Comparison of choroidal thicknesses in patients with coronary artery disease and patients at risk of coronary artery disease.

PURPOSE: The study aimed to compare choroidal thicknesses (CTh) in patients with coronary artery disease (CAD) and patients at risk of coronary artery disease and investigate whether thinning of the choroid can be used as a biomarker for development of coronary artery disease in patients at risk. MATERIALS AND METHODS: The study group was composed of 103 eyes of 53 patients with coronary artery disease, and the control group was composed of 62 eyes of 32 patients with diabetes mellitus, hypertension and/or hyperlipidemia without coronary artery disease. CAD was diagnosed in patients with one of the following: myocardial infarction with/without ST segment elevation, clinically proven history of cardiac catheterization testifying greater than 50% obstruction in at least one coronary artery, revascularization operations. The control group consisted of clinically proven patients with normal coronary arteries. The choroidal thickness was measured with enhanced depth imaging optical coherence tomography under the fovea and at six other points, located at 500 micron, 1000 micron and 1500 micron nasal to the fovea and 500 micron, 1000 micron, 1500 micron temporal to the fovea. RESULTS: The subfoveal choroidal thickness was significantly thinner in the coronary artery disease group compared to the control group (244 µm vs. 289 µm; p < 0,001). In all other measured regions (nasal 500, nasal 1000, nasal 1500, temporal 500, temporal 1000, and temporal 1500 micron), CTh was statistically significant thinner in the CAD group. A negative significant linear relationship (low level) between CAD duration and choroidal thickness in the subfoveal, nasal 1000, nasal 1500, temporal 500, temporal 1000 micron regions was detected. CONCLUSION: Patients with CAD have a decreased choroidal thickness compared to patients at risk of CAD. Detection of CTh thinning in a patient with diseases, such as diabetes, hypertension and/or hypercholesterolemia, which pose a risk for CAD may be a predictor of development of coronary artery disease. Clinical Trials Registration Kocaeli Derince Training and Research Hospital ethics committee-protocol number: 2020-106.

Assessment of macular choroidal thickness, central macular thickness and retinal nerve fiber layer in patients receiving oral isotretinoin treatment.

PURPOSE: To investigate the impact of oral isotretinoin therapy in choroidal thickness, central macular thickness (CMT), and retinal nerve fibre layer (RNFL) thickness using optical coherence tomography (OCT). PATIENTS AND METHODS: Choroidal thicknesses, CMT, and RNFL thickness of 64 eyes were evaluated at baseline and the end of the third month of isotretinoin therapy by spectral-domain OCT. For assessment of choroidal thickness, OCT measurements were obtained at the fovea with 6 additional measurements at adjacent locations (at 500-1000-1500 µm temporal to the fovea and 500-1000-1500 µm nasal to the fovea). RESULTS: There was not a statistically significant difference between the baseline and third-month follow-up measurements of choroidal thicknesses at seven distinct locations (p > 0.05). Similarly, RNFL thickness and CMT did not change with a mean dose of 30 (±6) mg per day isotretinoin therapy during follow-up (101.82 vs 102.24, p = 0.079; 217.77 vs 217.25, p = 0.731, respectively). CONCLUSION: After the use of oral isotretinoin for 3 months, no significant side effects have been observed in choroidal thickness, CMT, and RNFL thickness by OCT.

Duane Retraction Syndrome and Accompanying Ocular Abnormalities.

OBJECTIVES: Duane retraction syndrome (DRS) is a congenital syndrome characterized by limitation in adduction and/or abduction eye movements and narrowing of the palpebral fissure in adduction, and may include globe retraction, upshoot or downshoot. Several systemic abnormalities, syndromes, and additional ocular findings can accompany DRS. This study is an evaluation of eye findings in patients with DRS. METHODS: The records of 632 patients with DRS who were followed up between 1995 and 2016 were reviewed retrospectively. Patients with a follow-up of less than 6 months and patients with a history of eye/cranial trauma or injury were not included in the study. Before the patients were examined, a detailed anamnesis was obtained. Details of the medical records, including additional systemic diseases, were recorded. RESULTS: The average of follow-up time was 45 months (min-max: 6-128 months). There were 255 male and 377 female patients. A total of 34 patients (5.4%) had additional ocular abnormalities. The most frequently observed ocular pathologies associated with DRS were congenital ptosis (n=6, 0.94%) and coloboma of the iris (n=4, 0.63%). CONCLUSION: Most cases of DRS are observed as isolated. However, various ocular and systemic abnormalities and syndromes are associated with DRS. In particular, synkinetic syndromes may frequently be seen alongside DRS. Therefore, a complete ocular examination and anamnesis are crucial in cases with DRS.

Topiramate-Induced Acute Myopia, Diplopia, and Photosensitivity: A Case Report.

