The Effect of Age on Dexamethasone Intravitreal Implant (Ozurdex®) Response in Macular Edema Secondary to Branch Retinal Vein Occlusion.

PURPOSE: To investigate the effect of age on dexamethasone intravitreal implant (Ozurdex®) response in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Seventy-three eyes of 73 patients with macular edema secondary to BRVO were recruited in the study. The patients in the study were divided into the following four groups according to their ages: group 1 (<60 years), group 2 (60-69 years), group 3 (70-79 years), and group 4 (≥80 years). Single-dose Ozurdex injection was applied to all patients. The effectiveness of Ozurdex treatment on macular edema is evaluated via optical coherence tomography (OCT) according to the age groups. RESULTS: Two months after Ozurdex injection, mean reduction of central retinal thickness in groups 1, 2, 3, and 4 were -466.4 ± 149.6, -379.7 ± 238.7, -280.1 ± 233.0, and -180.5 ± 81.4 µm, respectively. This reduction of central retinal thickness decreased with aging (p = 0.001). Also, ages of patients were negatively correlated with the mean reduction of central retinal thickness for the whole study group (r = -0.439, p < 0.001). CONCLUSION: Our study revealed that the effectiveness of Ozurdex treatment decreases with aging.

Evaluation of foveal photoreceptor layer in eyes with macular edema associated with branch retinal vein occlusion after ozurdex treatment.

The aim of this study was to evaluate the central retinal thickness (CRT), outer nuclear layer thickness (ONLT), photoreceptor layer thickness (PLT), photoreceptor layer integrity, and the correlation between visual acuity and PLT in eyes with branch retinal vein occlusion (BRVO) 2 months after treatment with intravitreal dexamethasone implant (Ozurdex; Allergan, Inc, Irvine, CA). In this prospective study, 32 eyes of 32 patients were enrolled. A single injection of Ozurdex was administered to all the patients. CRT, ONLT, and PLT were measured using spectral-domain optical coherence tomography before and 2 months after the injection. Best-corrected visual acuity (BCVA [logMAR]) and photoreceptor cell integrity were also evaluated. The average CRT, ONLT, PLT, and BCVA values for the sample group before the treatment were as follows: 707 ± 261, 608 ± 288, 70 ± 25, and 0.96 ± 0.22 µm, respectively. The average CRT, ONLT, PLT, and BCVA values for the sample group 2 months after the Ozurdex injection were as follows: 299 ± 149, 211 ± 138, 77 ± 20, and 0.63 ± 0.30 µm, respectively (p < 0.05). Two months after the Ozurdex injection, BCVA correlated with ONLT and PLT (r = 0.365, p = 0.048 and r = -0.488, p = 0.021, respectively), whereas BCVA was not correlated with CRT (r = 0.239, p = 0.189). Photoreceptor layer is associated with the visual function of eyes with macular edema secondary to BRVO. Also, ONLT seems to be more closely related to visual acuity improvement than CRT decrement.

Systemic endothelial function in primary open-angle glaucoma.

Objective. We aimed to assess peripheral vascular endothelial function in open-angle glaucoma (POAG) by measuring flow-mediated dilatation (FMD). Materials and Methods. The study included 20 cases with POAG (group 1, mean age 58.68 ± 13.3 years) and 30 healthy individuals (group 2, mean age 58.68 ± 13.6 years). In all cases, responses of endothelial function were assessed by a cardiologist through measurement of FMD following brachial artery occlusion. Results. Mean percent of FMD, an indicator of endothelial function, was found to be 11.9 ± 4.2% in group 1 and 12.3 ± 4.4% in group 2 (P = 0.86). Conclusion. No impairment in systemic vascular function of cases with POAG suggests that POAG could be a local disorder rather than being a component of systemic disease.

Evaluation of the Macular, Peripapillary Nerve Fiber Layer and Choroid Thickness Changes in Behçet's Disease with Spectral-Domain OCT.

