Routine Ophthalmologic Examination Research Articles

Tiroid Oftalmopati Hastalarında In vivo Konfokal Mikroskopi Kullanılarak Langerhans Hücrelerinin Değerlendirilmesi: Retrospektif Bir Çalışma

Objective: To assess corneal Langerhans cell (LC) density in thyroid-associated ophthalmopathy (TAO) patients to evaluate the role of inflammation in ocular surface disease related to TAO by using in vivo confocal microscopy (IVCM). Methods: Thirty-three patients who had inactive disease [(Clinical Activity Score (CAS)<3] and thirty age-matched healthy control subjects were enrolled in the study. All subjects underwent routine ophthalmologic examination including visual acuity levels, intraocular pressure, anterior segment, and posterior segment evaluation. The subjects were evaluated with tear break-up time (BUT). IVCM was performed to assess LC density in the central cornea. Also, correlation analyses of LC density and clinical data were performed. Results: The mean BUT was 9.61±5.01 seconds in the TAO group and 12.70±2.76 seconds in the control group (p=0.003). The median central corneal LC density in the control group was 19.00 (7.00-24.50) whereas it was significantly increased to 68.00 (50.00-92.00) in the TAO patients (p<0.001). In correlation analysis, there was a significant negative correlation between age and CAS of TAO patients (r=-0.348, p=0.047), and the age of TAO patients was not correlated with BUT and LC count (r=0.236, p=0.186 and r=-0.211, p=0.240, respectively). BUT of TAO patients was negatively correlated with LC count and CAS (r=-0.495, p=0.003 and r=-0.644, p<0.001, respectively). The CAS of the patients was not correlated with the LC count of the patients (r=0.261, p=0.143). In the control group, BUT, CAS and LC count was not correlated with each other. Conclusion: TAO patients in the inactive phase suffer from ocular surface inflammation and LC participates in corneal inflammation in TAO.

Hidden risks of respiratory support in neonates: retinopathy of prematurity

Background. Retinopathy of prematurity (RP) is the main reason for visual disability in premature survivors. RP increases chances for re-hospitalization and re-admission for special help by 1.5–4 times. It can lead to blindness in childhood. Risk factors for RP are mechanical ventilation and oxygen as well as weight gain problems in the postnatal period. The purpose was to assess the influence of different elements of intensive care on the development of severe RP, particularly, respiratory support strategies. Materials and methods. Simple retro-prospective blind non-randomized trial in two separate medical centers of Dnipro enrolled 122 premature neonates with the gestational age of 28–32 weeks from 2016 till 2020. The endpoint for assessment was the development of moderate and severe RP. We performed a univariate logistic regression analysis to analyze the odds ratio and 95% confidence interval (95% CI) for main risk factors. The confidence p level was 0.05. Results. Eighteen percent of premature neonates presented with moderate or severe RP on the 14th day of intensive care according to routine ophthalmologic examination. The moderate and severe RP was associated with an increase in length of noninvasive respiratory care by 4 times (p = 0.01), prolonged conventional ventilation by two-fold (p = 0.33), CPAP length by 4.5 times (p = 0.05), longer usage of additional oxygen (FiO2 > 30 %) by 4 times (p = 0.01). AUC for all these predictors ranged from 0.63 to 0.68. We found the following main predictors of retinopathy. According to statistics, every single day of respiratory support increases the chance of moderate or severe RP by 7–9 % depending on ventilation method, and caffeine citrate usage increases this chance by 6 times. Every 100 g of weight decrease is associated with a 16% increase in RP development risk (p = 0.03). Conclusions. Any respiratory support increases the risk of moderate and severe RP. Thus, the usage of these intensive care modalities can’t be preventive. Attentive modes of weight control should help in the prophylaxis of RP development as well as usual ophthalmologic examinations.

