Ophthalmologic Examination Research Articles

Prevalence and associated factors of epiretinal membrane using spectralis OCT in Fujian Eye Study

We aimed to determine the prevalence and risk factors of epiretinal membrane in a population-based study of residents aged 50 years and older in Fujian Province, Southeast China. The Fujian Eye Study is a population-based cross-sectional eye study in Fujian province, Southeast China. Residents aged 50 years and older were enrolled and did the questionnaire (educational background, income, blood type, disease history, medication history, smoking, drinking and tea consumption, et al.), physical and ophthalmological examinations with height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), refraction, intraocular pressure (IOP), slit lamp, nonmydriatic fundus photograph and spectralis optical coherence tomography (OCT) imaging. Nonmydriatic fundus photograph and Spectralis OCT were used to assess ERM according to a standardised protocol. A total of 8173 residents were included in this study. Among them, 8.42% (95% CI 0.0782–0.0902) had ERM in at least one eye. Multiple logistic regression showed the presence of ERM was only associated with urbanization and geographic location, but not with age, sex, refractive error, IOP, SBP, DBP, HR, BMI, hypertension, diabetic mellitus, hyperlipidemia, education, income, smoking, alcohol and tea consumption. ERM is common among Chinese with 8.42% in at least one eye. Urbanization and geographic location are the only associated factors for ERM in Fujian Eye Study.

Bitot-like Spots and Congenital Aniridia: A Case Report

Background: Bitot’s spots, defined as white foamy triangular or round-shaped spots with the base located at the temporal limbus and the apex towards the lateral canthus, were initially associated with vitamin A deficiency (VAD). More recently, Bitot’s spots were also described in patients with normal vitamin A levels, associated with aniridia, dry-eye syndrome and post-thermal or chemical injury, as well as the usage of benzalkonium chloride (BAK) eyedrops. The aim of this article is to present the management of Bitot-like spots in a patient with congenital aniridia. Methods: An 8-year-old female patient with type 1 congenital aniridia, glaucoma, cataract, strabismus, congenital nistagmus and aniridia-associated keratopathy presented with changes in conjunctival appearance. The ophthalmological examination revealed Bitot-like spots with a foamy appearance, triangular shape, temporal location and proximity to the limbus. Further investigations were required in order to identify the cause of Bitot-like spots. Vitamin D deficiency, dry-eye syndrome, birch and Phleum genus pollen allergy were diagnosed. The patient underwent oral medication with vitamin D and topical treatment with steroids eye solution, preservative-free artificial tears and vitamin A ointment. Results: After three months of treatment, we observed the disappearance of the Bitot-like spots. Conclusions: Congenital aniridia, but also its complications such as glaucoma, dry-eye syndrome and the use of benzalkonium chloride topical medication, increases the risk of Bitot-like spots.

Investigation of UCHL3 and HNMT Gene Polymorphisms in Greek Patients with Type 2 Diabetes Mellitus and Diabetic Retinopathy

Background and Objectives: Recent studies have shed light on the association between genetic factors and diabetic retinopathy (DR) onset and progression. The purpose of our study was to investigate the association between rs4885322 single-nucleotide polymorphism (SNP) of the UCHL3 gene and rs11558538 SNP of the HNMT gene with the risk of DR in Greek patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In our case–control study, we included 85 T2DM patients with DR and 71 T2DM patients without DR (NDR), matched by ethnicity and gender. Demographic and clinical data of all patients were collected, and then patients went through a complete ophthalmological examination and were genotyped for rs4885322 SNP of UCHL3 gene and for the rs11558538 SNP of HNMT gene. Statistical analysis was implemented by STATA v.16.1. Results: No significant differences in demographic and clinical data were observed between the DR and the NDR group (p-value ≥ 0.05), except for the lower mean of age, longer duration of DM, more frequent use of insulin therapy, and higher levels of hemoglobin A1c (HbA1c) in the DR group. The allelic effect of rs488532 increases the risk of DR by 2.04 times, and in the dominant genetic model, the risk of DR is elevated by 123%, while both associations are statistically significant (p-value < 0.05). Moreover, the allelic effect of rs11558538 is associated with a 3.27 times increased DR risk and, in the dominant genetic model, reveals an augmented risk of DR by 231%, while both associations are also statistically significant (p-value < 0.05). Conclusions: The rs4885322 SNP of the UCHL3 gene and the rs11558538 SNP of the HNMT gene are associated with DR risk in Greek patients with T2DM. However, further studies with larger samples and different ethnicities should be implemented to clarify the exact association of these SNPs and DR onset.