Purpose. To assess the macular, choroid, and peripapillary nerve fiber layer thickness (RNFL) in Behçet's disease (BD) patients with and without ocular involvement by means of optical coherence tomography (OCT) and compare these findings with healthy controls. Design. Eighty patients with BD and 40 healthy controls who were followed up at the Uveitis and Retina Clinic of the Kayseri Research and Education Hospital in Turkey were enrolled in this prospective study. Subjects and Controls. The patients with BD were divided into two groups according to the presence of ocular involvement. Group 1 consisted of 40 eyes of 40 patients with ocular involvement and group 2 consisted of 40 eyes of 40 patients without ocular involvement. Methods. All of the patients and controls underwent macular, choroid, and peripapillary nerve fiber layer thickness analysis with Spectralis domain OCT (Spectralis OCT Heidelberg Engineering, Dossenheim, Germany). Main Outcome Measures. The differences in macular, choroid, and peripapillary nerve fiber layer thicknesses between groups were analyzed statistically. Results. Macular thickness was thinner in patients with BD than in the control group; this result was statistically significant (P = 0.05). There was no statistically significant difference in thickness between RNFL analysis of the patients with BD and control subjects. However, the BD patients with ocular involvement had statistically significant thinning in RNFL compared with BD patients without ocular involvement. Although the choroid was thicker in patients with BD than in the control group, it did not reach a statistically significant level (P = 0.382). Conclusions. BD with ocular involvement may be associated with decreased macular and RNFL thickness measured with spectral-domain OCT.

Isolated multiple pigment epithelial detachments with unknown cause.

There are many etiological factors that have led to the development of retinal pigment epithelial detachment (PED). In this paper, we have reported a patient with isolated multiple PEDs. Based on this fact, this paper aimed to give an overview of the causes of PEDs.

Evaluation of the macula, retinal nerve fiber layer and choroid thickness in postmenopausal women and reproductive-age women using spectral-domain optical coherence tomography.

OBJECTIVE: Menopause is a physiological life period that potentially affects various organs and systems. Therefore, a wide spectrum of signs and symptoms of eyes may be clinically observed in the postmenopausal period. AIM OF THE STUDY: To evaluate the macular, retinal nerve fiber layer (RNFL) and choroidal thickness alterations by using spectral-domain optical coherence tomography (SD-OCT) in postmenopausal women and compare with healthy reproductive-age women controls. MATERIAL AND METHODS: The study population included a healthy reproductive-age control group (n = 72) and postmenopausal study group (n = 72). Retinal thickness parameters were measured by SD-OCT. Peripapillary RNFL thickness parameters, macular thickness and choroidal thickness were evaluated. RESULTS: Superior inner macula, temporal inner macula, inferior inner macula, nasal inner macula, inferior outer macula and choroid thickness were significantly thinner in the postmenopausal study group than the healthy reproductive-age control group (p = 0.007, p = 0.037, p = 0.027, p = 0.006, p = 0.016, p < 0.001, respectively). After adjusting for age, only choroid thickness was significantly thinner in the postmenopausal study group than controls (p (†) = 0.005). CONCLUSIONS: This study revealed that choroidal thickness measured by SD-OCT was significantly thinner in postmenopausal women than healthy reproductive-age women. We can speculate that the decrease in choroidal thickness in postmenopausal women may indicate a reduced estrogen-dependent vasodilatory effect in ophthalmic artery secondary to menopausal estrogen deficiency.

Short-term impact of intravitreal ranibizumab injection on axial ocular dimension and intraocular pressure.

