Evaluation of the effect of ocular dominance on macular microcirculation via swept-source optical coherence tomography angiography.

PURPOSE: To determine the existence of differences in the retinal microcirculation of dominant and non-dominant eyes, as well as of interocular differences in macular microcirculation, using swept-source optical coherence tomography angiography (OCTA). METHODS: In total, 122 eyes of 61 individuals were enrolled in this cross-sectional study. Measurements were taken using the swept-source optical coherence tomography Triton device (Topcon Corp, Tokyo, Japan) coupled with non-invasive OCTA technology. Macular perfusion parameters were assessed, including superficial vascular complex, vascular density of the deep vascular complex, vascular density of the choriocapillaris vascular complex, superficial foveal avascular zone and deep foveal avascular zone. Ocular dominance was determined among individuals with healthy eyes using the hole-in-the-card test. RESULTS: Ocular dominance was found in 68.9 % of right eyes and 31.1 % of left eyes. The mean age of the subjects was 34.45 ± 16.48 years (range: 18-73 years). We found that 16 (30.76 %) males and 22 (31.42 %) females had left-eye dominance (p > 0.05). None of the OCTA parameters differed between the eyes based on dominance (p > 0.05). Central macular thickness and sub-foveal choroidal thickness did not show significant differences (p > 0.05). When comparing interocular parameters, a significant difference was observed only in the inferior sector of the superficial vascular complex (p = 0.04). CONCLUSION: There was no significant difference in OCTA parameters between dominant and non-dominant eyes. There was no predominant interocular difference in the measurements.

Assessment of Serum Atherogenic Indices and Insulin Resistance in Retinal Vein Occlusion.

Objectives: This study aimed to investigate serum atherogenic indices as novel cardiovascular risk factors associated with retinal vein occlusion (RVO). Materials and Methods: This retrospective case-control study included 57 patients with newly diagnosed RVO whose plasma lipid profile (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglycerides [TG]) and insulin resistance were examined. Serum atherogenic indices (LDL-C/HDL-C, TC/HDL-C, TG/HDL-C, and non-HDL-C/HDL-C ratios) and presence of insulin resistance were compared between the patients and 63 healthy subjects. Cut-off values were determined by receiver operating characteristic curve analysis. Results: The mean age of the RVO patients was 63.7±9.4 years. Plasma levels of LDL-C, HDL-C, TC, and TG showed no significant difference between the patient and control groups (p>0.05). However, LDL-C/HDL-C, non-HDL-C/HDL-C, and TC/HDL-C ratios were higher in the RVO group compared to healthy subjects (p=0.015, p=0.036, and p=0.015, respectively). Fasting insulin concentrations, plasma insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were higher in the RVO patients compared to controls (p=0.003, p=0.001, and p=0.001, respectively). Conclusion: LDL-C/HDL-C, TC/HDL-C, and non-HDL-C/HDL-C ratios were found to be increased in RVO. Compared to the traditional plasma lipid profile, serum atherogenic indices were found to be superior predictors of RVO development. Measurement of HOMA-IR index should be taken into consideration in the evaluation of insulin resistance. High serum atherogenic indexes in RVO patients reveal the need to take precautions against the risk of cardiovascular disease and stroke.

Bilateral Retinal Venous Occlusion in Atypical Hemolytic-Uremic Syndrome Due to Complement Factor H Mutation.

PURPOSE: Atypical hemolytic uremic syndrome (aHUS) is a rare progressive thrombotic microangiopathy caused by overactivation in the alternative complement pathway. A wide spectrum of environmental triggers, such as viruses, vaccination, drugs, pregnancy, neoplasms, transplant, and autoimmune diseases can cause aHUS in genetically susceptible individuals. In this report, the diagnosis and treatment process of aHUS and bilateral retinal venous occlusion (RVO) will be presented. METHODS: Single-case, retrospective management of ophthalmological and systemic manifestations. RESULTS: A 28-year-old G2P2 female with acute blurred vision and history of acute renal failure. She was diagnosed with preeclampsia in her gestation history. After the laboratory work-up, the diagnosis of aHUS was confirmed. She was treated with eculizumab following 14 days of plasmapheresis. However, her visual acuity was 20/20 on the right and 20/60 on the left at the time of admission. Retinal examination revealed flame-shaped hemorrhages, exudation, and macular edema. The patient was diagnosed with branch RVO in the right eye. Subsequently, central RVO was occurred in the left eye. Intravitreal dexamethasone implant was administered for both eyes since there was no reasonable regression in retinal findings with bevacizumab treatment. She went into remission and her BCVA reached 20/25 during the 12-month follow-up period under the eculizumab therapy. CONCLUSION: Diagnosis of aHUS is challenging especially during pregnancy and the postpartum period. Although ocular involvement is quite rare, we described bilateral RVO in aHUS case with homozygous nonsense mutation (c.2134 G > T p.G712). Dexamethasone implant should be considered for the treatment of RVO in aHUS cases.

Anterior Segment Swept Source Optical Coherence Tomography and In Vivo Confocal Microscopy Findings in a Case With Bleb-Like Epithelial Basal Membrane Dystrophy.