Assessment of Subfoveal Choroidal Thickness with SD-OCT in Eyes with Different Stages of Age-Related Macular Degeneration (AMD)

Purpose: The aim of the study was to compare the subfoveal choroidal thickness (SFCT) with the use of Spectral-Domain OCT in eyes with AMD of different stages.
 Methods: The participants comprised of 30 age-matched normal eyes as controls (Group 1), 19 with early-AMD eyes (Group 2), 14 with intermediate-AMD eyes (Group 3) and 29 with advanced (neovascular) AMD eyes (Group 4). All subjects underwent routine ophthalmologic examination. The choroid images, which included the subfoveal choroidal thickness images, obtained using Spectral-Domain Optical Coherence Tomography (and the technique of Enhanced Depth Imaging-EDI). All of the participants volunteered in this study and remained anonymous due to the protection of their personal data.
 Results: 92 eyes with age greater than 65 years old were included. The mean subfoveal choroidal thickness was 260.93 ± 46.54 μm in age-matched normal eyes, 255.10 ± 44.85 μm in early AMD eyes, 230.92 ± 45.70 μm in intermediate AMD eyes and 206.82 ± 44.43 μm in advanced (neovascular) AMD eyes. There were statistically significant differences in the measurement results between the 4th Group with the 1st Group (P<0.0001) and 2nd Group (P=0.0006) respectively, meaning that SFCT was greater in normal and early AMD eyes.
 Conclusion: Decreasing subfoveal choroidal thickness was demonstrated in the progression of AMD, especially in the advanced AMD eyes compared to normal or early AMD eyes.

PERIPAPILLARY RETINAL NERVE FIBER ALTERATIONS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

Objectives: To evaluate the effect of heart failure with reduced ejection fraction (HFrEF) on retinal nerve fiber layer (RNFL) thickness.
 Methodology: The study included patients who were being followed at Kartal Kosuyolu High Speciality Training and Research Hospital for HFrEF and were referred to the Eye Clinic of the Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey between 2017-2019. Study participants were divided into two groups, one comprising HFrEF patients and a control group of patients without HF. Each patient underwent a routine ophthalmologic examination including best corrected visual acuity evaluation, intraocular pressure measurement, slit-lamp biomicroscopy and fundus examination. The RNFL of each patient was measured using spectral domain OCT.
 Results: A total of eyes of 37 HFrEF patients and 38 controls were evaluated. Superior RNFL thickness was 113.71±17.08 μm in the HFrEF group and 126.22 ± 13.68 μm in the control group (p=0.001). Inferior RNFL thickness was 117.88 ± 14.5 μm in the HFrEF group and 131.69 ± 12.93 μm in the control group (p<0.001). Average RNFL thickness in the HFrEF and control groups was 92.32 ± 10.22 μm and 103.31 ± 8.14 μm, respectively. There were significant differences between the study groups in all five parameters.
 Conclusion: In this study, RNLF thinning occurs in HFrEF compared to the control group that may be useful for demonstrate tissue perfusion deficiency in HFrEF.

Prevalence of Diabetic Retinopathy and Correlation with HbA1c in Patients Admitted in Khyber Teaching Hospital Peshawar

Objective: To determine the prevalence of diabetic retinopathy in patients admitted in Khyber Teaching Hospital Peshawar and to correlate different stages of diabetic retinopathy with HbA1C levels. Methodology: This cross sectional study was conducted at Department of Ophthalmology, Khyber Teaching Hospital, MTI, Peshawar from December 2019 to May 2020. All patients over the age of 15 years who were diagnosed with diabetes mellitus were included in the study while patients with cataract or retinopathy due to other pathologies were excluded. All diabetic patients were admitted through outpatient department. In the ward their blood pressures were recorded and HbA1c levels were also measured. Visual acuity (VA) was checked. Screening for diabetic retinopathy was done by a consultant ophthalmologist by Optos Ultrawide Field Imaging of retina and Optical Coherence Tomography (OCT) of macula to establish stages of diabetic retinopathy and presence of diabetic macular edema respectively. Results: A total of 103 diabetic patients were included. Their retina was photographed, viewed and analyzed. Diabetic retinopathy, irrespective of the type, was found in 69 patients with a prevalence of 66.9%. Patients with lower ranges of HbA1c (below 6%) showed no evidence of DR. The clustering of majority of patients with diabetic retinopathy with HbA1c levels of 8 to 12 %, showed a significant relationship between high blood sugar levels and severity. Conclusion: In our study the higher frequency of retinopathy is alarming by considering it one of the leading causes of blindness in working class. It is highly recommended that routine ophthalmologic examination may be carried out along with optimal diabetic control.

