Macula vessel density and its relationship with the central visual field mean sensitivity across different stages of exfoliation glaucoma

CLINICAL RELEVANCE

Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma.

BACKGROUND

This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages.

METHODS

In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature-function and structure-function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately.

RESULTS

The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p = 0.9). The macula vessel density (%)-visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes (r = 0.464 p = 0.01), while no such correlation was notable for the early stage POAG eyes (r = -0.029 p = 0.89).

CONCLUSION

The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

The comparison of corneal densitometry in cases with glaucoma following childhood cataract surgery and juvenile glaucoma

PURPOSE

To compare the corneal densitometry (CD) in pediatric cases with glaucoma following childhood cataract surgery and juvenile open-angle glaucoma (JOAG).

METHODS

This prospective comparative study involved 13 eyes with JOAG, 12 eyes with pseudophakic glaucoma, 13 eyes with aphakic glaucoma, and 15 control subjects. Pentacam HR Scheimpflug corneal topography was employed to evaluate corneal thickness (CCT) and CD values.

RESULTS

The mean intraocular pressure (IOP) and CCT were significantly higher in aphakic glaucoma cases than the other groups (p = 0.001). In aphakic eyes, the mean CD values were higher in most of the anterior, center, and posterior layers of 0-2 mm, 2-6 mm, 6-10 mm, and total zones (p < 0.001 for all). In pseudophakic eyes, the mean CD values were statistically similar with that of aphakic eyes and higher than that of JOAG and control eyes in all layers of 0-2 mm zone and in anterior layer of 10-12 mm and anterior and total layers of 2-6 mm zones (p < 0.05 for all). The CD values demonstrated significant correlations with CCT values in both aphakic and pseudophakic eyes. However, a significant correlation of CD values with IOP was only demonstrated in aphakic eyes (p = 0.01 for all).

CONCLUSION

The probable effects of childhood cataract surgery especially aphakia might cause corneal backscatter of light and increased CD in all layers in all zones of the cornea. Increased CD values and its correlation with CCT and IOP in aphakic glaucoma eyes may be of importance in clinical management.

The Assessment of Radial Peripapillary Capillary Vessel Density in Adult Children of Patients with Primary Open-Angle Glaucoma

PRCIS

The observed decrease in radial peripapillary capillary vessel density among adult children of individuals with primary open-angle glaucoma, in comparison to controls, suggests the possibility of early microvascular alterations in the eyes of these at-risk individuals.

PURPOSE

To compare the radial peripapillary capillary vessel density (RPCVD) and peripapillary retinal nerve fiber layer (RNFL) thickness values of eyes between healthy adults with a maternal or paternal history of primary open angle glaucoma (POAG) and age-matched healthy controls without a family history of POAG.

METHODS

RPCVD values and RNFL thicknesses in the peripapillary region and 4 quadrants (superior, inferior, nasal, and temporal) were evaluated using optical coherence tomography angiography (OCT-A) among 30 adult children of patients with POAG and 30 age-matched healthy controls without a family history of POAG.

RESULTS

The mean whole image RPCVD (51.6±1.7% vs. 49.8±1.7%, P=0.0006) and average RPCD (54.7±1.7% vs. 53.2±2.1%, P=0.006) values were significantly lower in the adult children of patients with POAG compared to age-matched healthy controls without a family history of POAG. There was no difference in terms of RNFL thickness values in any region.

CONCLUSION

Despite having similar RNFL thickness values to the control group, the observation of lower RPCVD in the eyes of adult children of POAG patients may indicate potential early vascular alterations. The result of the present study encourages further longitudinal studies to determine the potential importance of the underlying vascular alterations in these high-risk individuals.

Risk factors for posterior capsule rupture in mature cataract surgery: A study of 1302 cases

Purpose

To identify the risk factors predisposing posterior capsule rupture (PCR) during mature cataract surgery.

Methods

A total of 1302 consecutive mature cataract cases were included in this retrospective study. A detailed examination was performed for each patient and risk factors including age, gender, systemic diseases, ocular comorbidities, surgeon, and surgery method were recorded. Cases with PCR during surgery were classified as complicated. Multivariate logistic regression analysis with a generalized estimating equations method was applied for statistical analysis.

Results

The overall rate of PCR was 7.30% (n=95 eyes). After adjusting for confounders, factors that remained significant on multivariate analysis were strabismus (odds ratio [OR]: 5.70, 95% confidence interval [CI]: 2.17-14.97; P < 0.001), phacodonesis (OR: 4.62, 95% CI: 2.59-8.22; P < 0.001), history of trauma (OR: 4.46, 95% CI: 1.64-12.12; P = 0.003), surgery method (extracapsular cataract extraction/phacoemulsification) (OR: 2.61, 95% CI: 1.60-4.26; P < 0.001), and pseudoexfoliation (OR: 1.94, 95% CI: 1.20-3.16; P = 0. 007).

Conclusion

Strabismus, phacodonesis, history of trauma, extracapsular cataract extraction method, and pseudoexfoliation were found to be important risk factors for developing PCR. Appropriate preoperative and perioperative precautions for these higher-risk cases can reduce complications.

The Efficacy and Safety of Trehalose in Primary Trabeculectomy with Mitomycin C: A Report of Early Findings

Objective

To compare bleb morphology and tear tests of glaucoma patients who used trehalose and those who did not use after primary trabeculectomy with mitomycin C (MMC) during the early post-operative period.

Methods

This retrospective study included two groups: Group 1 using Trehalose + hyaluronic acid (THA) after primary trabeculectomy with MMC (n = 19) and Group 2 undergoing primary trabeculectomy with MMC (n = 16). The preoperative and postoperative intraocular pressure (IOP), the results of Schirmer, and tear break-up time tests were analyzed. Postoperative bleb morphology was also evaluated at the 1st day, and 1st and 2nd weeks, and 1st and 2nd months.

Results

There was no statistically significant difference in preoperative IOP, Schirmer test or tear break-up time between groups. The mean horizontal extent of the blebs was significantly wider in Group 1 at the first week (p= 0.02). Bleb vascularization was also found to be lower in Group 1 at the second week (p= 0.001). The mean bleb height and horizontal extent were significantly higher in Group 1 at the first month (p=0.02, p= 0.03, respectively). The mean bleb horizontal extent was significantly higher in Group 1 at the second month (p= 0.03).

Conclusion

The use of trehalose improved surgical success of primary trabeculectomy with MMC in terms of IOP control, post-operative complications, and bleb morphology during the early postoperative period. Trehalose might contribute to wound healing which led to an ideal bleb.

Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome

OBJECTIVES

To evaluate corneal densitometry and endothelial cell properties in patients with unilateral Fuchs uveitis syndrome (FUS), and to compare results with unaffected contralateral eyes and healthy control subjects.

METHODS

A total of 90 participants were included in this prospective cross-sectional study. Forty-five affected eyes of patients with FUS were regarded as group 1 (FUSa), 45 fellow eyes were regarded as group 2 (FUSf), and 45 healthy-control eyes were regarded as group 3. Corneal densitometry was measured with densitometry software of Scheimpflug Corneal Topography (Pentacam HR, Oculus GmbH, Wetzlar, Germany), whereas endothelial cell measurement was evaluated with specular microscopy (Tomey, EM4000, GmbH, Germany).