A 13-week repeated oral dose toxicity evaluation and a 4-week recovery evaluation of rosemary concentrate containing 50% ursolic acid in male and female rats.

This study was performed to evaluate the safety of rosemary concentrate containing 50% ursolic acid (RCUA50), the ethanolic extract of rosemary. RCUA50 was administered orally for 13 weeks at 1000, 2000, and 4000 mg/kg/day, and then the rats were maintained for 4 weeks without RCUA50 administration for recovery evaluation. We observed clinical signs, body weights, food consumption, functional observations, ophthalmological examination, urinalysis, estrus cycle, hematology, clinical chemistry, sperm analysis, organ weights, gross examination, and histopathological examinations. During the dosing and recovery period, there were no test substance-related deaths, clinical signs, changes of body weights, and food consumption in all treated groups. In the main group, there were no test substance-related effects in functional observations and ophthalmological examination. In the main and recovery groups, there were no test substance-related effects in hematology, clinical chemistry, sperm examination, organ weights, necropsy and histopathological examination. In conclusion, the repeated oral administration of RCUA50 for 13 weeks resulted in no test substance-related adverse effect at all dose levels. Therefore, the NOAEL was considered to be greater than 4,000 mg/kg/day in both sexes under the conditions of this study.

A Novel Variant in TUBB4B Causes Progressive Cone-Rod Dystrophy and Early Onset Sensorineural Hearing Loss.

Sensorineural hearing loss (SNHL) is a frequent manifestation of syndromic inherited retinal diseases (IRDs), exemplified by the very rare form of autosomal-dominant Leber congenital amaurosis with early onset deafness (LCAEOD; OMIM #617879). LCAEOD was first described in 2017 in four families segregating heterozygous missense mutations in TUBB4B, a gene encoding a β-tubulin isotype. To date, only eight more families with similar TUBB4B-associated sensorineural disease (SND) have been reported. Most cases harbored missense variants affecting the same amino acid (Arg391) and only three families segregated variants involving different residues (Tyr310, Arg390). We performed whole-exome sequencing and a full ophthalmological and audiological examination of the affected members in an Italian family segregating syndromic IRD with early onset deafness. We identified a novel, ultra-rare, disease-causing variant in TUBB4B (NM_006088.6:c.1049A>C) that replaces a highly conserved lysine with threonine at amino acid position 350. The functional impact of the Lys350Thr substitution was supported by protein structure modeling studies. The variant segregates in the family members presenting retinal disease with early onset SNHL. Detailed ophthalmological assessment of the affected subjects diagnosed a progressive cone-rod dystrophy. These findings expand the limited number of disease-causing TUBB4B variants, corroborating their association with SND forms, and suggest Lys350 is an important residue for β-tubulin function. Interestingly, our results demonstrate that TUBB4B mutations can cause cone-dominated retinal phenotypes.

Temporal impacts of diverse concentrations of pilocarpine ophthalmic solution on human accommodation

