95%, the AHP was eliminated in 86% of patients, the abduction was improved by 42%, and a useful BSVF of ≈ 67% of normal was achieved at 1 year post operation. In sixth nerve palsy patients, the deviation was reduced by 99%, the abduction was improved by 59%, and a useful BSVF of ≈ 71% of normal was achieved at 1 year post operation. In both groups, the improvements in deviation angle and abduction were stable postoperatively. Sixteen patients needed reoperation for undercorrection.

CONCLUSION

VRT surgery with posterior fixation is an effective treatment method for complete sixth nerve palsy and Duane syndrome with esotropia, AHP, and abduction deficiency. The procedure carries a small risk of reoperation for undercorrection. The effect of the Foster suture did not decline over time.

Femtosecond lenticule extraction for correction of myopia: a 6 month follow-up study

Aims

To report our initial experience with femtosecond lenticule extraction (FLEX) compared with femtosecond laser-assisted in situ keratomileusis (LASIK).

Settings and design

This was a prospective pilot study carried out at the Refractive Surgery Department of the Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

Materials and methods

Surgery was performed on both eyes of 14 consecutive patients with myopia or myopic astigmatism. Patients underwent FLEX in one eye and femtosecond LASIK (FemtoLASIK) in the other eye. The primary outcome was based on uncorrected distance visual acuity, corrected distance visual acuity, and spherical equivalent of the subjective manifest refraction, at 1 week, 1 month, and 6 months postsurgery. Statistical analyses were performed using PAWS Statistics 18. Unpaired Student’s t-test was used to compare the groups.

Results

During the last follow-up visit (6 months postsurgery), the mean spherical was −0.37 ± 0.60 diopters (D) (range −1.00 to 0.50) (P < 0.001) and −0.25 ± 0.41 D (range −0.88 to 0.12 D) (P < 0.001) in the FLEX and FemtoLASIK eyes, respectively. The spherical was within ± 0.50 D of the intended correction in ten (72%) of the FLEX eyes and 12 (86%) of the FemtoLASIK eyes (P > 0.05). No complications occurred during surgery or the postoperative period.

Conclusion

FLEX is a safe, effective, and predictable procedure for surgical correction of myopia. Refractive results were stabilized within the first postoperative week, and visual acuities were stabilized within the first month, comparable to FemtoLASIK.