RESULTS

The mean corneal densitometry values were higher in the midstromal (zones; 2-6, 6-10 mm), posterior (all zones), and total thickness (zones; 2-6, 6-10 mm) layers in the FUSa compared with FUSf and control eyes (P<0.05 for all comparisons). The mean values of average cell area and cell size characteristics (minimum, maximum, SD, and coefficient of variation) were higher; endothelial cell density and percentage of hexagonal cells were lower in the FUSa than in the other two groups (P<0.05 for all comparisons). There was a significantly strong correlation between specular microscopy parameters and posterior corneal densitometry values in the FUSa group.

CONCLUSIONS

Impairment of endothelial cell function in affected eyes of patients with FUS resulted in increased values of corneal densitometry, especially posterior layer.

Evaluation of aqueous humor and serum clusterin levels in patients with glaucoma

Background

To compare the aqueous humor (AH) and the serum clusterin levels of patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), and primary open-angle glaucoma (POAG) with each other and with an age- and sex-matched control group.

Methods

This prospective, cross-sectionalstudy evaluated 92 eyes from 92 adult cases of uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation. The cases were divided into PEX, PEXG, POAG, and control groups. Serum samples were taken from the antecubital vein just before the surgery, and the AH samples were aspirated at the beginning of the surgery. Kruskal-Wallis H, One-way ANOVA, Mann-Whitney U with Bonferroni correction and Chi-Square tests were used for statistical analysis.

Results

The serum clusterin levels were the highest in the PEXG group, but no statistically significant differences were observed between the groups (p=0.633). The mean AH clusterin levels were 286.79±29.64 μg/mL in the PEXG group, 263.92±31.70 μg/mL in the PEX group, 272.59±49.71 μg/mL in the POAG group, and 193.50±62.38 μg/mL in the control group (p< 0.001). This came out to be 1.48 times increase for the PEXG group, 1.36 for the PEX group, and 1.41 for the POAG group when compared with the control subjects.

Conclusions

A higher level of clusterin in the anterior chamber was found to be associated with PEX and PEXG. In addition, a high level of anterior chamber clusterin in POAG, which is a new finding, showed that this molecule might be important not only in pseudoexfoliation, but also other types of glaucoma like POAG.

Peripapillary and macular choroidal vascularity index in patients with clinically unilateral pseudoexfoliation syndrome

PURPOSE

To investigate choroidal vascular changes using an image binarization tool in patients with clinically unilateral pseudoexfoliation syndrome (XFS).

METHODS

This cross-sectional study included 150 eyes of 100 patients. The eyes were divided into three groups: (1) 50 affected eyes of patients with clinically unilateral XFS; (2) 50 unaffected fellow eyes; and (3) 50 healthy control eyes. Enhanced depth imaging optical coherence tomography scans of the macula and peripapillary regions were acquired. Images were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The choroidal vascularity index (CVI) was defined as proportion of the luminal area to the total circumscribed choroidal area.

RESULTS

Horizontal and vertical scans revealed that the macular CVI values of the affected eyes (60.08 ± 2.06 and 62.21 ± 2.10, respectively) were lower compared with control eyes (67.31 ± 2.24; p = 0.001 and 68.11 ± 2.36; p < 0.001, respectively). Conversely, no significant difference in the macular CVI was found between unaffected fellow and control eyes (p = 0.094 and p = 0.120, respectively). The mean peripapillary CVI values of the temporal (58.73 ± 3.15), superior (59.84 ± 3.09), and inferior (56.94 ± 2.47) sectors were significantly lower in affected eyes compared to control eyes (63.21 ± 3.00, 62.07 ± 3.05, and 60.78 ± 2.88, respectively; p < 0.05 for all). In addition, the unaffected fellow eyes had significantly lower CVI values in the temporal (61.42 ± 3.07) and inferior (57.61 ± 2.56) peripapillary sectors compared with the control eyes (p = 0.007 and p = 0.005, respectively).

CONCLUSIONS

These findings suggest that XFS is associated with decreased macular and peripapillary choroidal vascularity. Furthermore, the unaffected eyes of patients with unilateral XFS may show vascularity changes in the peripapillary choroid.

Characteristics of uveitic glaucoma in Turkish patients

PURPOSE

To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases.

METHODS

This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results.

RESULTS

During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes.

CONCLUSION

UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.

Evaluation of the optic nerve head vessel density in the patients with asymmetric pseudoexfoliative glaucoma: an OCT angiography study

PURPOSE

To evaluate vascular microcirculation changes of the optic nerve head (ONH) in the patients with asymmetric pseudoexfoliative glaucoma (XFG) using optical coherence tomography angiography (OCTA) and to compare vessel density (VD) results with healthy individuals.

METHODS

This prospective study enrolled 120 eyes in total. The eyes were divided into 3 groups: 40 glaucomatous and 40 non-glaucomatous fellow eyes without clinically pseudoexfoliation material (XFM) of patients with asymmetric XFG, and 40 healthy eyes as controls. The optic disc region was evaluated with OCTA (Optovue, Inc., Fremont, CA). VD was assessed as the ratio of the area formed by the vessels in 3 different regions: (1) inside disc; (2) in the peripapillary area defined as a 1-mm wide elliptical annulus around the disc; and (3) in the whole image defined as a 4-mm wide papillary region.

RESULTS

There were significant decreases in VD values of all regions in XFG eyes compared to fellow and control eyes (p < 0.05 for all comparisons). The mean VD values of peripapillary area and whole image were lower in the non-glaucomatous fellow eyes compared with control eyes (p = 0.011 and p = 0.015, respectively). The receiver operating characteristic analysis for differentiating fellow eyes from healthy eyes had highest area under the curve and sensitivity at 90% specificity for superior-hemi (0.811, 65.2%), followed by ppVD (0.775, 61.8%) and whole image (0.743, 55.9%).

CONCLUSIONS

OCTA as a novel imaging may be a valuable structural test in diagnosis and follow-up of glaucoma.

Evaluation of biometric parameters in phacomorphic glaucoma and mature cataracts

PURPOSE

The aims of this study were to compare the biometric parameters and axial lengths of eyes with phacomorphic glaucoma and mature cataract and to identify differences that might predispose to development of phacomorphic glaucoma.

METHODS

Three hundred forty-two patients were enrolled in this retrospective study. The eyes were divided into four groups-Group (G)1: phacomorphic glaucoma (n = 29), G2: mature cataract (n = 313), G3: contralateral phacomorphic glaucoma (n = 29), and G4: contralateral mature cataract (n = 313). Central corneal thickness and anterior chamber depth were assessed by optical low-coherence reflectometry (Lenstar LS 900®; Haag-Streit AG, Switzerland), while axial length was determined by A-scan ultrasound biometry.