ABSTRACT Clinical relevance Accommodation is crucial for clear near vision and is predominantly affected by presbyopia. The ability to modulate accommodative function with eye drops could offer a pharmacological approach to manage presbyopia. Background To investigate the effects of different concentrations of pilocarpine eye drops on ocular accommodation in young volunteers. Methods In this prospective study, healthy volunteers with mild or moderate myopia with corrected visual acuity of no less than 20/20 were recruited. Participants underwent four visits for baselining and administration of low (0.75%), medium (1.00%), and high (1.25%) concentrations of pilocarpine eye drops respectively. One eye of each participant was chosen and analysed. Ophthalmologic examinations included objective and subjective refraction, corrected distance visual acuity, intraocular pressure, and pupil size. Accommodation was assessed using the WAM-5500 binocular autorefractor. Accommodation facility and the defocus curve were measured. Results Volunteers (n = 24, mean age 23.7 ± 1.5 years) with a mean spherical equivalent of −2.91 ± 1.54 dioptres (D) were recruited. No serious adverse events occurred. All pilocarpine concentrations showed similar pupil constriction without significant intraocular pressure changes (p > 0.05). Pilocarpine induced greater objective refraction changes with higher concentrations (−1.12 ± 1.07D, −1.56 ± 1.38D, −1.68 ± 1.60D for low, medium, and high concentrations, respectively; p < 0.01). Subjective refraction showed a similar dose-response. Accommodative response decreased significantly at the 20 cm stimulus for medium and high concentrations (p < 0.05). Corrected distance visual acuity improved beyond −1.00D to + 0.50D defocus after all three pilocarpines. Accommodative facility improved more by 1.25% than 0.75% (p = 0.04). Conclusions Pilocarpine eye drops are effective in improving ocular accommodation, with higher concentrations leading to greater accommodative changes. Pilocarpine has potential for managing presbyopia.

Serum Levels of Thyroid Hormones and Thyroid Peroxidase Antibodies in Different Types of Glaucoma

Abstract Aim of this study is to analyze connection between thyroid hormones disbalance and thyroid peroxidase antibodies in serum and different types of glaucoma. This was a hospital-based, retrospective case-control study. Eighty-seven patients were recruited for outdoor department of Clinic of ophthalmology for the routine ophthalmological examination from an endocrinologist, with laboratory analysis of serum levels of thyroid hormones and thyroid peroxidase antibodies test. We specifically included patients with primary open-angle glaucoma and pseudoexfoliation glaucoma, since these two types of glaucoma are highly reported clinically. Based on laboratory analysis, we divided patients into three groups: primary open-angle glaucoma patients with hypothyroidism, pseudoexfoliation glaucoma patients with hypothyroidism and control group that included healthy subjects. In our research, we found that there were discrete differences between glaucoma patients and control subjects in serum levels of free triiodothyronine and free thyroxine. In other words, these differences were insignificant. Patients with primary open-angle glaucoma and pseudoexfoliation glaucoma had increased serum levels of thyroid stimulating hormone, when compared to patients in control group. This study highlights the interaction between thyroid hormones and glaucoma development. Laboratory analysis of glaucoma patients confirmed thyroid peroxidase antibodies levels greater than normal. Control group had physiological range of thyroid peroxidase antibodies. These findings support autoimmune theory of glaucoma development.

Prevalence of strabismus in different age groups in Macedonia

Aim: To investigate the prevalence of strabismus by age groups in Caucasian Macedonian population. Methods: A study population of 1900 patients (aged 0-86 years) from the capital city, Skopje, Macedonia, were analysed in a secondary health institution in the central urban area. Ophthalmological examination included: visual acuity, slit- lamp biomicroscopy, autorefraction, and ocular motility examination. Results: In our retrospective cohort (1900), 60 patients did have strabismus (3.2%). The highest prevalence of strabismus was in primary school children (10-14 years- 20.2 %; 0-4 years- 16.2 %; 15-19 years- 11.8% and 5-9 years- 8.6%). Our adult population showed results similar to Caucasian Danish population with prevalence of strabismus of 0.7% (age group 50-54 years) and 0.8 % (age group 55-59). The most frequently identified subtype was esotropia (73.3%), followed by exotropia (23.4%) and cyclovertical strabismus (3.3 %). Conclusion: The overall prevalence of strabismus on Macedonian cohort was 3.2%. Our results on primary school children are much higher than other studies on Caucasian and Asian population, but similar to prevalence in the population in Saudi Arabia. The most prevalent type of strabismus was esotropia (73.3%). Regarding gender distribution, both esotropia and exotropia were more frequent in males.