PERIPAPILLARY RETINAL NERVE FIBER ALTERATIONS IN HEART FAILURE WITH REDUCED EJECTION FRACTION

Objectives : To evaluate the effect of heart failure with reduced ejection fraction (HFrEF) on retinal nerve fiber layer (RNFL) thickness. Methodology: The study included patients who were being followed at Kartal Kosuyolu High Speciality Training and Research Hospital for HFrEF and were referred to the Eye Clinic of the Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey between 2017-2019. Study participants were divided into two groups, one comprising HFrEF patients and a control group of patients without HF. Each patient underwent a routine ophthalmologic examination including best corrected visual acuity evaluation, intraocular pressure measurement, slit-lamp biomicroscopy and fundus examination. The RNFL of each patient was measured using spectral domain OCT. Results : A total of eyes of 37 HFrEF patients and 38 controls were evaluated. Superior RNFL thickness was 113.71±17.08 μm in the HFrEF group and 126.22 ± 13.68 μm in the control group (p=0.001). Inferior RNFL thickness was 117.88 ± 14.5 μm in the HFrEF group and 131.69 ± 12.93 μm in the control group (p<0.001). Average RNFL thickness in the HFrEF and control groups was 92.32 ± 10.22 μm and 103.31 ± 8.14 μm, respectively. There were significant differences between the study groups in all five parameters. Conclusion : In this study, RNLF thinning occurs in HFrEF compared to the control group that may be useful for demonstrate tissue perfusion deficiency in HFrEF.

Ophthalmologic findings and complications before and after hematopoietic stem cell transplantation: single-center study.

Different and various system complications and late effects may occur after hematopoietic stem cell transplantation (HSCT). It was aimed to obtain information about the frequency of ophthalmologic complications and their relationship with treatment. This retrospective study includes 104 children who underwent HSCT between February 2019 and June 2020 at the Pediatric Bone Marrow Transplant Unit. Patients' ages, genders, diagnosis, transplant types, chemotherapy regimens, transplantation details, conditioning regimens, supportive cares, graft versus host disease (GvHD) prophylaxis, infection episodes, and ophthalmologic findings were evaluated. Of the 104 patients included in the study, 38 (36.5%) were female and 66 (63.5%) were male. Average age ± SD was 8.7 ± 4.91. Considering the diagnoses, the majority of the patients were acute lymphoblastic leukemia (46 patients-44%). Myeloablative regimen was used in 93 (89%) of the patients, and reduced intensity conditioning (RIC) was used in 11 patients (10%). While total body irradiation was applied in 16 (15%) patients, one patient was received cranial radiotherapy. Cyclosporine was used in 96 (92%) patients. CMV reactivation was detected in 54 (51%) of the patients. CMV retinitis was not seen. Ocular pathology was detected in 20 (19%) patients before HSCT and in 12 (11%) patients after HSCT. The most common pathology was dry eye. Routine ophthalmologic examinations are important in terms of early diagnosis. In addition, GvHD and CMV prophylaxis is important because of reducing the risk of ocular complications after HSCT.

The electrophysiological tests in the early detection of the visual pathway dysfunction in patients with microadenoma