RESULTS

The mean central corneal thickness of G1 was significantly higher than in other groups (p < 0.001) and the mean anterior chamber depth of G1 was the lowest among the groups (p < 0.001). Also, G2 had lower mean anterior chamber depth than G4 (p < 0.001) and G3 had lower mean anterior chamber depth than G4 (p = 0.007). Anterior chamber depth less than 3.27 mm had the higher odds ratio for distinguishing G3 versus G4 (odds ratio = 10.79, p < 0.001). Furthermore, patients aged ⩾68.9 years had the higher odds ratio for distinguishing G1 versus G2 (odds ratio = 2.82, p = 0.019). There was no significant difference in the presence of pseudoexfoliation material between G1 and G2 (p = 0.057). There were no significant differences in axial length values among the four groups (p = 0.097).

CONCLUSION

Advanced age and shallow anterior chamber depth were found to be risk factors for developing phacomorphic glaucoma, but the presence of pseudoexfoliation material was not found to play a role as a risk factor in phacomorphic glaucoma development.

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis

PURPOSE

To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis (FHI)-related glaucoma in 1-year follow-up period.

METHODS

This retrospective study included 50 eyes with FHI-related glaucoma those had underwent initial trabeculectomy with MMC (0.2 mg/ml-3 min). Thirty-one of them had single-dose bevacizumab injection (1.25 mg/0.05 ml) into the bleb area just at the end of the surgery, while 19 eyes did not have. The intraocular pressure (IOP) and the mean number of anti-glaucomatous medications were evaluated. The IOP value ≤ 21 mmHg was defined as complete or qualified surgical success in terms of using medical anti-glaucomatous treatment. Bleb height and vascularity were evaluated with Indiana bleb grading system. Paired sample t test, t test, Chi-square and Kolmogorov-Smirnov tests were used for statistical analysis.

RESULTS

The preoperative IOP values of bevacizumab and without bevacizumab groups were 32.8 ± 4.5 mmHg and 32.8 ± 4.5 mmHg, respectively, and they decreased to 17.5 ± 4.6 mmHg and 17 ± 5.2 mmHg at the final visit (p < 0.001 for all values). There were no significant differences in postoperative IOP and the number of medications between the groups at the final visit. In bevacizumab group, complete success was achieved in 100% within the third month but decreased to 22.5% (complete) and 74.1% (qualified) at the first year. In the other group (without bevacizumab group), complete success was achieved in 94.7% within the third month but decreased to 15.8% (complete) and 84.2% (qualified) at the first year.

CONCLUSION

Initial trabeculectomy with MMC and subconjunctival bevacizumab injection was found to have lower rates of complete success with relatively acceptable qualified success rates in the management of FHI-related glaucoma. Subconjunctival bevacizumab was not found to have additional effect to improve the surgical success.

Early visual field changes in patients with type 1 diabetes mellitus

PURPOSE

To assess the visual field sensitivity changes and investigate the association between visual field sensitivity and retinal nerve fiber layer thickness in patients with type 1 diabetes mellitus.

MATERIALS AND METHODS

In this cross-sectional and observational study, 46 patients (22 males, 24 females) with type 1 diabetes mellitus and no diabetic retinopathy formed the diabetes mellitus group and 50 age-matched healthy subjects (32 males, 18 females) formed the control group. Retinal nerve fiber layer thickness, full-threshold standard automated perimetry, and short-wavelength automated perimetry were performed. Main outcomes were retinal nerve fiber layer thickness, mean deviation, pattern standard deviation, and short fluctuation.

RESULTS

Average retinal nerve fiber layer thickness was significantly thinner in the diabetes mellitus group (p < 0.001). The mean values of mean deviation and pattern standard deviation of the full-threshold standard automated perimetry did not differ between the groups (p = 0.179, p = 0.139, respectively). Mean short fluctuation was significantly greater in the diabetes mellitus group (p < 0.001). Both mean deviation and pattern standard deviation of the short-wavelength automated perimetry were significantly greater in the diabetes mellitus group (p < 0.001, p < 0.001, respectively). Pattern standard deviation of short-wavelength automated perimetry equal or higher than 1.57 dB had 91% sensitivity and 90% specificity (area under the curve = 0.969, p < 0.001) and short fluctuations of full-threshold standard automated perimetry equal or higher than 0.80 dB had 80% sensitivity and 76% specificity over detecting early retinal nerve fiber layer loss in patients with type 1 diabetes mellitus (area under the curve = 0.855, p < 0.001).

CONCLUSION

This study showed that thinner retinal nerve fiber layer in patients with type 1 diabetes mellitus may be associated with abnormal retinal sensitivity to short-wavelength stimulations in short-wavelength automated perimetry; however, retinal sensitivity to white stimulus was similar to that in healthy subjects in full-threshold standard automated perimetry.

Comparison of Refractive Status and Anterior Segment Parameters of Juvenile Open-Angle Glaucoma and Normal Subjects

Objectives:

Our aim was to compare the refractive status and anterior segment parameters of patients with juvenile open-angle glaucoma (JOAG) and normal subjects.

Materials and Methods:

Twenty-five recently diagnosed cases of JOAG and 24 normal subjects were included in this prospective controlled clinical trial. Central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL), K1 and K2 keratometry, and white-to-white distance (WTW) measurements were performed with optical biometry (LenStar LS 900, Haag Streit Diagnostics). Spherical equivalent (SE) values and anterior segment parameters were statistically compared by chi-square, Kolmogorov- Smirnov, and independent samples t-tests.

Results:

The mean age of the 15 male and 10 female JOAG patients was 11.8±2.78 (8-18) years and the mean age of the 14 male and 10 female normal subjects was 11.58±3.04 (7-16) years (age: p=0.51; sex: p=0.18). Mean intraocular pressure in the JOAG group before treatment was 30.08±4.3 mmHg. The mean SE values of the JOAG and the control group were -1.94±1.86 (+2.35/-5.5) and -0.76±2.03 (+2.25/-4.85) diopters, respectively (p=0.048). JOAG patients had lower mean CCT values (p=0.016) and higher mean AL and ACD values (p=0.049 and p=0.016). There were no significant differences between the groups for LT, WTW, K1, or K2 (p=0.61; p=0.52; p=0.95; p=0.31 respectively).

Conclusion:

JOAG patients were found to be more myopic and have lower CCT and greater AL and ACD values than normal subjects. These anterior segment changes may be associated with myopia, which is common in JOAG.

Evaluation of dynamic thiol-disulfide homeostasis in glaucoma patients and the correlation with retinal nerve fiber layer analysis

PURPOSE

The aim of this study was to evaluate thiol/disulfide homeostasis and ischemia-modified albumin levels with primary open-angle glaucoma, ocular hypertension, and control group; also to interpret the correlation between these biochemical parameters and retinal nerve fiber layer analysis.

MATERIAL AND METHODS

In a prospective cross-sectional study, 30 primary open-angle glaucoma cases, 30 ocular hypertension cases, and 30 control subjects were included in the study. Native thiol, total thiol, and disulfide measurements and disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios were evaluated as thiol-disulfide homeostasis. Albumin and ischemia-modified albumin parameters were also evaluated. All cases underwent detailed ophthalmologic examination including visual acuity, retinal nerve fiber layer via optical coherence tomography, intraocular pressure, and central corneal thickness measurements and visual field analysis by 24-2 Swedish Interactive Threshold Algorithm (SITA) Standard visual field test.