OBJECTIVE: To evaluate the short-term impact of intravitreal ranibizumab injection on axial ocular dimension (AOD) and intraocular pressure (IOP). METHODS: A total of 31 patients who received 0.05 mL intravitreal ranibizumab injection (IRI) for age-related macular degeneration and 30 healthy volunteers were enrolled in the study. AODs i.e. anterior chamber depth and axial length were measured with IOL Master and IOP with noncontact tonometer before and 5 min, 30 min and 1 day after the injection. RESULTS: Five minutes after the injection, mean IOP increased to 24.8 ± 9.5 (13-46) mmHg from 14.5 ± 2.3 (10-18) mmHg (p < 0.001). Thirty minutes after the injection, IOP decreased a mean level of 17.3 ± 4.1 (11-26) mmHg. The change in axial length and anterior chamber depth measurements did not reach a statistical significance across the time points (p > 0.05, for all values). There was no correlation between biometric measurements and IOP before (r = 0.016, p = 0.948 for axial length and r = -0.48 p = 0.075 for anterior chamber depth) and 5 min after IRI (r = 0.049, p = 0.835 for axial length and r = -0.219 p = 0.367 for anterior chamber depth). Measurements of control group taken across same time points did not reveal statistically significant differences (p > 0.05, for all measurements). CONCLUSION: Although IOP increases transiently after the intravitreal injection of 0.05 mL ranibizumab, axial length and anterior chamber depth are not affected by this amount of injection, and the increase in IOP after the injection seems to be irrelevant to AL and anterior chamber depth. Therefore, it is postulated that ranibizumab can be used safely in patients with age-related macular degeneration who have shallow anterior chamber and/or short axial length simultaneously.

The change in ocular higher-order aberrations after pterygium excision with conjunctival autograft: a 1-year prospective clinical trial.

PURPOSE: To investigate the effects of pterygium excision with conjunctival autograft plus corneal polishing on ocular higher-order aberrations (HOAs) and to monitor the changes throughout the first postoperative year. METHODS: A total of 18 eyes of 16 patients with primary pterygium who had an indication for surgical excision were included in the study. All patients underwent a detailed ophthalmologic examination preoperatively and at the third and twelfth postoperative months. Pterygium excision with conjunctival autograft plus corneal polishing was performed by the same surgeon (K.G.). Corneal topography and ocular HOAs were measured by NIDEK optical path difference scanning system ARK-10000 refractive power/corneal analyzer. RESULTS: Root mean square values of total aberrations and total HOAs were found to be significantly decreased both at 3 and 12 months after an uneventful pterygium surgery. Although solely root mean square values of coma and trefoil revealed a statistically significant reduction in the third postoperative month (P=0.043 and P=0.018, respectively), after 1 year, all parameters (total coma: P<0.001; total trefoil: P=0.004; total quatrefoil: P=0.010; and total high astigmatism: P=0.016) except for total spherical aberration (P=0.236) were found to be lower when compared with the preoperative values. CONCLUSION: Uneventful pterygium excision with conjunctival autograft plus corneal polishing can significantly reduce most of the pterygium-induced HOAs. Moreover, the reduced postoperative aberrations continue to change beyond the early postoperative period even into the 1-year postoperative period. Therefore, any refractive procedures should be postponed at least 1 year after the pterygium surgery until corneal stability occurs.

An assessment of ocular morbidities of children born prematurely in early childhood.

PURPOSE: To assess the ocular morbidities of premature children in early childhood. METHODS: One hundred seventeen children with a history of gestational age of less than 37 weeks at birth underwent ophthalmic examination including visual acuity testing with Lea symbols, anterior and posterior segment examination, refraction, orthoptic examination for strabismus, and ocular biometry. They were subdivided into three groups according to gestational age (28 or less, 29 to 32, and 33 to 36 weeks). The prevalence of ocular morbidities and mean value of refractive errors were studied. RESULTS: The mean age of the subjects at examination was 37.6 ± 1.1 months (range: 20 to 65 months). Only 62.4% of the eyes had visual acuity better than 20/32. The prevalence of high myopia (above -5.0 diopters [D]), myopia (below -5.0 D), and strabismus was 12.5%, 22.5% and 33.3% in the 28 weeks or less group and 3.6%, 18.9%, and 24.1% in the 29 to 32 weeks group, respectively, whereas 7.9% of the 33 to 36 weeks group had myopia and 13.2% had strabismus. Spherical equivalent in eyes that received cryotherapy and with macular heterotopia was -2.7 ± 3.9 and - 4.4 ± 3.4 D, respectively. Biometric measurements showed that high myopic eyes had statistically significantly thicker lenses compared to myopic and hyperopic eyes (P = .01). CONCLUSION: This study confirms that children born prematurely are at increased risk of ocular morbidities such as defective visual acuity, myopia, and strabismus. High myopic eyes have thicker lenses compared to myopic and hyperopic eyes, and eyes with macular heterotropia and treated with cryotherapy are more prone to development of high myopia.