PURPOSE: The aim of this study was to evaluate the anterior segment swept source optical coherence tomography (SS-OCT) and in vivo confocal microscopy (IVCM) features in a patient with bleb-like epithelial basement membrane dystrophy (EBMD). METHODS: A 67-year-old man was referred to the hospital for recurrent attacks of severe ocular pain, tearing, and photophobia, typically upon awakening in the right eye. Biomicroscopic examination revealed pebbled glass-like appearance in the corneal epithelium which was remarkable with retroillumination and the patient was suspected to have bleb-like EBMD. The cornea was further evaluated using SS-OCT DRI Triton (Topcon, Tokyo, Japan) and IVCM (Heidelberg Retina Tomograph 3, Rostock Cornea Module). RESULTS: Using anterior segment SS-OCT, multiple, hyporeflective, round-oval structures within the size range of 30 to 90 µm were observed at the basal epithelial level. IVCM showed circular or oval hyporeflective areas with a diameter ranging from 30 to 140 µm at the level of the basal epithelium in a depth of 35 to 40 µm from the corneal surface and hyperreflective linear structures extending into the corneal epithelium. The corneal stroma was normal, while a few round hyperreflective deposits and guttae were noted at the endothelial cell layer. CONCLUSIONS: Anterior segment SS-OCT and IVCM can be used in the diagnosis of bleb-like EBMD and are very helpful in differentiating from other epithelial/subepithelial corneal dystrophies and cystic disorders of the corneal epithelium.

Retinal and choroidal vascular changes in newly diagnosed celiac disease: An optical coherence tomography angiography study.

PURPOSE: To investigate the retinal and choroidal microcirculation changes in celiac disease (CD) patients via optical coherence tomography angiography (OCT-A). METHODS: This cross-sectional study included 44 pediatric patients with newly diagnosed CD and 44 healthy pediatric subjects. The vascular densities (VD) of the superficial, deep, and choriocapillar plexuses (VDs, VDd, and VDcc, respectively) (%), the superficial and deep foveal avascular zones (FAZs and FAZd) (%), the central macular thickness (CMT) (µm), and the subfoveal choroidal thickness (SFCT) (µm) were measured with swept-source OCT-A in addition to a complete ophthalmological examination. RESULTS: Mean ages of the CD patients and the healthy participants were 12.02 ± 2.9 and 13.6 ± 2.3 years, respectively. The central sectors of the VDs and VDd measurements were found to be significantly higher in the study group compared to the control group (p = 0.006; P = 0.001, respectively), and the temporal and nasal values of the VDcc measurements were significantly lower in the study group than in the control group (p < 0.05 for both values). CMT and FAZ metrics did not differ between the groups (p > 0.05). SFCT was significantly reduced (p = 0.001), and choroidal thinning was more considerable in female CD patients (p = 0.045). CONCLUSION: CD seems to affect macular and choroidal microcirculation. The reduced choriocapillaris plexus parameters and choroidal thickness may provide disease activity information.

Unilateral Acute Iris Transillumination Syndrome following Uneventful Phacoemulsification Surgery with Intracameral Moxifloxacin.

PURPOSE: We report a case of unilateral acute iris transillumination (AIT) and iris sphincter paralysis in a 63-year-old male undergone uneventful phacoemulsification surgery with intracameral moxifloxacin (ICM). CASE PRESENTATION: This is a case of AIT with no history of viral disease or use of systemic fluoroquinolone but an association with ICM after uneventful phacoemulsification. The clinical features of the affected eye are perfectly similar to what has been described in BAIT and hence we consider that unilateral AIT and BAIT share the same etiopathogenesis. At the end of the phacoemulsification, the patient received 0.15 ml of 5mg/ml moxifloxacin, which is notably higher than the dose that is commonly used for ICM. This may have caused the patient to develop BAIT-like syndrome after the ICM. CONCLUSION: 0.1 ml of 5mg/ml moxifloxacin or less should be used to reduce the risk of occurrences of this toxic effect caused by ICM.

Evaluation of the effect of fingolimod (FTY720) on macular perfusion by swept-source optical coherence tomography angiography in patients with multiple sclerosis.

AIM: To determine changes in retinal microcirculation, caused by fingolimod (FTY720) use, via swept-source optical coherence tomography angiography (SS-OCTA) in relapsing-remitting multiple sclerosis (RR-MS) patients. MATERIALS AND METHODS: 80 patients with RR-MS, who were using fingolimod, and 50 healthy control subjects were included in the study. Group 1 consisted of 40 eyes from 40 RR-MS patients, who had been using fingolimod for less than six months, and Group 2 consisted of 40 eyes from 40 RR-MS patients, who had been using fingolimod for longer than six months. All participants underwent SS-OCTA via DRI OCT Triton (Topcon, Tokyo, Japan), analysing their central macular thickness (CMT) (µm), subfoveal choroidal thickness (SFCT) (µm), superficial (VDs) (%) and deep vascular plexuses (VDd) (%), choriocapillaris (VDcc) (%), and superficial and deep foveal avascular zones (FAZs, FAZd, respectively) (%) in mean values. RESULTS: The mean follow-up times for patients in Groups 1 and 2 were 2.9 ± 1.5 months and 22.5 ± 11.3 months, respectively. The FAZs value in Group 2 was found to be significantly higher than that in both Group 1 and the control group (p = 0.034, p = 0.042, respectively). The VDs central value in Group 2 did not differ significantly from that in Group 1 or the control group (p > 0.05), while the VDs central value was higher in Group 1 than in the control group (p = 0.008). In Group 1, the VDd central value was significantly higher than in Group 2 and the control group (p = 0.047; p = 0.020, respectively). The CMT measurement for Group 2 was significantly lower than in Group 1 and the control group (p = 0.008, p = 0.003, respectively). CONCLUSION: Fingolimod use seems to remarkably increase VDs and VDd measurements in the early period of administration and decrease CMT over a longer period of administration in patients with RR-MS.