RESULTS

Primary open-angle glaucoma group had significantly higher ischemia-modified albumin values than ocular hypertension and control group (p < 0.001). Native thiol and total thiol values of control group were statistically higher than those of primary open-angle glaucoma and ocular hypertension groups. The correlation between the temporal retinal nerve fiber layer value and ischemia-modified albumin, disulfide/native thiol, and disulfide/total thiol values of the primary open-angle glaucoma patients included in the study was moderate correlation in negative direction (r = -0.46, r = -0.39, r = -0.39, respectively), whereas there was a statistically significant moderate correlation in positive direction between the native thiol/total thiol values (r = 0.39) (p < 0.05).

CONCLUSION

These findings have reinforced the role of oxidative stress in the etiopathogenesis of primary open-angle glaucoma, suggesting that the thinning retinal nerve fiber layer may be associated with oxidative stress in favor of prooxidant shift.

Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives

Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.

Seasonal distribution of ocular conditions treated at the emergency room: a 1-year prospective study

PURPOSE

To determine the clinical characteristics and seasonal distribution of patients admitted to the ocular emergency department of a tertiary ophthalmology care center.

METHODS

The study cohort includes 27,120 patients who were admitted to ocular emergency room between November 2013 and November 2014. The age, sex, reason for admission, diagnosis, and complete ocular examination reports were recorded for each patient. X-ray and ultrasonographic examinations were performed if necessary.

RESULTS

The mean patient age was 32.83 ± 17.62 years (range, 0-95). The number of males was nearly two times the number of females, with 18,808 (69.4%) males and 8312 (30.6%) females. The diagnoses included viral conjunctivitis (7,859 patients; 29.0%), corneal foreign body (5,286 patients; 19.5%), bacterial conjunctivitis (3,892 patients; 14.4%), corneal abrasions (2,306 patients; 8.5%), and allergic conjunctivitis (1,433 patients; 5.3%) (Table 1). Other frequent diagnoses included subconjunctival hemorrhage, photo keratopathy, chemical eye injury, and penetrating and blunt eye injuries. Allergic conjunctivitis, ocular trauma, and corneal foreign body were more frequent in spring, whereas keratitis and chemical eye injury were more common in winter (chi-square test). The most common reasons for emergency room admission, in order of frequency, were viral conjunctivitis, corneal foreign body, bacterial conjunctivitis, and corneal abrasions.

CONCLUSION

This study is the first long-term prospective study to evaluate the seasonal distribution and diagnosis of all adult and pediatric patients admitted to the emergency room for ocular conditions. The frequency of ophthalmological conditions seen in the emergency room may vary according to the season.

Comparison of anterior segment parameters in patients with pseudoexfoliation glaucoma, patients with pseudoexfoliation syndrome, and normal subjects

PURPOSE

To compare the anterior segment parameters of patients with pseudoexfoliation syndrome, patients with pseudoexfoliation glaucoma, and normal subjects.

METHODS

This prospective, controlled, comparative study included 150 eyes of 150 patients. The patients were divided into the pseudoexfoliation syndrome group, the pseudoexfoliation glaucoma group, and the control group (50 patients in each group). Axial length, central corneal thickness, aqueous depth, anterior chamber depth, lens thickness, K1 and K2 keratometry values, and white to white distance measurements were obtained by optical biometry and compared between the groups.

RESULTS

The mean ages of the pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and control patients were 62.18 ± 6.21, 61.80 ± 6.62, and 59.40 ± 6.89 years, respectively. There were no statistically significant differences between the groups in mean age or sex ratio (p>0.05). Mean central corneal thickness was statistically significantly greater, mean aqueous depth and anterior chamber depth were statistically significantly greater, and mean lens thickness was statistically significantly less in the control group than in the pseudoexfoliation syndrome and pseudoexfoliation glaucoma groups (p<0.05). Pairwise comparisons of the pseudoexfoliation syndrome group and the pseudoexfoliation glaucoma group revealed that there were no significant differences between these two groups in central corneal thickness, aqueous depth, anterior chamber depth, and lens thickness (p>0.017).

CONCLUSIONS

Patients with pseudoexfoliation glaucoma and pseudoexfoliation syndrome had greater lens thickness, shallower aqueous depth and anterior chamber depth, and less central corneal thickness than normal subjects. None of the anterior segment parameters differed between patients with pseudoexfoliation syndrome and patients with pseudoexfoliation glaucoma.

Comparison of total/active ghrelin levels in primary open angle glaucoma, pseudoexfoliation glaucoma and pseudoexfoliation syndrome

AIM

To investigate the levels of ghrelin (Gh), acylated ghrelin (AGh) and AGh/Gh ratio in the humor aqueous (HA) of cases with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), primary open angle glaucoma (POAG) and to compare these with control subjects.

METHODS

A prospective examination was made of the total Gh, and AGh levels in HA of 67 patients undergoing cataract surgery. Patients were divided into 4 groups. HA samples were aspirated at the beginning of the surgery, stored at -70°C. Gh and AGh quantification was performed with ELISA kits and the AGh/total-Gh ratios were calculated. ANOVA, Kruskal-Wallis, Chi-square and post-hoc tests were used for statistical analysis.

RESULTS

Total Gh levels in HA were 189.2±45.6 pg/mL in the control group, 199.2±32.9 pg/mL in PXS, 180.6±20.9 pg/mL in PXG and 176.8±21.4 pg/mL in POAG groups (P>0.05). AGh levels in HA were 23.09±5.01 pg/mL in the control group, 24.13±5.22 pg/mL in PXS, 22.29±1.55 pg/mL in PXG and 19.69±2.93 pg/mL in POAG groups (P>0.05). The ratio of AGh/Gh was 10.3%±2.34% in the control group, 13.03%±2.58% in PXS, 12.3%±1.54% in PXG and 11.79%±1.41% in POAG groups (P=0.044). The difference between the PXS and control groups was significant (P=0.03).

CONCLUSION

In spite of statistically insignificant results, the HA total Gh levels were lower than those of the control subjects but not parallel with the AGh levels in glaucoma patients. The relative increase in the AGh/Gh ratio in glaucoma cases supports the view that proportional increases of AGh might play a role in the pathogenesis of glaucoma.

The effect of trabeculectomy on serum brain-derived neurotrophic factor levels in primary open-angle glaucoma

PURPOSE

We aimed to investigate the effect of trabeculectomy on serum brain-derived neurotrophic factor (BDNF) levels. Our secondary goal was to compare serum and aqueous humor (AH) BDNF levels in primary open-angle glaucoma (POAG) and control subjects.

METHODS

This prospective, cross-sectional study consists of 20 eyes of with advanced-stage POAG who had trabeculectomy and 19 eyes of age- and sex-matched control healthy subjects who had cataract surgery. Serum and AH samples were obtained preoperatively in trabeculectomy group and control subjects. Serum samples were obtained at the third postoperative month in both groups.