PurposeTo evaluate the validity of electrophysiological tests in the early diagnosis of a ganglion cells and/or optic nerve dysfunction in patients with pituitary microadenoma.Methods66 eyes, from 33 patients with microadenoma with no evidence of the optic chiasm compression in magnetic resonance imaging (MRI) and the visual impairment in the routine ophthalmological examination, standard static perimetry (24-2 white on white) and optical coherence tomography (HD-OCT), were analysed. The pattern electroretinogram (PERG), standard pattern visual evoked potentials (PVEPs) and multichannel visual evoked potentials (mVEPs) (ISCEV standards) were performed. The results obtained from the electrophysiological tests were compared to the same number of age-matched healthy controls.ResultsStatistically significant differences between the patients with microadenoma and healthy controls were detected in all electrophysiological tests (p < 0.001). The most frequent abnormalities were observed in mVEPs (25/33 patients, 75.8%; 43/66 eyes, 65.2%). The most frequent features registered in this test were: (1°4′)—an increase in the P100wave latency from uncrossed fibres (13/33 patients, 39.39%; 21/66 eyes, 31.8%) and (0°16′)—an amplitude reduction of this wave from the crossed fibres (11/33 patients, 33.33%; 19/66 eyes, 28.8%). The changes in PVEPs (15/33 patients, 45.5%; 25/66 eyes, 37.9%) and PERG (10/33 patients, 30.3%; 15/66 eyes, 22.7%) were also registered. Of all the tests and parameters analysed in the study, the greatest diagnostic value in detecting the visual pathway dysfunction in this group of patients was the amplitude of P100 wave from the crossed fibres of the mVEPs (1°4′) with a sensitivity of 60.6% and a specificity of 93.8%. These parameters suggest that this type of dysfunction is downstream to the chiasm and can also indicate the visual pathway dysfunction severity.ConclusionsIn patients with microadenoma, the abnormalities in the electrophysiological tests are registered even without clinical evidence of visual impairment from the routine ophthalmological examination, SAP, OCT and chiasmal compression in MRI. The mVEPs have the most significant role in the diagnosis of the visual pathway dysfunction in patients with microadenoma.

Comparison of the morphological and biomechanical characteristics of keratoconus, forme fruste keratoconus, and normal corneas

ABSTRACT Purpose: To explore the feasibility of corneal morphological and biomechanical parameters for keratoconus and forme fruste keratoconus diagnosis. Methods: This case–control study included a total of 517 eyes from 408 keratoconus patients (KC group), 83 eyes from 83 forme fruste keratoconus patients (FFKC group), and 158 eyes from 158 patients with normal corneas (NL group). All subjects underwent routine ophthalmologic examinations. Pentacam and Corneal Visualization Scheimpflug Technology (Corvis ST) were used to obtain corneal morphological and biomechanical parameters. Differences between groups were compared using receiver operating characteristic (ROC) curve analysis. Results: ROC analysis showed that all corneal morphological parameters and most biomechanical parameters distinguished KC from NL, with an area under the curve (AUC) greater than 0.80, of which Belin–Ambrósio enhanced ectasia total deviation index (BAD-D) and tomographic and biomechanical index (TBI) were most efficient. The AUC for distinguishing KC from NL of the BAD-D was 0.989 and the TBI was 0.993, which were not statistically significant (DeLong et al., P= .232). The BAD-D cut-off point of 1.595 provided 95.9% sensitivity for distinguishing KC from NL with 100% specificity. The TBI cut-off point of 0.515 provided 96.7% sensitivity for distinguishing KC from NL with 100% specificity. The ability of other parameters to distinguish KC from NL was lower than that of BAD and TBI. Except for central astigmatism from the anterior corneal surface (AstigF), the AUC that distinguished FFKC from NL was 0.862. The AstigF cut-off point of 4.65 provided 73.5% sensitivity for distinguishing FFKC from NL with 99.3% specificity. Other parameters distinguished FFKC from NL with low efficiency. Among them, the AUC for distinguishing FFKC from NL of the TBI was 0.722, whose cut-off point of 0.273 provided 55.4% sensitivity for distinguishing KC from NL with 79.7% specificity. Conclusion: BAD-D and TBI have the highest efficiency, sensitivity, and specificity for distinguishing KC from NL. Except for AstigF, other corneal morphological and biomechanical parameters have a relatively low ability to distinguish FFKC from NL.