Blinking characteristics analyzed by a deep learning model and the relationship with tear film stability in children with long-term use of orthokeratology

PurposeUsing deep learning model to observe the blinking characteristics and evaluate the changes and their correlation with tear film characteristics in children with long-term use of orthokeratology (ortho-K).Methods31 children (58 eyes) who had used ortho-K for more than 1 year and 31 age and gender-matched controls were selected for follow-up in our ophthalmology clinic from 2021/09 to 2023/10 in this retrospective case-control study. Both groups underwent comprehensive ophthalmological examinations, including Ocular Surface Disease Index (OSDI) scoring, Keratograph 5M, and LipiView. A deep learning system based on U-Net and Swim-Transformer was proposed for the observation of blinking characteristics. The frequency of incomplete blinks (IB), complete blinks (CB) and incomplete blinking rate (IBR) within 20 s, as well as the duration of the closing, closed, and opening phases in the blink wave were calculated by our deep learning system. Relative IPH% was proposed and defined as the ratio of the mean of IPH% within 20 s to the maximum value of IPH% to indicate the extent of incomplete blinking. Furthermore, the accuracy, precision, sensitivity, specificity, F1 score of the overall U-Net-Swin-Transformer model, and its consistency with built-in algorithm were evaluated as well. Independent t-test and Mann-Whitney test was used to analyze the blinking patterns and tear film characteristics between the long-term ortho-K wearer group and the control group. Spearman’s rank correlation was used to analyze the relationship between blinking patterns and tear film stability.ResultsOur deep learning system demonstrated high performance (accuracy = 98.13%, precision = 96.46%, sensitivity = 98.10%, specificity = 98.10%, F1 score = 0.9727) in the observation of blinking patterns. The OSDI scores, conjunctival redness, lipid layer thickness (LLT), and tear meniscus height did not change significantly between two groups. Notably, the ortho-K group exhibited shorter first (11.75 ± 7.42 s vs. 14.87 ± 7.93 s, p = 0.030) and average non-invasive tear break-up times (NIBUT) (13.67 ± 7.0 s vs. 16.60 ± 7.24 s, p = 0.029) compared to the control group. They demonstrated a higher IB (4.26 ± 2.98 vs. 2.36 ± 2.55, p &amp;lt; 0.001), IBR (0.81 ± 0.28 vs. 0.46 ± 0.39, p &amp;lt; 0.001), relative IPH% (0.3229 ± 0.1539 vs. 0.2233 ± 0.1960, p = 0.004) and prolonged eye-closing phase (0.18 ± 0.08 s vs. 0.15 ± 0.07 s, p = 0.032) and opening phase (0.35 ± 0.12 s vs. 0.28 ± 0.14 s, p = 0.015) compared to controls. In addition, Spearman’s correlation analysis revealed a negative correlation between incomplete blinks and NIBUT (for first-NIBUT, r = −0.292, p = 0.004; for avg-NIBUT, r = −0.3512, p &amp;lt; 0.001) in children with long-term use of ortho-K.ConclusionThe deep learning system based on U-net and Swim-Transformer achieved optimal performance in the observation of blinking characteristics. Children with long-term use of ortho-K presented an increase in the frequency and rate of incomplete blinks and prolonged eye closing phase and opening phase. The increased frequency of incomplete blinks was associated with decreased tear film stability, indicating the importance of monitoring children’s blinking patterns as well as tear film status in clinical follow-up.

P-67 TWO RARE GENETIC DISORDERS IN ONE CASE ‘’ALLAN-HERNDON-DUDLEY-SYNDROME’’ AND’ “TREACHER COLLINS SYNDROME’’:A CASE REPORT