RESULTS

The aqueous humor and serum levels of BDNF at the surgery day were found to be strongly positive correlated (r = 0.868; p < 0.001). Serum and AH BDNF levels of POAG cases were significantly lower than control subjects at the surgery day (respectively p = 0.038, p = 0.011). In POAG cases, serum BDNF levels significantly increased at the third month after trabeculectomy while there was not a significant difference in control subjects with cataract surgery (p < 0.001; p = 0.717 respectively).

CONCLUSION

Trabeculectomy was found to have a positive effect on serum BDNF levels in POAG cases.

Relationship between Central Corneal Thickness and Parameters of Optic Nerve Head Topography in Healthy Subjects

Purpose

To investigate the relationship between central corneal thickness (CCT) and topographic parameters of optic nerve head (ONH) in healthy eyes.

Methods

Right eyes of 208 healthy subjects between 40 and 59 years of age with refractive error less than 1 D were enrolled in this cross-sectional study. Ultrasonic pachymeter was used to measure CCT, and the ONH parameters were obtained by using confocal scanning laser ophthalmoscope. Relationship of various topographic parameters to age and sex were also investigated. For statistical analysis Student t test, analysis of variance, Pearson and Spearman test, and partial correlation coefficients were used.

Results

Mean CCT of subjects was 540.71±35.53 μm (462–621 μm), and the mean disc area was 2.37±0.44 mm2 (1.28–3.66 mm2). CCT showed negative correlations to disc area, rim area, rim volume, and retinal nerve fiber layer (RNFL) area. These correlations were found to be stronger in females. Negative correlations were demonstrated between age and the mean cup depth, maximum cup depth, RNFL thickness, and RNFL cross sectional area. Women had lesser rim volumes, but bigger cup to disk (C/D) area and linear C/D ratios compared to those of men.

Conclusions

In addition to its effect in the accuracy of intraocular pressure measurements, CCT has a structural relationship with the ONH in healthy nonglaucomatous eyes. Therefore, its effect on disc area might be especially important to explain the structural strength of the ONH in the pathogenesis of glaucoma.

The Comparison of Eyelash Lengthening Effect of Latanoprost Therapy in Adults and Children

PURPOSE

To compare the eyelash lengthening effect of latanoprost in adults and children with glaucoma.

METHODS

Twenty eyes of 13 men and 7 women (mean age: 54.9, range 42-69 years) with primary open-angle glaucoma and 20 eyes of 9 boys and 11 girls (mean age: 10.7, range 6-16 years) with glaucoma were included in this prospective study. In 19 children, juvenile glaucoma and in one, pseudophakic glaucoma had been detected. A single eyelash was pulled from the center of the upper eyelid before latanoprost therapy and at the sixth month of therapy, and measured.

RESULTS

In adult cases, the mean eyelash length was 5.79+/-0.18 mm (5.5-6.1 mm) at baseline and 6.45+/-0.21 mm (6.2-6.8 mm) at the sixth month. In children, the mean length was 5.66+/-0.22 mm (5.3-6.0 mm) at baseline and 6.39+/-0.37 mm (5.9-6.9 mm) at the sixth month. The mean difference in eyelash lengths at baseline and the sixth month was 0.67+/-0.09 mm (0.5-0.7 mm) in adults and 0.75+/-0.25 mm (0.4-1.2 mm) in children.

CONCLUSIONS

The differences in mean eyelash lengths at baseline and at the sixth month of latanoprost therapy were statistically significant in both adults and children (p=0.000). The mean of the difference of the eyelash length in children was higher than in adults but the result was not statistically significant (p=0.678).

Comparison of anterior segment parameters and axial lengths of myopic, emmetropic, and hyperopic children

PURPOSE

To compare the anterior segment parameters of myopic, hyperopic, and emmetropic children by using optical biometry.

METHODS

This prospective cross-sectional study included 150 eyes of 150 children between 6 and 16 years old. The eyes were divided into three groups according to their spherical equivalent (SE) refractive error values as myopic [between - 1.0 and - 6.0 diopter (D)], emmetropic (between + 0.50 and - 0.50 D), and hyperopic (between + 1. 0 and + 3.0 D). Axial length (AL), central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and mean keratometry (K mean) measurements were obtained by an optical biometry (LenStar LS 900, Haag Streit Diagnostics) were compared between the groups.

RESULTS

There were no statistically significant differences regarding the ages and genders of the participants between the groups (p > 0.05). The mean SE refractive error values were - 2.20 ± 0.71 D in myopic, - 0.08 ± 0.49 D in emmetropic, and + 2.06 ± 0.53 D in hyperopic eyes. The mean AL values were 24.50 ± 0.69, 23.41 ± 0.61, and 22.33 ± 0.61 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean ACD values were 3.94 ± 0.22, 3.78 ± 0.23, and 3.45 ± 0.20 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean LT values were 3.56 ± 0.20, 3.43 ± 0.17, and 3.31 ± 0.12 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). There were no significant differences in the other parameters between the groups.

CONCLUSIONS

Refractive errors are the main factors those affect anterior segment parameters and AL in children and the most severely affected parameters were found to be the AL, ACD, and LT values.

Prospective, non-interventional, multicenter study of the intraocular pressure-lowering effects of prostaglandin analog/prostamide-containing therapies in previously treated patients with open-angle glaucoma or ocular hypertension

OBJECTIVE

The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting.

METHODS

This non-interventional, multicenter study enrolled previously treated patients who failed to achieve target IOP (or experienced unacceptable adverse events [AEs]) and were prescribed a PGA/P-containing IOP-lowering agent. Treatment was initiated at baseline (V1), and patients returned at weeks 4-6 (V2) and 8-12 (V3). The primary efficacy measure was the change in IOP from baseline at V3 in each eye. The secondary measures were physician's assessment of IOP-lowering efficacy, patients (%) reaching target IOP determined at V1, hyperemia score, physician and patient assessment of study treatment tolerability at V3, and AE frequency/severity. A subgroup analysis of patients receiving the most common study treatment was conducted. All analyses were performed using the safety population (patients who received one or more doses and had any data available).

RESULTS

Of 358 enrolled patients, 60.6% had primary open-angle glaucoma, 29.9% had secondary open-angle glaucoma (protocol amendment), and 13.1% had OHT; 13 patients had multiple diagnoses. At V3, the mean IOP change from baseline was ≥-4.2 mmHg (≥21.1%). IOP met or was lower than the target in 81.7% of patients, 95% exhibited none to mild conjunctival hyperemia (most common AE), and tolerability was rated good/very good by >91.1% of patients and physicians. The results were similar in patients who received the most common study treatment, bimatoprost 0.03%/timolol 0.5% (bim/tim; n=310).

CONCLUSION

PGA/P-containing medications, including bim/tim, significantly reduced IOP in previously treated patients with open-angle glaucoma or OHT; most reached their target IOP or an IOP even lower than their target and reported good/very good tolerability. PGA/P-containing medications such as bim/tim should be considered as a safe, effective therapeutic option for Turkish patients who exhibit poor response, tolerance, or adherence to their previous therapy.

Comparison of anterior segment measurements with LenStar and Pentacam in patients with newly diagnosed glaucoma

PURPOSE

To compare anterior segment measurements obtained using the Pentacam; Oculus, HR and the LenStar LS 900 in patients with newly diagnosed glaucoma.