Corneal endothelial characteristics and central corneal thickness in a population of Turkish cataract patients.

OBJECTIVES: The aim was to assess corneal endothelial characteristics and central corneal thickness (CCT) in a population of Turkish cataract patients and to define the impact of age and gender on these parameters. METHODS: Five hundred and seventeen cataract patients were examined with noncontact specular microscope preoperatively. The eye planned to be operated was selected for analysis. The parameters measured were endothelial cell density (ECD), cell area (CA), coefficient of variation (CV) of the CA, percentage of hexagonal cells (PHCs), and CCT. RESULTS: The mean values in ECD, CA, CV, PHC, and CCT in all eyes were 2,258 ± 474 cells per square millimeter, 468 ± 130 µm(2), 39%±7%, 49%±12%, and 500 ± 37 µm, respectively. Regression analysis revealed a statistically significant decrease in ECD (R=-0.169, P<0.0001), increase in CA (R=0.186, P<0.0001), and decrease in the CCT (R=-0.122, P=0.006) with increase in age. The changes in the CV (R=0.008, P=0.861) and PHC (R=-0,060, P=0.177) were not found to be dependent on age. The parameters showed no sex differences. The number of eyes with ECD below 1,000 and 2,000 cells per square millimeter was 5 (0.97%) and 130 (25.1%), respectively. CONCLUSIONS: The data from our study emphasize that age, but not gender, is the main determinant of ECD.

Bilateral acute depigmentation of the iris first misdiagnosed as acute iridocyclitis.

Acute depigmentation of the iris is a new condition characterized by pigment dispersion in the anterior chamber, depigmentation of the iris stroma, and pigment deposition in the anterior chamber angle. A 33-year-old woman using a topical corticosteroid every 2 h for the treatment of acute iridocyclitis was referred to our clinic to seek another opinion because her symptoms had not improved. An ocular evaluation of the patient revealed pigment precipitates on the corneal endothelium, pigment dispersion in the anterior chamber, symmetrical diffuse depigmentation, granularity of the iris stroma, and pigment deposition in the trabecular meshwork. These findings suggested a diagnosis of bilateral acute depigmentation of the iris (BADI) instead of iridocyclitis. Clinicians should be careful in the differential diagnosis of iris depigmentation from iridocyclitis to avoid the unnecessary use of high-dose topical corticosteroids.

Evaluation of the effect of tolterodine on pupil diameter and anterior chamber parameters with the Pentacam.

BACKGROUND: To evaluate the effect of tolterodine on pupil diameter and anterior chamber parameters, including volume, depth, and angle, with the Pentacam. METHODS: The 56 eyes of 28 patients who were diagnosed as having overactive bladder and planned to be treated with tolterodine were followed up prospectively in the study. All the patients underwent full ophthalmic examination and scanning with the Pentacam (Oculus, Inc., Wetzlar, Germany) before and 4 weeks after the start date of tolterodine therapy. In addition, the 30 eyes of 15 healthy volunteers were analyzed twice as a control group for repeatability of the measurements. RESULTS: The quantitative descriptors of the anterior chamber before and after the treatment, respectively, were as follows: pupil diameter, 3.02 ± 0.56 mm and 3.01 ± 0.55 mm; anterior chamber depth, 2.74 ± 0.35 mm and 2.75 ± 0.34 mm; anterior chamber volume, 150.23 ± 33.95 mm(3) and 150.27 ± 34.48 mm(3); and anterior chamber angle, 34.56° ± 5.68° and 35.03° ± 5.99°. For all the measurements, the differences did not reach statistical significance (p > .05). Also, the comparison of the same parameters obtained from the first and second measurements of healthy volunteers was not statistically significant (p > .05). CONCLUSION: Our study demonstrates that tolterodine does not affect pupil diameter and anterior chamber parameters, including angle, volume, and depth. Most likely, it is an organ-selective agent, inhibiting muscarinic receptors in the bladder rather than in the anterior segment of the eye.