Effects of Medetomidine, Dexmedetomidine and their combination with Acepromazine on the intraocular pressure (IOP), tear secretion and pupil diameter in dogs

BackgroundA great number of sedatives and anaesthetics have been used to perform surgeries or routine ophthalmologic examinations in animals and sometimes the combination of these medicines has more suitable effects than each one alone.ObjectivesThis paper aims to explore the main effects of Medetomidine + Acepromazine, Dexmedetomidine + Acepromazine on intraocular pressure, tear secretion and pupil diameter.MethodsTo accomplish the aforementioned aim, 32 adult dogs (aged one‐to‐three‐years‐old) were clinically examined. Dogs were divided into four groups consisting of group DA, Dexmedetomidine (5 µg/kg) + Acepromazine (0.05 mg/kg); Group D, Dexmedetomidine (5 µg/kg); Group M, Medetomidine (10 µg/kg); Group MA, Medetomidine (10 µg/kg) + Acepromazine (0.05 mg/kg). The ocular factors including tear production, pupil diameter and intraocular pressure of both right and left eyes were first measured and then recorded in each dog at time T0 (−15 min). Afterwards, the drugs were administered intramuscularly, based on which the ocular factors were re‐measured at T1 (+5 min), T2 (+15 min) and T3 (+20 min). All four groups showed a reduction in intraocular pressure, which was significant in DA, D and M groups.ResultsFurthermore, there was a fluctuation in the amount of tear secretion in DA and D groups (increase and then decrease), as well as a significant reduction in M and MA groups. Decreasing in pupil diameter also occurred in all four groups, but the reduction was significant only in DA and MA groups.ConclusionAccording to the results obtained, as the changes caused by the systemic administration of the above drug compounds did not exceed the physiological range, it can be concluded that these combinations could be utilized as suitable sedatives or pre‐anaesthetic compounds in the eye surgeries.

Multimodality Image Analysis in a Cohort of Patients with Atypical Juvenile Ocular Toxocariasis.

Purpose To analysis the multimodal imaging of a group of patients diagnosed clinically with atypical juvenile ocular toxocariasis (OT). Methods In this case series study, we examined 9 young patients diagnosed with atypical OT. Routine ophthalmological examinations, fundus photography, optical-coherence tomography (OCT), fluorescein angiography (FFA), and B-mode ultrasound were performed. A questionnaire was used to record whether the patients were newly diagnosed and whether they had a history of exposure to a cat and dog. Aqueous humor and serum samples were taken for serological tests. Results In all the patients, yellow-and-white dot-shaped lesions and perivascular white sheath were seen in the fundus. Heterogeneous changes including hyper-reflection in the disrupted neuroretina, hyper-reflection in the outer retinal layer, high-reflection mass on the surface of the neuroretina accompanied with reflective attenuation, and high-reflection mass involving the entire neuroretina or high-reflection mass in the vitreous body were noticed in OCT images. On FFA, seven of these patients (77.8%) showed leakage of fluorescein in the small- and medium-branch veins of the retina, and a “bristle-like” change indicated increased permeability of the vessels. B-mode ultrasound showed proliferative membranes and proliferative bands (33.3%), as well as spotted opacity in the vitreous (66.7%). The antibodies to Toxocara canis in the aqueous humor and serum were positive, and the Goldmann–Witmer coefficient was significantly increased in 6 out of 7 patients. Conclusions Multimodality images are useful in the diagnosis of atypical juvenile OT, which could be easily overlooked and misdiagnosed.

Pseudotumor cerebri syndrome in a child with Alagille syndrome: intracranial pressure dynamics and treatment outcome after ventriculoperitoneal shunting

Alagille syndrome (AS) is a rare multisystem disease of the liver, heart, eyes, face, skeleton, kidneys, and vascular system. The occurrence of pseudotumor cerebri syndrome (PTCS) in patients with AS has been reported only exceptionally. Owning to its rarity and a mostly atypical presentation, the diagnosis and natural history of affected patients remain uncertain. We report an atypical case of PTCS in a 4-year-old boy with a known history of AS who presented with bilateral papilledema (PE) on a routine ophthalmological examination. Visual findings deteriorated after treatment with acetazolamide. Continuous intracranial pressure (ICP) monitoring was then utilized to investigate ICP dynamics. Successful treatment with resolution of PE was achieved after ventriculoperitoneal shunting but relapsed due to growth-related dislocation of the ventricular catheter. This report brings new insights into the ICP dynamics and the resulting treatment in this possibly underdiagnosed subgroup of PTCS patients. It also demonstrates that ventriculoperitoneal shunting can provide long-term improvement of symptoms for more than 10 years.