METHODS

Patients with ocular hypertension and primary open-angle glaucoma who had been treated with PGA were included in the study. Anterior segment measurements including central corneal thickness (CCT), keratometry, anterior chamber depth (ACD) and white-to-white (WTW) corneal diameter obtained with the optic low-coherent reflectometer (LenStar LS-900, Haag-Streit AG, Switzerland) and with the Scheimpflug system (Pentacam; Oculus, HR) were compared. In order to compare LenStar and Pentacam measurements, paired sample t test and 'Bland-Altman' plot were used in the statistical analysis.

RESULTS

Twenty-two female (59.5%) and 15 male (40.5%) totally 37 cases with newly diagnosed glaucoma were included in the study. Anterior segment parameter measurements obtained with both the LenStar and the Pentacam were significantly correlated for right and left eyes, so the right eye values were used in statistical analysis. WTW and ACD values measured with LenStar were statistically significantly higher than those measured with Pentacam (p: 0.0001, p: 0.0001, respectively). There was no statistically significant difference between the CCT values measured by the two devices (p: 0.217).

CONCLUSION

There was a statistically significant difference between the mean values of ACD and WTW measured with the LenStar and Pentacam. These biometric devices should not be used interchangeably. It should be appropriate to use the same device on follow-up of glaucoma patients.

Early Postoperative Effects of Cataract Surgery on Anterior Segment Parameters in Primary Open-Angle Glaucoma and Pseudoexfoliation Glaucoma

Objectives:

To compare the effect of cataract surgery on anterior segment parameters measured by optical biometry in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Materials and Methods:

Twenty-five eyes of 25 patients with POAG and 29 eyes of 29 patients with PXG who had uncomplicated phacoemulsification and posterior chamber intraocular lens implantation surgery were included to our prospective study. Central corneal thickness (CCT), anterior chamber depth (ACD) and axial length (AL) were measured with an optical biometer preoperatively and at 1 month postoperatively. The pre- and postoperative values of intraocular pressure (IOP) and the anterior segment parameters and the differences between POAG and PXG were compared statistically by paired t, independent t and chi-square tests.

Results:

The mean values of preoperative CCT (p=0.042) and ACD (p=0.012) were significantly lower in the PXG than in the POAG group. In the PXG group, IOP decreased (p=0.001) but CCT (p=0.03) and ACD (p=0.001) increased significantly postoperatively; AL did not change significantly. In the POAG group, IOP decreased (p=0.01) and ACD (p=0.004) increased significantly postoperatively, while AL and CCT did not change significantly. There were no significant differences in the pre- to postoperative changes in IOP (p=0.76), AL (p=0.44) and CCT (p=0.52) values between the two groups. However, the postoperative increase in ACD was larger in the PXG group (p=0.03).

Conclusion:

Cataract surgery may cause some changes in IOP and anterior segment parameters like ACD and CCT postoperatively in eyes with POAG and PXG, and these changes may differ between eyes with PXG and POAG.

Oxidant/antioxidant balance in the aqueous humor of patients with glaucoma

AIM

To evaluate total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI) of the aqueous humor (AH) in patients with glaucoma.

METHODS

The prospective study was composed of a study group (n=31) and a control group (n=31). Fifteen patients in the study group were diagnosed with primary open angle glaucoma (POAG), and 16 patients were diagnosed with pseudoexfoliation glaucoma (PEG). The control group was composed of non-glaucomatous patients with cataracts. AH samples were collected and analyzed for TAS, TOS, and OSI levels.

RESULTS

Mean AH TAS level was significantly higher in patients with glaucoma than that in the control group (P<0.01). Mean TOS and OSI levels tended to increase in patients with glaucoma. No significant differences in TAS, TOS, or OSI levels were observed between patients with POAG and PEG.

CONCLUSION

High levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients.

The early effects of intravitreal anti vascular endothelial growth factor agents on intraocular pressure and central corneal thickness

To investigate the early effects of two intravitreal (IV) anti vascular endothelial growth factor agents (anti-VEGF), bevacizumab and ranibizumab, on intraocular pressure (IOP) and central corneal thickness (CCT) within the first post-injection month. This prospective study comprised 109 eyes of 109 adult cases who had IV bevacizumab or ranibizumab injections because of age-related macular degeneration (ARMD), retinal venous occlusion (RVO), diabetic retinopathy, and macular edema or central serous chorioretinopathy (CSCR). None of the cases had medical histories of any kinds of glaucoma or increased IOP and IV injection before and all of them underwent a detailed ocular examination including measurements of IOP by non-contact tonometer and CCT by ultrasonic pachymeter pre-injection. IOP measurements were repeated at 30 min and 1st, 7th, and 30th day after the injection. CCT measurements were repeated at the 7th and 30th post-injection day. Paired sample t tests were used for the statistical analysis in order to evaluate the significance of changes in IOP and CCT. The mean age of 56 male and 53 female cases was 63.58 ± 11.04 years. Fifty-six cases (51.4 %) had diabetic retinopathy, 33 cases (30.3 %) had ARMD, 11 cases (10.1 %) had RVO, and 9 cases (8.3 %) had CSCR. Bevacizumab was used in 97 (89 %) cases and ranibizumab was used in 12 (11 %) cases. The IOP increased significantly 30 min after the injection (p < 0.001) but significant decreases were observed at the 1st, 7th, and 30th day post-injection (p < 0.001). No significant differences were observed in CCT between pre-injection and 7th and 30th post-injection day values (p = 0.924 and p = 0.589, respectively). Intravitreal bevacizumab and ranibizumab injections can cause hyper acute increase in IOP because of vitreal expansion but this effect is generally reversible in non-glaucomatous cases.

Canaliculitis Awareness

Objectives:

To evaluate the demographic characteristics, treatment, and results of patients with canaliculitis.

Materials and Methods:

Medical records including the demographic characteristics, clinical findings, and treatment outcomes of patients diagnosed and treated for canaliculitis between September 2009 and March 2014 were analyzed retrospectively.

Results:

The median age of the 7 canaliculitis patients consisting of 4 women and 3 men was 49 (range 8-58) years. All patients had unilateral canaliculitis (on the right side in 2 and left side in 5 patients) and the inferior canaliculus was involved more frequently (71.4%). Epiphora, chronic conjunctivitis, a palpable and thickened canaliculus, and yellow discharge from the punctum were present in all cases. Actinomyces spp. was the most frequently cultured microorganism (75%). Dacryolith was observed in 6 patients. Canaliculotomy and dacryolith removal with canalicular curettage were performed, followed by medical treatment (topical penicillin 100,000 U/ml and oral ampicillin/sulbactam) for 10 days. Patients were followed up for a mean duration of 17.0±15.2 (range 3-46) months. Signs and symptoms resolved completely within a month. Epiphora recurred in the 36th month in a single patient and was treated with daily canalicular irrigation with antibiotics and there were no further symptoms during 10 months of follow-up after the recurrence.

Conclusion:

Canaliculitis is often overlooked and can be misdiagnosed. Every patient with chronic conjunctivitis and lacrimal infection should be examined carefully for canaliculitis.