Bilateral Tonic Pupils in the Absence of Pupillary Cholinergic Supersensitivity.

We report a 24-year-old woman with a presenting complaint of bilateral dilated pupils. The pupils were found to be dilated in bright and dim room lighting with minimal light reaction, showed an accommodation response, but did not demonstrate cholinergic supersensitivity. Neurological examination and neuro-imaging of the patient were normal. Syphilis serology was negative. This case emphasises that tonic pupil may be found in the absence of pupillary cholinergic supersensitivity.

Common embryological links to the optic pit and anterior segment structures.

PURPOSE: To analyze the anterior segment structures in patients with an optic disc pit to evaluate the common embryological links to the optic disc pit and anterior segment structures in these patients. METHODS: Ten patients with a unilateral optic disc pit detected during routine examination of the posterior pole and 15 healthy subjects as a control group underwent anterior segment analysis with Pentacam (Oculus, Inc., Wetzlar, Germany). Anterior segment parameters were compared between the eyes with an optic disc pit and fellow eyes of the patients and between the right and the left eyes of the healthy subjects. RESULTS: The anterior segment parameters of the eyes with an optic disc pit and fellow eyes of the patients were as follows, respectively: radius of the anterior corneal surface (7.68 +/- 0.28 and 7.71 +/- 0.28 mm), radius of the posterior corneal surface (6.36 +/- 0.28 and 6.43 +/- 0.28 mm), corneal thickness (532.40 +/- 31.32 and 530.20 +/- 28.51 micorm), corneal volume (58.86 +/- 3.72 and 58.42 +/- 3.37 mm), anterior chamber depth (3.28 +/- 0.80 and 2.98 +/- 0.39 mm), anterior chamber volume (178.00 +/- 36.48 and 168.30 +/- 38.14 mm), anterior chamber angle (39.30 +/- 6.00 and 36.52 +/- 5.66 degrees), and pupil diameter (3.15 +/- 0.64 and 2.96 +/- 0.47 mm). Only the back radius of corneal curvature was found to be statistically significantly lower in eyes with an optic disc pit (p = 0.025). The interocular comparison of anterior segment parameters in the healthy subjects showed no statistically significant difference (p > 0.05). CONCLUSIONS: The study demonstrates that those eyes with an optic disc pit have smaller back radius of corneal curvature compared with fellow eyes. Possibly, the embryological factors in the development of optic disc pit influence the development of cornea.

Retinal tomographic measurements in optic disc pit.

BACKGROUND: The aim was to assess the Heidelberg Retina Tomograph II measurements in optic disc pit. METHODS: The study included 10 patients with a unilateral optic disc pit. The patients had no other ocular conditions except refractive errors. Normal fellow eyes of the patients were used as a control group. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, Heidelberg Retina Tomograph II (HRT II). RESULTS: The topographic parameters of the eyes with optic disc pit and normal fellow eyes were as follows, respectively: disc area (3.77 +/- 1.50 and 3.07 +/- 0.83 mm(2)), cup area (1.99 +/- 1.71 and 1.09 +/- 0.54 mm(2)), rim area (1.67 +/- 0.55 and 1.87 +/- 0.75 mm(2)), cup volume (0.94 +/- 1.24 and 0.34 +/- 0.27 mm(3)), rim volume (0.51 +/- 0.40 and 0.55 +/- 0.19 mm(3)), mean cup depth (0.44 +/- 0.20 and 0.31 +/- 0.11 mm) and mean retinal nerve fibre layer thickness (0.25 +/- 0.20 and 0.28 +/- 0.59 mm). Eyes with an optic disc pit were found to have significantly larger disc area compared to fellow eyes (p = 0.038). All the other parameters showed no statistically significant interocular differences (p > 0.05). CONCLUSION: Our study demonstrates that the optic disc pit affects only the disc area measurement in HRT II. Other changes in optic nerve head morphometric parameters were insignificant. The clinician must be careful in the evaluation of HRT II results with respect to optic disc area in a disc with a pit.