Abstract Introduction Resistance to thyroid hormone syndrome (RTH), also named Refetoff Syndrome is an autosomal dominant or recessive rare genetic disease. It’s incidence is approximately 1:50.000 in newborns. Increasing awareness and knowledge about RTH will increase the diagnosis rate. So that other genetic diseases that accompany can be detected with early genetic consultation. Clinical Case A 45-year-old female patient was consulted to the endocrinology department for abnormal thyroid function tests. In her medical history, she had no known disease and no medication she used regularly. Her TSH level was 1,26 mıU/L(0,45-4,31), fT4:1,94ng/dl(0,85-1,70 ng/dl), fT3:5,73 ng/L(2-4,4). Thyroid autoantibodies were negative. In pituitary MRI, nodular formations that were hypointense compared to normal tissue were observed on the right and left sides of the pituitary (microadenoma?). Anterior pituitary hormones within the normal range. Heterophile antibody was negative. RTH or TSHoma was considered. She was admitted to the service for further examinations. Alpha subunit level could not measured. Basal TSH was found to be 1,49mU/L (0,54-4,31). A TRH stimulation test was performed on the patient and end of the test TSH was found to be 14.6 mıU/L. T3 supression test was performed. End of the test TSH was &amp;lt;0,1 mıU/L. Thyroid hormone resistance was considered. During the patient’s medical history there were no signs of hyperthyroidism other than fatigue. In patient's genetic analysis heterozygous c.401A&amp;gt;C:p variant detected in the THRB gene. NM_006517.5:C.401A&amp;gt;C:p.(Glu134Ala) missense variant heterozygous was detected in SLC16A2 gene and was associated with the ‘’Allan-Herndon-Dudley Syndrome’’ phenotype. The NM__001371623.1;C.2998G&amp;gt;A:p(Glu1000Lys)rs755763024 missense variant was observed heterozygous in the TCOF1 gene and was associated with the ‘’Treacher Collins Syndrome 1’’phenotype. Thyroid function tests were performed to the daughter and sons of the patient (table2). Genetic counseling was recommended to the patient and her family. There in no phenotypic features of ‘’Allan-Herndon-Dudley Syndrome ‘’ and Treacher Collins Syndrome ‘’ detected in the patient. Ophthalmology, otorhinolaryngology and cardiology examination was normal. The patient was diagnosed as RTH. She was clinically asymptomatic and discharged with plans to remain under medication-free monitoring. Conclusion As far as the literature is examined there is no previous case of the coexistence of TCS with RTH and other thyroid function test abnormalities. More case reports are needed to determine whether the coexistence of these two rare diseases is coincidental or related. According to previous literature information AHDS is usually clinically asymptomatic in women. But it is with RTH in the female patient in this case. As in the case, it is important to perform genetic screening and provide genetic counseling to the patients and family members.Table 1:Thyroid Function Tests of the Patient Table 2:Family Members Thyroid Function Test Results (1 daughter and 3 son of the patient)

The Effect of Cataract Surgery on Stereoacuity, Balance, and Falls in Patients With Senile Cataract.

To investigate the effect of cataract surgery on visual acuity, stereoacuity, balance, and falls in patients with senile cataract. Prospective, cross-sectional study. The patients were divided into group 1 if the first surgery was performed on the dominant eye and group 2 on the nondominant eye. After a complete ophthalmologic examination, all patients underwent stereoacuity tests (Titmus and TNO test); Berg Balance Scale and the number of falls in the last 36 months were recorded. All assessments were performed at three time points: the preoperative period, 6 months after the first surgery (primary endpoint), and 24 months after the second surgery (secondary endpoint). The mean number of falls was 4.95±2.6/year in the preoperative period and 1.43±0.59/year in the postoperative period. The incidence of falls after the second surgery decreased by 53.15% compared with the preoperative period. The number of falls and preoperative stereoacuity were negatively and moderately correlated (r=-0.546) (P=0.033). In univariate and multivariate analysis, only low preoperative corrected distance visual acuity in the dominant eye was associated with poor stereoacuity (P=0.001) and a high number of falls (P<0.001) in the preoperative period. Cataract surgery in patients with senile cataracts not only improves visual acuity but also increases stereoacuity level, improves balance, and decreases falls. These effects should be further studied in multicenter, large-participant studies.

Efficacy of sulfasalazine on recurrent acute anterior uveitis: a three-year follow-up.