Comparing acromegalic patients to healthy controls with respect to intraocular pressure, central corneal thickness, and optic disc topography findings

Aims:

The aim was to compare the intraocular pressure (IOP), central corneal thickness (CCT), and optic disc topography findings of biochemically controlled acromegalic patients and the control group and to evaluate the effect of the duration of acromegaly and serum growth hormone and insulin-like growth factor-1 (IGF-1) levels on these ocular parameters.

Materials and Methods:

IOP measurement with Goldmann applanation tonometry, CCT measurement with ultrasonic pachymetry, and topographic analysis with Heidelberg retinal tomograph III were performed on 35 biochemically controlled acromegalic patients and 36 age- and gender-matched controls.

Results:

Mean IOP and CCT were 14.7 ± 2.9 mmHg and 559.5 ± 44.9 μm in the acromegaly patients and 13.0 ± 1.6 mmHg and 547.1 ± 26.7 μm in controls (P = 0.006 and P = 0.15, respectively). A significant moderate correlation was found between the duration of acromegaly and CCT (r = 0.391) and IOP (r = 0.367). Mean retinal nerve fiber layer (RNFL) thickness was significantly lower in the acromegalic patients (0.25 ± 0.05 mm) as compared to controls (0.31 ± 0.09 mm) (P = 0.01). A significant moderate correlation was detected between IGF-1 level and disc area (r = 0.362), cup area (r = 0.389) and cup volume (r = 0.491).

Conclusion:

Biochemically controlled acromegalic patients showed significantly higher CCT and IOP levels and lower RNFL thickness compared to healthy controls and the duration of disease was correlated with CCT and IOP levels.

Conjunctival impression cytology in non-proliferative and proliferative diabetic retinopathy

AIM

To examine the integrity of the ocular surfaces of subjects with and without diabetes with no conjunctival and dry eye signs and symptoms and compare conjunctival impression cytology findings in diabetics with non-proliferative and proliferative diabetic retinopathy.

METHODS

Conjunctival impression cytology was performed on 43 eyes of 43 subjects with non-proliferative diabetic retinopathy (NPDR), 42 eyes of 42 subjects with proliferative diabetic retinopathy (PDR), and 30 eyes of 30 control subjects. Impression cytology specimens of each group were graded and scored in the range 0-3 according to Nelson's method.

RESULTS

There were 45 (52.9%) women and 40 (47.1%) men. The mean age of the patients was 59.6±9.3y (range, 43-76y) in NPDR group and 58.0±8.8y (range, 41-85y) in PDR group. Cases with NPDR and PDR showed statistically significant higher impression cytology scores than control group (P<0.05). There was no difference between the NPDR and PDR patients for impression cytology grading scores.

CONCLUSION

It is determined that impression cytology grades are altered in patients with NPDR and PDR. Consequently, we suggest that there might be an association between the impression cytology grading scores and the severity of diabetic retinopathy.

Comparison of autofluorescence and optical coherence tomography findings in acute and chronic central serous chorioretinopathy

AIM

To discuss and compare the fundus autofluorescence (FAF) and optical coherence tomography (OCT) in acute or chronic central serous chorioretinopathy (CSCR).

METHODS

Medical records of 100 cases of CSCR were reviewed. Acute and chronic cases were evaluated according to the duration of decreased visual acuity, serous retinal detachment (RD) and focal leakage on fluorescein angiography (FA). Chi-square test was used for statistical analysis.

RESULTS

Forty cases had acute and 60 cases had chronic CSCR. FAF showed focal hypo-autofluorescence in 34 (85%) and iso-autofluorescence in 6 (15%) of acute cases and hypo-autofluorescence in 51 (85%), hyper-autofluorescence in 6 (10%) and iso-autofluorescence in 3 (5%) of chronic cases. OCT showed serous RD with distinct borders correlated with FAF findings (hypo-autofluorescence) in all acute CSCR cases. In chronic CSCR group, OCT showed serous RD with indistinct borders correlated with FAF findings. The differences between the OCT and FAF findings of the two groups were significant (P=0.000).

CONCLUSION

OCT and FAF findings can support the clinical observations in differential diagnosis of acute and chronic CSCR and help clinicians to evaluate retinal pigment epithelium, outer segments of photoreceptors and the components of serous RD.

Corneal properties in children with congenital isolated growth hormone deficiency

AIM

To compare the corneal parameters of children with congenital isolated growth hormone deficiency and healthy subjects.

METHODS

In this cross-sectional, prospective study, 50 cases with growth hormone (GH) deficiency treated with recombinant GH and 71 healthy children underwent a complete ophthalmic examination. The corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were measured with the Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured by a ultrasonic pachymeter.

RESULTS

The mean age was 13.0±3.0 years in the GH deficiency group consisting of 21 females and 29 males and 13.4±2.4 years in the healthy children group consisting of 41 females and 30 males. There was no statistically significant difference between the groups for gender or age (Chi-square test, P=0.09; independent t-test, P=0.28, respectively). The mean duration of recombinant GH therapy was 3.8±2.4y in the study group. The mean CH, CRF, IOPg and IOPcc values were 11.0±2.0, 10.9±1.9, 15.1±3.3, and 15.1±3.2 mm Hg respectively in the study group. The same values were 10.7±1.7, 10.5±1.7, 15.2±3.3, and 15.3±3.4 mm Hg respectively in the control group. The mean CCT values were 555.7±40.6, 545.1±32.5 µm in the study and control groups respectively. There was no statistically significant difference between the two groups for CH, CRF, IOPg, IOPcc measurements or CCT values (independent t-test, P=0.315, 0.286, 0.145, 0.747, 0.13 respectively).

CONCLUSION

Our study suggests that GH deficiency does not have an effect on the corneal parameters and CCT values. This observation could be because of the duration between the beginning of disease and the diagnosis and beginning of GH therapy.

Fundus autofluorescence imaging of patients with idiopathic macular hole

AIM

To investigate the role of fundus autofluorescence (FAF) both in the diagnosis and the preoperative and postoperative evaluation of patients with idiopathic macular hole (MH).

METHODS

Forty eyes of 40 patients diagnosed as idiopathic MH between May 2010 and May 2011 were included in this retrospective study. All patients underwent full ophthalmologic examinations and imagings including fluorescein angiography, fundus autofluorescence (FAF) and optical coherence tomography. Thirty of these patients underwent MH surgery. FAF findings were associated with duration of symptoms, visual acuity at presentation, stage of MH, and postoperative anatomical correction.

RESULTS

The mean duration of patients' symptoms was 3.8±2.0 (1-9) months. The MH was stage 2 in 4 (10%), stage 3 in 24 (60%) and stage 4 in 12 (30%) eyes. The median preoperative best corrected visual acuity was 20/200 (between 20/800 and 20/100). Twenty-eight of cases (70%) showed a stellate appearance with dark radiating striae. Having a visual acuity ≥20/200 was significantly more common in eyes with stellate appearance (P<0.001). The mean duration of symptoms was significantly shorter in eyes with stellate appearance (2.75±0.8 vs 6.33±1.61 months) (P<0.001). The frequency of stage 4 MH was significantly higher in eyes with non-stellate appearance (P<0.001). Anatomical correction of MH was achieved in 91.3% (21/23) of eyes with stellate appearance and 71.4% (5/7) of eyes without this appearance (P=0.225).