Comparison of Macular Choroid Thickness in Healthy Individuals and Non-Ocular Involvement Sarcoidosis Patients

Amaç: Bu çalışmada oküler tutulumu olmayan sarkoidoz hastaları ile sağlıklı bireylerde maküler koroid kalınlığının karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Bu retrospektif çalışmaya oküler tutulumu olmayan 25 sarkoidoz hastasının 25 gözü ile sağlıklı 25 bireyin 25 gözü dahil edildi. Hasta dosyalarından rutin oftalmolojik muayene bilgileri ve Spektral Domain Optik Koherens Tomografi (Heidelberg Engineering, Heidelberg, Germany) yardımıyla koroid kalınlığı kayıtları alındı. Koroid kalınlığı subfoveal, 1500 µm nazal ve 1500 µm temporal kadranlarda ölçüldü. Bulgular: Oküler tutulumu olmayan sarkoidozlu hastalarda ortalama yaş 43,02±3,25 iken kontrol grubunda 44,07±4,21 idi (p=0,65). Oküler tutulumu olmayan sarkoidozlu hastalarda 12 erkek olgu varken kontrol grubunda 11 erkek olgu mevcuttu (p=0,53). Ortalama aksiyel uzunluk ise oküler tutulumu olmayan sarkoidozlu hastalarda 22,30±0,46 izlenirken kontrol grubunda 22,16±0,34 bulundu (p=0,27). Koroid kalınlıkları sarkoidozlu hastalarda subfoveal kadranda 248,16±42,7 µm, nazal kadranda 254,21±42,6 µm, temporal kadranda 260,5±31 µm iken sağlıklı bireylerde subfoveal kadranda 254,13±52,3 µm, nazal kadranda 259,26±52,3 µm, temporal kadranda 267,19±64,7 µm olarak saptandı. Sarkoidozlu hastalar ve sağlıklı bireylerin subfoveal, temporal ve nazal kadranlarda koroid kalınlıkları arasında anlamlı bir fark bulunamadı (sırasıyla p=0,059, p=0,072, p=0,088). Sonuç: Oküler tutulumu olmayan sarkoidoz hastaları ile benzer yaş grubu sağlıklı bireylerin subfoveal, temporal ve nazal kadranlarda koroid kalınlığı arasında anlamlı bir fark bulunamadı. Ancak koroid kalınlıkları arasında fark saptanamamasının nedeni hasta grubunun evresi ve hasta sayısının az olması ile ilgili olabileceği düşünülmüştür.

Experience of applying cosmetic Etafilcon A contact lens in cases with microcornea.

Microcornea is a rare condition that frequently resulets in serious cosmetic concerns due to the resultant asymmetrical appearance of the eye, and its cosmetic rehabilitation is possible with the use of colored contact lenses. This paper aims to present our experiences with the use of cosmetic Etafilcon A contact lenses for microcornea. Eight patients with unilateral microcornea without any systemic involvement were included in this study, and they underwent routine ophthalmological examination, corneal topography, and optical biometry. We applied the cosmetic Etafilcon A contact lens (1-DAY ACUVUE® DEFINE® with Lacreon®) of the same edge color to the patients. The levels of satisfaction in terms of cosmesis and comfort were evaluated with the use of visual analog scales (VAS). In the patients, the corneal diameter asymmetry was acceptably adjusted, and each of the patients reported extreme satisfaction. The mean VAS score was 8.9 ± 1.0 (range: 7-10) for the cosmetic satisfaction rate and 8.4 ± 1.0 (range: 7-10) for the comfort rate. The patients obtained the best-corrected visual acuity without or with additional eye-glasses. None of the patients complained about vision issues under photopic and scotopic conditions. 1-DAY ACUVUE® DEFINE® with Lacreon® lens has promising satisfactory cosmetic outcomes along with visual enhancement in cases of microcornea. This is the first study to report the use of this lens for the cosmetic rehabilitation of patients with microcornea.

Non-infectious Intraocular Inflammation Following Intravitreal Anti-Vascular Endothelial Growth Factor Injection.