To evaluate the efficacy of sulfasalazine (SSZ) for recurrent acute anterior uveitis (AAU). Retrospectivechartreview ofpatientsdiagnosed withrecurrent AAU treated with SSZfromJanuary2008 toSeptember 2023. Thegrading ofuveitisactivitywasdefined asper SUNworkinggroup. The primary outcome was thereductionin thenumber ofuveitisflare-upsover a one-year, two-year and three year-period,comparedto pre-treatment year.The response criteriato SSZwere defined as normal ophthalmologic examination. Paired samples Wilcoxon test and Kaplan-Meiersurvival curvewerecalculated using R-Commander statistical software (p < 0.05). Fifty-three patients were included. Mean time of follow up was 38.51 ± 38.45months.Nine patients developed adverse effects to SSZ (16.98%) most of them mild. Ankylosingspondylitis was the most frequent association(n = 28,52.83%), while HLA-B27 was positive in 69.23% of the patients (n = 36). The most frequent indication for SSZ was based on ocular activity in 52.83% (n = 28). The number of flare-ups dropped from 2.25 (± 1.34) in the pre-treatment year to, 0.81(± 0.99) at year 1 (p < 0.001), 0.61 (± 0.78) at year 2 (p < 0.001) and 0.65 (± 0.83) at year 3 (p = 0.005).The median time to flare-upof AAUafter SSZwas15.13months(CI 95, 7.97-27.40). Our data point to sulfasalazine as an effective treatmentto reduce flare-upsin patients with recurrentnon-infectious AAU.Itslow cost andgoodsafetyprofilemake it an interestingtherapeuticalternative,especially in women of childbearing age.

Thrombolytic efficacy and safety of recombinant scu-PA in a rabbit retinal vein occlusion model.

Retinal vein occlusion (RVO) has become the second most common retinal vascular disease after diabetic retinopathy. Existing therapeutic approaches, including intravitreal injection of antivascular endothelial growth factors (anti-VEGFs) and/or glucocorticoids and laser therapy, primarily address secondary macular edema and neovascularisation. However, these strategies do not address the underlying cause of the disease and may have harmful side effects. There is an urgent need for therapies that have a better prognosis and include the administration of thrombolytics at an early stage. Therefore, in the present study, we investigated the thrombolytic effect of treatment with recombinant human Single-chain urokinase-type plasminogen activators (scu-PA)and the differences in its efficacy at different doses in a rabbit RVO model. In addition, through a series of ophthalmological examinations, such as optical coherence tomography (OCT) and electrophysiology, conducted to ascertain the effects of treatment with scu-PA on the ocular fibrinolytic system, we noted a definitive safety window for the vitreous administration of scu-PA. Therefore, this study is the first to confirm that an intravenous or vitreous cavity injection of scu-PA has definitive potential for treating RVO; however, additional clinical studies are needed for further validation.

Altered retinal vasculature in childhood cancer survivors: Data from the German CVSS-study.

Childhood cancer is a risk factor for cardiovascular diseases in later life. Retinal examination allows to non-invasively observe the vasculature of an end-organ. We observe alterations in long-term childhood cancer survivors (CCS). In the Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer-Study, 1002 CCS (23-48 years) having neoplasia prior to 15 years of age were prospectively enrolled in a general and ophthalmologic examination including fundus photography. Central retinal vessel equivalents (arterial: CRAE; venous CRVE) were measured and linear regression analysis was computed to compare CCS to controls from the population-based Gutenberg Health Study (GHS) with adjustment for potential cardiovascular and ophthalmological confounders. Differences in cancer types and treatments were explored. For 837 CCS (45.3% female), CRAE and CRVE were conducted. Both were smaller in CCS previously having leukaemia, central nervous system tumour, neuroblastoma, renal tumour, malignant bone tumour, soft tissue sarcoma and germ cell tumour than in GHS controls. No difference was found for CCS with prior lymphoma. Previous radiotherapy of head or neck was associated with a smaller CRVE. Higher mean arterial blood pressure and intake of antihypertensive medication were associated with smaller CRAE. Retinal vasculature is altered in CCS leading to smaller retinal arteries and veins. Our finding indicates that childhood cancer and its treatment leads to systemic alterations of the microcirculation on both branches of the vasculature system. While the retinal venous vasculature is altered by radiotherapy, the lower vessel width of the arterial branch is associated with arterial hypertension.

Evaluation of Retinal Changes in Women with Different Phenotypes of Polycystic Ovary Syndrome.