CONCLUSION

Stellate appearance in FAF is associated with earlier stages of macular hole, better visual acuity at presentation, shorter duration of symptoms, thus more favorable prognosis.

Thirteen-year vitreoretinal surgical outcomes of 5,097 cases from a tertiary referral center in Turkey

A 13-year retrospective chart review of 5,097 consecutive cases that underwent pars plana vitrectomy (PPV) in a tertiary referral center in Turkey was performed. Age at onset, sex, laterality, associated systemic disease, pre- and postoperative visual acuities (VA), indications, type of surgery and outcomes of surgery were analyzed. The most common indications for vitreoretinal surgery (VRS) were rhegmatogenous retinal detachment (n = 1,802, 35.4%) and proliferative diabetic retinopathy (n = 1,505, 29.5%). The most common vitreoretinal technique combinations performed were PPV with encircling endolaser (EL) and phacoemulsification with intraocular lens implantation (33.0%), PPV with encircling EL (30.4%), and only PPV (7.0%). A statistically significant increase in the mean VA was noted at the first- (1.16 ± 0.44 logarithm of the minimum angle of resolution, logMAR) and sixth-month (1.06 ± 0.61 logMAR) visits when compared to the preoperative VA (1.77 ± 0.58 logMAR; p < 0.001). Comparisons in the top surgical indications, techniques and outcomes for vitrectomy between the countries could be important for the development of subspecialization in VRS.

Comparison of needle revision with subconjunctival bevacizumab and 5-fluorouracil injection of failed trabeculectomy blebs

PURPOSE

To evaluate the efficacy and complications of bevacizumab versus 5-fluorouracil (5-FU)-augmented bleb needling of failed filtration blebs following trabeculectomy.

METHODS

Twenty-seven eyes of 27 patients with bleb failure were included. Patients were randomly assigned to receive either 5-FU or bevacizumab. Needling was performed in the operating room under sterile conditions. After the needling procedure, a viscoelastic material was injected subconjunctivally around the bleb area to avoid the entrance of 5-FU or bevacizumab into the anterior chamber. Bevacizumab (1.25 mg/0.1 mL) was injected into 12 eyes and 5-FU injected into 15 eyes subconjunctivally. All of the patients were controlled weekly until a filtration bleb was maintained. Intraocular pressure (IOP), bleb appearance, and complications were noted in each group. Success was defined as absolute if the IOP 21 mmHg or less without any medication or surgical intervention at last visit, and qualified if the IOP 21 mmHg or less with topical antiglaucomatous medications. The patients were followed from 11 to 26 (median, 17) months.

RESULTS

The IOP decreased, from 31.2±3.2 mmHg to 16.1±2.1 mmHg, in the bevacizumab group on the first postoperative day. The IOP was within normal limits in 1 (8.3%) patient without medication and controlled with topical antiglaucomatous drops in 2 (16.7%) patients. The total success rate was 25% at the time of the last visit. Success was not achieved in 9 (75%) eyes. The IOP was 32.0±4.6 mmHg preoperatively and 12.2±2.6 mmHg on the first postoperative day in the 5-FU injected patients. The total success rate was 80%; 8 (53.3%) eyes showed absolute success, whereas 4 (26.7%) eyes showed a qualified success. A statistically significant difference between groups in terms of success rates was observed (P=0.04).

CONCLUSIONS

Subconjunctival 5-FU application is a more effective therapy than bevacizumab application for needling procedures in failed trabeculectomy blebs.

Autofluorescence and optical coherence tomography findings in optic disc pit-associated maculopathy: case series

The aim of this case series was to report and discuss the clinical, fundus autofluorescence (FAF), and optical coherence tomography (OCT) findings of four eyes of three cases with optic disc pit (ODP)-related serous macular detachment. Three cases were referred to the retina department of our hospital for decreased visual acuities in four of their eyes. In addition to ophthalmological examinations, OCT and FAF were also performed. ODP-related serous macular detachment was detected clinically in all the eyes. OCT also showed two typical components named as 'bilaminar structure' in all eyes and OCT and FAF photography showed precipitates in the retinal outer layers of the detachment area in three eyes. OCT and autofluorescence photography findings can support clinical observations in the diagnosis of ODP-related maculopathy.

Comparison of the outcome of repeat trabeculectomy with adjunctive mitomycin C and initial trabeculectomy

Purpose

To compare the efficacy and safety of repeat and initial trabeculectomy with mitomycine C (MMC).

Methods

Eighty seven patients, who had underwent repeat (repeat group) or initial (initial group) trabeculectomy with MMC, were enrolled in this prospective trial. Postoperative outcome measures included the amount of decrease in intraocular pressure (IOP), the number of anti-glaucoma medications, and the complications. The success of trabeculectomy was defined on the basis of three definitions which were: IOP ≤18 mmHg (definition 1), IOP ≤21 mmHg (definition 2), and the amount of decrease in IOP from baseline ≥30% (definition 3). Success was further defined as "complete" when these criteria were obtained without any anti-glaucoma medications and "qualified" with or without medical therapy and no further surgical procedures.

Results

Fifty nine eyes underwent initial and 28 eyes underwent repeat trabeculectomy. The mean follow-up period was 19.1 ± 5.9 months. Complete success rates were significantly greater in the initial trabeculectomy group (p = 0.02 for definition 1, p = 0.038 for definition 2, p = 0.003 for definition 3). A higher proportion of eyes in the initial group achieved qualified success relative to the group A eyes, but the differences were not statistically significant (p = 0.33 for definition 1, p = 0.99 for definition 2, p = 0.24 for definition 3). The mean number of antiglaucomatous medications at the last examination was 1.2 ± 1.2 in repeat group and 0.7 ± 1.1 in initial group (p = 0.01). The number of complications during the follow up period did not differ significantly between the two groups (p = 0.65).

Conclusions

Repeat trabeculectomy with MMC has high success and low complication rates in patients with previously failed trabeculectomy in spite of the need of higher number of anti-glaucoma medications.

A 1.5 cm-long unknown subconjunctival grass inflorescence misdiagnosed as relapsing conjunctivitis for one year

Foreign bodies are usually detected at the first visit. However, they may be overlooked sometimes, especially in children, and may cause some clinical conditions including unilateral relapsing conjunctivitis. A five-year-old girl was presented to the emergency clinic of our hospital with epiphora, purulent discharge, eyelid swelling, and a foreign body feeling in her right eye. The symptoms had been present for one year, and the patient was treated for relapsing conjunctivitis. In slit lamp examination performed with difficulty because of the patient's lack of cooperation, a localized edema and erythema were observed under the right eyelid. An exploration under general anesthesia was planned, and a 1.5 cm-long subconjunctival grass inflorescence was removed. An unknown subconjunctival foreign body should be considered in each patient with relapsing conjunctivitis, especially in children, even in the absence of ocular trauma.