Objectives:To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD).Materials and Methods:The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded.Results:Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients.Conclusion:Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.

A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study

Introduction: Primary keratoconus is a non-inflammatory corneal ectasia disease with an unknown cause. Nowadays, the most widely used treatment method is corneal collagen crosslinking based on the Dresden protocol. Due to the long surgery time, we have been searching for a new method which cost less time in surgery. Methods: A retrospective, observational cohort study was used. A total of 31 participants (59 eyes) with primary keratoconus were collected. Twelve of them (24 eyes) used the standard Dresden protocol, and the remaining 19 (35 eyes) used a higher-energy accelerated corneal collagen cross-linking method. Application of riboflavin solution to the de-epithelialized cornea for 10 min, then the cornea is UVA irradiated (wavelength, 365 nm and power, 30 mW/cm²) for another 3.55 min, and the total irradiation energy is 6.4J/cm². Participants were followed up for 12 months after surgery and underwent complete examinations at 3, 6, and 12 months in predetermined windows of time. The examinations items include routine ophthalmological examination, uncorrected vision acuity (UCVA), best corrected visual acuity (BCVA), refraction, corneal curvature, the elevation of the thinnest point on front surface and back surface (F Ele Th, B Ele Th), the thickness of the thinnest point of the cornea (CT), and the density of the corneal endothelial cells (ECD). The independent sample t-test method was used to compare the changes of the parameters of the standard Dresden protocol and the higher-energy accelerated corneal collagen cross-linking. Results: In the A-CXL treatment group, the maximum keratometry value decreased by 1.48D from baseline, UCVA improved by an average of 0.07 logarithm of the minimum angle of resolution (logMAR) units, BCVA improved by an average of 0.15 logarithm of the minimum angle of resolution (logMAR) units. All of those are similar to standard Dresden protocol group. There were no significant changes in endothelial cell count and thickness of cornea 1 year after treatment. Conclusions: In this study, we found that accelerated corneal collagen cross-linking under 6.4J energy has a similar surgical effect as corneal collagen cross-linking under the Dresden protocol, and did not cause more adverse events.

Evaluation of Peripapillary and Macular Vascular Flow Changes with OCT-A in Patients with Superficial Optic Disk Drusen.

ObjectivesThe purpose of this study was to compare the peripapillary and macular vascular flow changes between healthy adults and adult patients with superficial optic disk drusen (ODD), as evaluated by optical coherence tomography angiography (OCT-A).MethodsIn this retrospective study, 44 eyes of 22 patients with superficial ODD followed-up in our neuro-ophthalmology unit and 54 eyes of 27 healthy individuals admitted to our clinic for routine ophthalmological examination were included in the study. The superior, inferior, nasal, and temporal radial peripapillary capillary plexus (RPC) vessel density (VD) values; superior, inferior, nasal, and temporal parafoveal and foveal region superficial capillary plexus (SCP) and deep capillary plexus (DCP) VD values; and choriocapillaris flow (CCF) area and foveal avascular zone area were evaluated by OCT-A.ResultsThere was no statistically significant difference between groups in terms of age and sex. While there was a significant decrease in the temporal RPC VD values in cases with ODD (p=0.02), no significant difference was observed in other quadrants. No significant differences in either parafoveal zone four quadrant, foveal SCP and DCP VD values, or foveal avascular zone measurements were found between groups, while CCF area values were significantly higher in the study group (p=0.012).ConclusionCompared to healthy controls, our results showed a decrease in the RPC temporal quadrant VD values, and an increase in CCF area in cases with superficial ODD. To evaluate the effects of ODD on optic nerve head and macular perfusion, and to understand its underlying mechanisms and secondary complications, longer follow-up studies with larger case series are needed.

