Real-World Outcomes of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Diabetic Macular Edema in Türkiye: MARMASIA Study Group Report No. 1.

Objectives: This study aimed to report the demographic and clinical characteristics of diabetic macular edema (DME) patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factors (anti-VEGF) and provide an overview of outcomes during routine clinical practice in Türkiye. Materials and Methods: This retrospective, real-world study included 1,372 eyes (854 patients) treated with a pro re nata protocol by 21 ophthalmologists from 8 tertiary clinics on the Asian side of the Marmara region of Türkiye (MARMASIA Study Group). Five cohort groups were established by collecting the patients' baseline and 3, 6, 12, 24, and 36-month follow-up data, where each subsequent cohort may include the previous. Changes in best-corrected visual acuity (BCVA, approximate ETDRS letters) and central macular thickness (CMT, µm), number of visits and IVI, and rates of anti-VEGF switch and intravitreal dexamethasone implant (IDI) combination were evaluated. Results: The 3, 6, 12, 24, and 36-month cohorts included 1372 (854), 1352 (838), 1185 (722), 972 (581), and 623 (361) eyes (patients), respectively. The mean baseline BCVA and CMT were 51.4±21.4 letters and 482.6±180.3 µm. The mean changes from baseline in BCVA were +7.6, +9.1, +8.0, +8.6, and +8.4 letters, and in CMT were -115.4, -140.0, -147.9, -167.3, and -215.4 µm at the 3, 6, 12, 24, and 36-month visits (p<0.001 for all). The median cumulative number of anti-VEGF IVI was 3.0, 3.0, 5.0, 7.0, and 9.0, respectively. The overall anti-VEGF switch and IDI combination rates were 18.5% (253/1372 eyes) and 35.0% (480/1372 eyes), respectively. Conclusion: This largest real-life study of DME from Türkiye demonstrated BCVA gains inferior to randomized controlled trials, mainly due to the lower number of IVI. However, with the lower baseline BCVA and higher IDI combination rates in our cohorts, these gains were relatively superior to other real-life study counterparts.

Effects of fluorescein on corneal endothelial morphology after fundus fluorescein angiography in patients with diabetic macular edema.

PURPOSE: To evaluate the effects of fluorescein dye on corneal endothelial morphology (CEM) after fundus fluorescein angiography (FFA) in patients with diabetic macular edema (DME). METHODS: In this retrospective study, patients were divided into two groups, nonproliferative diabetic retinopathy (Group-1, NPDR) and proliferative diabetic retinopathy (Group-2, PDR). CEM properties including endothelial cell density (ECD), coefficient of variation of cell area (CV), average cell area (AVG), percentage of hexagonal cells (HEX), and central corneal thickness (CCT) were measured before FFA and at week 1 and month 1 after FFA were collected from patients' charts. RESULTS: The study consisted of 48 patient's 48 eyes in Group-1 and 50 patient's 50 eyes in Group-2. In both groups, the mean ECD, CV, AVG, HEX, and CCT measurements at week 1 and month 1 after FFA did not differ statistically from the mean measurements before FFA (p > 0.05). The mean ECD measurements in Group-1 were higher than that in Group-2 and showed statistically significant differences among the groups (p < 0.01 for all). In the Pearson correlation analysis in Group-1, there was no statistically significant relationship between best-corrected visual acuity (BCVA) and (intraocular pressure) IOP values and ECD, AVG, CV, HEX, and CCT measurements (except central macular thickness [CMT] and HEX) before FFA, at week 1 and month 1 after FFA (p > 0.05). In Group-2 there was no statistically significant relationship between BCVA, IOP, and CMT measurements and ECD, AVG, CV, HEX, and CCT measurements before FFA, at week 1 and month 1 after FFA (p > 0.05). CONCLUSIONS: There is no significant change in CEM after FFA in patients with NPDR and PDR with DME.

Glutathione S-transferase expression in benign and malignant eyelid tumors.

Eyelid tumors commonly originate from the skin and its appendages. Environmental toxins and oxidants affect eyelid carcinogenesis. Glutathione S-transferases (GST) are antioxidants that participate in pathogenesis. We investigated GST levels in malignant and benign eyelid tumors in otherwise healthy individuals. We used 57 malignant eyelid biopsies, benign eyelid biopsies, and tissue removed during blepharoplasty and entropion operations culled from pathology archives. Specimens were divided into three groups: malignant lesions, benign lesions and controls consisting of eyelid tissue removed during routine blepharoplasty and entropion surgery. Specimens were immunostained for seven GST (GST-A, GST-P, GST-Z, GST-S, GST-K, GST-O, GST-T) and the intensity of staining was quantified. In the malignant group, GST-O and GST-P staining was less intense than for the control group. In the benign group, the GST-P level was less than for the control group. We found no significant difference between the intensity of staining in malignant and benign groups. Our findings suggest that GST-O and GST-P enzymes may play significant roles in eyelid carcinogenesis.