Background: The aim of our study was to evaluate the retinal nerve fiber layer (RNFL) and macular and choroidal thicknesses in women with different phenotypes of polycystic ovary syndrome (PCOS), and compare these measurements with those of healthy women of reproductive age. Materials and Methods: This prospective case-control study included 120 eyes of 120 women with PCOS, with each of the four distinct phenotypes comprising 30 eyes of 30 women. Additionally, 30 eyes from 30 healthy women were included in the control group. All participants underwent comprehensive ophthalmologic examinations, and RNFL thickness, macular thickness (MT), and choroidal thickness (CT) in each eye were measured via spectral-domain optical coherence tomography. The body mass index (BMI) of the patients was recorded and compared with the retinal changes. Results: The average mean and nasal segments of the RNFL were significantly greater in the PCOS group than in the healthy control group (p < 0.001). There was a statistically significant difference in foveal retinal thickness between the groups (p < 0.001). Our study revealed significant choroidal tissue thickening subfoveally and at locations 500 μm temporal, 500 μm nasal, 1500 μm nasal, and 1500 μm temporal to the fovea in all phenotypes of the PCOS group (p < 0.001). Additionally, there was a positive correlation between BMI and all CT changes. Conclusions: Our findings indicate that the retinal layers and choroid are affected by all phenotypes of PCOS, one of the most common reproductive abnormalities, albeit to varying degrees. Furthermore, these changes were found to be correlated with BMI.

Assessment of interocular symmetry of choroidal vascularity index and thickness in patients with systemic sclerosis: a prospective study.

Systemic sclerosis (SSc) affects blood vessels, internal organs, and skin. In ophthalmology, SSc impacts the choroid. The choroidal vascularity index (CVI) measures the vascular component of the choroid and may serve as a biomarker for the disease staging and prognosis. Studies have reported reduced choroidal thickness and altered CVI in SSc, which supports the theory of vascular damage. This study aimed to examine interocular symmetry in choroidal parameters among SSc patients. It has provided the insight into the disease symmetry and assessed the representativeness of examining one eye. This prospective single-center cross-sectional study included 33 patients with SSc and 40 healthy controls. The patients underwent ophthalmological examination (including refraction, visual acuity, IOP, biometry, slit-lamp biomicroscopy, dilated fundus examination, and spectral-domain optical coherence tomography) and rheumatological evaluation. Various parameters of the choroid in the macular and peripapillary regions were analyzed, including choroidal thickness, choroidal volume, and CVI. The interocular asymmetry in the choroidal parameters was quantified using signed and absolute differences. The correlation analysis between the left and right eyes was based on the intraclass correlation coefficient (ICC), Spearman's correlation coefficient, and paired Wilcoxon test. There were no significant differences in the macular and peripapillary choroidal parameters between fellow eyes in both SSc patients and controls (p > 0.05). The parameter that showed the lowest correlation among those examined was CVI-in both groups, as well as in both examined areas. The interocular correlation of choroidal parameters was stronger in the peripapillary area than in the macular area in both groups. In general, the results were confirmed in subgroup analyses stratified according to sex, SSc subtype, Scl70 antibody positivity and previous and/or active digital ulcers. There is interocular symmetry of the choroidal parameters in patients with SSc and controls included in our study. The parameters from one eye are representative of the fellow eye of a given patient. This conclusion may contribute to the design and interpretation of future studies. It also broadens our knowledge of SSc pathophysiology.

New systemic treatment approach for primary lymphoma of the orbit and the ocular adnexa

Orbital lymphomas are the most frequently occurring malignant tumor entities in this region. They are less frequently also localized in the ocular adnexa and show ahigh entity-specific heterogeneity regarding the treatment and prognosis. This article gives an overview of the heterogeneity of symptoms of orbital lymphoma and lymphoma of the ocular adnexa and focuses on new systemic options for treatment of this disease. For this article a systematic search of the PubMed databank was carried out and the practical knowledge of the authors was taken into account. Orbital lymphoma and lymphoma of the ocular adnexa show ahigh variability in the clinical symptoms and therefore require acomprehensive ophthalmological examination of the affected patients. Histopathologically assisted diagnostics after an incisional biopsy are essential for the classification into the various lymphoma entities. This is necessary for developing and carrying out atargeted treatment concept consisting of local and systemic treatment modalities. Especially for the new systemic treatment approaches, in addition to the histopathological classification of the lymphoma entity it is also necessary to analyze the molecular features in order to efficiently implement the new highly specific medications. Finally, a close interdisciplinary cooperation of all disciplines involved is absolutely necessary for the best possible treatment, including ophthalmology, hemato-oncology, radiotherapy, radiology, pathology and psycho-oncology. Depending on the localization of the tumor, inclusion of otorhinolaryngology, oral and maxillofacial surgery and/or neurosurgery can be necessary.