Comparison of macular thickness change by optical coherence tomography after uncomplicated cataract surgery in eyes with and without exfoliation syndrome

To evaluate the effect of exfoliation syndrome (ES) on macular thickness after uncomplicated cataract surgery. 87 patients (87 eyes) who underwent uncomplicated cataract surgery were included in the study. Optical coherence tomography (OCT) films were taken in addition to the routine ophthalmologic examination before the surgery and at postoperative 1st week, 1st, 3rd and 6th months. Mean macular thickness, central macular thickness and macular volume values obtained from the 6 × 6mm macular map in the OCT measurements were recorded. The cases were divided into two groups as Group 1: cases without ES and Group 2: cases with ES. The macular values obtained from the OCT measurements of the two groups were compared with statistical methods. Eighty-seven eyes were included in the study; while 51 had no ES (Group 1), 36 had ES (Group 2). The mean age of all cases was 66.70 ± 9.13years. While the mean macular thickness, central macular thickness and macular volume were similar at the preoperative visit and the postoperative 1stweek of all cases (each p value > 0.05); these values were higher at the postoperative 1st, 3rd and 6thmonth compared to the preoperative and the postoperative 1stweek values (each p value < 0.05). The highest values were obtained at the postoperative 1stmonth; while the values of 1st, 3rd and 6thmonths were statistically similar (each p value > 0.05). No statistically significant difference was observed between Group 1 and Group 2 in terms of macular volume, central macular thickness and average macular thickness in these periods. Exfoliation syndrome has not been evaluated as a risk factor for an increase in macular thickness after uncomplicated cataract surgery.

Use of automatic refractometer infrared images to screen pigment dispersion syndrome: a cross-sectional observational study from a preliminary hypothesis

Background: This study was performed to evaluate the use of anterior segment images, obtained with an automatic refractometer, to identify early defects of the iris pigment epithelium in patients with pigment dispersion syndrome (PDS) or pigmentary glaucoma (PG) without observable alterations at the slit lamp.&#x0D; Methods: In this cross-sectional observational study, carried out from January 2018 to December 2019, in Policlinico Citta di Udine Health Center, Udine, Italy, we observed anterior segment infrared images of 1700 subjects who were undergoing routine ophthalmological examination using an automatic refractometer. We selected infrared images of subjects who fulfilled the inclusion and exclusion criteria and looked for a focal defect in the iris pigment epithelium.&#x0D; Results: Twenty patients with focal iris pigment epithelial defect were identified and none of them showed evident signs of PDS. After the necessary explanations, they agreed to have further examinations to verify the possibility of PDS. An in-depth evaluation of ocular structures, including gonioscopy, demonstrated the presence of PDS in all subjects with iris defects.&#x0D; Conclusions: The use of infrared images obtained by an automatic refractometer could provide early and easy identification of PDS in crowded ophthalmology clinics or mass screening programs; yet, more well-designed studies are necessary to confirm these preliminary findings and prove this proposed screening tool.

The prevalence of keratoconus in children with allergic eye disease in an Egyptian population.

To determine the prevalence of keratoconus (KC) among children with ocular allergy. A cross-sectional study was conducted on all children presenting with ocular allergic disease from September 2017 to September 2018. All study participants were subjected to history taking (a specially designed questionnaire), routine ophthalmological examination, and corneal tomography. A total of 79% of the study patients had vernal keratoconjunctivitis (VKC) while the remaining had perennial allergic conjunctivitis (10%), seasonal allergic conjunctivitis (9%) and atopic keratoconjunctivitis (2%). Manifest KC was seen in 7% of cases, suspect KC was found in 27% of cases, and 66% had no evidence of KC. For the manifest KC, 56% had clinical signs, while 44% were diagnosed by tomography. For the purpose of statistical analysis, the cohort was divided into group KC (manifest or suspicious KC) and group non-KC (no KC). The mean age was 11.2 years in group KC, and 9 years in group non-KC (p < 0.001). The mean duration of allergic symptoms was 3.75 years in group KC, and 2.5 years in group non-KC (p = 0.001). The mean duration of eye rubbing was 2.5 years in group KC, and 0.83 years in group non-KC (p = 0.02). Systemic atopy was present in 35.3% of group KC, and in 12.5% in group non-KC (p = 0.005). The overall prevalence of KC was 34%. Risk factors for the development of KC in patients with ocular allergy were age, duration of symptoms specially eye rubbing, systemic atopy and VKC. Tomographic diagnosis of KC can be present in absence of clinical signs.