Topiramate is primarily used as an antiepileptic drug. It has also demonstrated effectiveness in migraine prophylaxis, depression, trigeminal neuralgia, bipolar disorders, and idiopathic intracranial hypertension. The drug has a large number of potential ocular side effects, such as acute-onset angle closure glaucoma (ACG), acute myopia, nystagmus, diplopia, photosensitivity, suprachoroidal effusions, peri-orbital edema, and blepharospasm. Presently described is the case of a 24-year-old woman presenting with a sudden loss of vision in both eyes. Her medical history revealed that the patient had initiated topiramate use 12 days earlier. The uncorrected visual acuity was 20/400 in both eyes and the best corrected visual acuity was determined to be 20/25 in the right eye with -5.50 spherical refractive correction and 20/20 in the left eye with -6.25 spherical refractive correction. On the second day of examination, diplopia developed. The patient's clinical condition was considered to be related to the drug and topiramate was discontinued immediately. The clinical findings of the patient subsequently improved rapidly without treatment. On the fifth day of examination, her autorefractometry measurements were +0.25 -0.25 α 121° in her right eye and +0.25 in her left eye and her uncorrected visual acuity was 20/20 in both eyes with normal bilateral anterior chamber depth. She had no vision complaint or diplopia but she began to experience photosensitivity, which persisted for 4 months before regressing completely. When ophthalmologists encounter acute myopia and acute-onset ACG, especially in young patients, they should keep the use of topiramate in mind.

Management of Duane retraction syndrome with prismatic glasses.

PURPOSE: To report the results of using prismatic glasses for Duane retraction syndrome (DRS). METHODS: Data were obtained from the records of patients who were evaluated during the year 2000 in the Strabismus Unit of the Beyoglu Eye Training and Research Hospital. The average follow-up was 12.2±17.7 months. In all cases, 2 main variables were evaluated: horizontal deviation in the primary position and face turn. Prismatic glasses were provided to patients according to the degree of shift in the primary position. RESULTS: The mean age of patients was 11.2 years. An analysis was performed on the data collected from 12 cases; 7 patients were females (58.3%) and 5 were males (41.7%), with 11 (91.7%) cases being of type I DRS. All 12 patients had abnormal head posture (face turn) and an angle of mean deviation equaling 10 PD (prism dioptri). CONCLUSION: Treatment was individualized on a case-by-case basis. Prismatic glasses are useful for eliminating abnormal head posture and ocular misalignment in selected cases.

The Efficacy of Intravitreal Bevacizumab in Vitreous Hemorrhage of Diabetic Subjects.

OBJECTIVES: To evaluate the efficacy of intravitreal bevacizumab (IVB) in the resolution of vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). MATERIALS AND METHODS: Seventy eyes of 70 patients (43 male, mean age 55.6±12.2 years) diagnosed with VH secondary to PDR were evaluated retrospectively. Demographic characteristics of the patients, baseline and final clinical results, and the interventions the patients were subject to were recorded. The patients who received IVB injections (group 1, n=29) were compared to those who did not receive injections (group 2, n=41) in terms of VH clearance time and surgery rates. RESULTS: The mean follow-up time was 14.5±6.1 months in group 1 and 18.4±9.6 months in group 2 (p=0.185). The mean visual acuity was similar between the groups at baseline and at the last visit (for all p>0.05). Panretinal photocoagulation could be applied in 86% of subjects in group 1 and in 58% in group 2 2 within the first month (p=0.016). VH clearance time was not different between the groups (2.3±2.1 months in group 1 and 3.4±2.6 months in group 2, p=0.146). The number of subjects requiring surgery was 7 (24%) in group 1 and 20 (48.8%) in group 2 (p=0.048). CONCLUSION: IVB was found effective in cases with VH secondary to PDR in terms of reducing the need for surgery and increasing the rate of subjects to whom panretinal photocoagulation could be applied in the early period, although there was no impact on final visual acuity.

CORRELATION OF CHOROIDAL THICKNESS AND BODY MASS INDEX.

PURPOSE: To evaluate the possible changes in the microvascular structure of the choroid by measuring choroidal thickness (CT) in four different body mass index (BMI) groups of healthy individuals. METHODS: One hundred and sixty eyes of 160 healthy individuals (70 females and 90 males) were included in this cross-sectional study. Healthy individuals were divided into 4 groups according to their BMIs. Cases with BMI ≤ 18.50 formed Group 1, cases with BMI between 18.50 and 24.99 formed Group 2, cases with BMI between 25.00 and 29.99 formed Group 3, and cases with BMI between 30.00 and 34.99 formed Group 4. The CT was measured by the enhanced depth imaging technique of the spectral domain optical coherence tomography. The CT was measured at subfoveal area and at 500-µm intervals to the nasal and temporal to the fovea up to 2,000 µm. The measurements were then statistically compared among the four groups. RESULTS: The mean ages were 26.5 ± 6.9 years (range: 18-39 years) in Group 1, 27.2 ± 5.0 (range: 21-38 years) in Group 2, 28.5 ± 5.9 (range: 20-40 years) in Group 3, and 29.25 ± 5.6 (range: 20-40 years) in Group 4. The mean subfoveal CT (in micrometers) was 378 ± 86 (range: 189-563) in Group 1, 384 ± 102 (range: 225-643) in Group 2, 314 ± 66 (range: 160-455) in Group 3, and 317 ± 63 (range: 220-411) in Group 4. There was a statistically significant difference among the 4 groups in regard to CT in all locations (P < 0.05). CONCLUSION: We have demonstrated that BMI may have an influence on the CT of healthy persons. Individuals in both Group 3 and Group 4 have thinner choroids than the individuals in both Group 1 and Group 2.