Rebound tonometry intraocular pressure reference values for conscious adult Egyptian vultures (Neophron percnopterus).

To obtain standard reference values of intraocular pressure measured with rebound tonometry in conscious healthy Egyptian vultures (Neophron percnopterus). 17 Egyptian vultures presented for a routine health check, involving a full physical examination, blood film examination, Hct, manual total leukocyte count, and plasma biochemistry. 15 animals considered healthy and with no signs of stress underwent an ophthalmic examination, including observation of facial symmetry, adnexa, and direct fundoscopy to screen for ocular disease. Healthy animals, with no evidence of ocular disease and no signs of stress, were included in the study. The birds were manually restraint in an upright position for rebound tonometry of the right and left eyes. Mean and SD of intraocular pressure were 27.33 ± 3.54 mm Hg for the right eye and 27.00 ± 4.11 mm Hg for the left eye. There was no statistical difference when comparing the right and left eyes. The combined mean ± SD for both eyes was 27.2 ± 3.76 mm Hg. Rebound tonometry was well tolerated in all animals included in the study. The results of intraocular pressure with rebound tonometry can be used as reference values during the ophthalmological examination of Egyptian vultures. The investigation of vision threatening diseases in Egyptian vultures may necessitate rebound tonometry as part of a comprehensive ophthalmologic examination. Rebound tonometry values obtained from anesthetized Egyptian vultures, or Egyptian vultures restrained in lateral, dorsal, or sternal positions, may differ from those reported here.

Could Nocturnal Chronic Hypoxia Cause Ocular Surface Symptoms by Affecting Limbal Epithelial Cells in Patients With Obstructive Sleep Apnea?

To investigate the effect of nocturnal chronic hypoxia on the thickness changes of the corneal limbal epithelial area that provides regeneration of the corneal epithelium and ocular surface evaluation parameters in patients with obstructive sleep apnea (OSA). All patients diagnosed with OSA and the control group underwent a complete ophthalmological examination, including slit-lamp examination and funduscopy. Tear break-up time, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and anterior segment optical coherence tomography were performed with fluorescein sterile strip for ocular surface evaluation. Oxygenation levels of patients during night sleep were different between mild-severe and moderate-severe groups. The Ocular Surface Disease Index results were statistically significantly different between the severe OSA group and the mild OSA group, and between the control group and all other OSA groups (P < 0.05). The limbal epithelial thickness (LET) value was found to be lower in the moderate OSA group than in the mild OSA group and the control group and was statistically significantly higher than in the severe OSA group. In the severe OSA group, the LET value was found to be statistically significantly lower than all other groups (P < 0.05). In the literature, there is no study evaluating the effect of prolonged hypoxia on limbus epithelium as in patients with OSA. In this study, LET was measured to be statistically significantly thinner as the severity of OSA increased. Considering these results, it can be concluded that the proliferation of limbal stem cells is reduced in prolonged hypoxia.

Is obstructive sleep apnea syndrome a risk factor for floppy eyelid syndrome? A multicenter study

ABSTRACT Objective Evaluate the relationship between OSAS and floppy eyelid syndrome [FES], along with possible confounding factors such as gender, age, and BMI. Methods This was a multicenter, cross-sectional prospective study. Patients referred to the sleep clinic suspected of OSAS were included in the study. Polysomnography, ophthalmological examination, and standard sleep questionnaires were applied for all patients. Results A total of 617 patients, 68.4% of whom were men, with a mean age of 50.66 [±12.43] years were included. While FES was 70.2% in the group with OSAS for ≥5/h, OSAS was detected in 93.6% of the individuals with FES. In addition, a positive correlation was found between AHI and FES. Age and the male gender were independent risk factors for FES. Conclusion A direct relationship was found between FES and the severity of AHI and OSAS. However, there was no evidence that OSAS is an independent risk factor for FES.