The Effect of Diabetic Retinopathy and Blood Glucose Regulation on Corneal Biomechanical Parameters.

PURPOSE: The aim of this study was to evaluate the effects of different stages of diabetic retinopathy (DR) and metabolic control of blood glucose levels on corneal biomechanical parameters. METHODS: Diabetic patients were categorized into three groups: no DR group, nonproliferative DR (NPDR) group, and proliferative DR (PDR) group. Of the 141 eyes examined, 40 belonged to the control group, 34 to no DR group, 34 to NPDR group, and 33 to PDR group. Using an Ocular Response Analyzer to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc). IOP was assessed using a Tono-Pen, while central corneal thickness (CCT) was determined using an ultrasonic pachymeter. HbA1c levels were also recorded. We conducted comparisons among these groups across biomechanical parameters and IOP (tonopen), and CCT, while also investigating the impact of HbA1c levels on these parameters. RESULTS: Among any groups show a statistically significant difference in CCT, IOP (tonopen), CH, CRF, IOPg, and IOPcc. In diabetic patients, CRF, CTT, and IOPg values were significantly higher in those with HbA1c levels ≥ 7 mg/dl than in those with HbA1c levels < 7 mg/dl (p = 0.009, p = 0.013, p = 0.038), respectively, while there was no statistically significant difference in IOPcc, CH, and IOP (tonopen). Linear regression analysis showed that CH was positively associated with CCT (p < 0.001) and negatively associated with IOPcc (p < 0.001), while CRF was positively associated with CCT (p < 0.001), HbA1c (p < 0.05), and negatively associated with diagnosis of DR (p < 0.05). CONCLUSION: This study underscores the influence of metabolic control, as reflected by HbA1c levels, on corneal biomechanical parameters in diabetic patients, emphasizing the importance of monitoring and managing glycemic control in this population.

CHANGES IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY MEASURES THROUGHOUT THE DAY: Diurnal Variation or Test-Retest Variability?

PURPOSE: To evaluate the repeatability and diurnal variation of the retinal vessel density and foveal avascular zone parameters using optical coherence tomography angiography. METHODS: Forty-one healthy individuals were measured twice in the morning and once in the evening. Foveal avascular zone area, perimetry, foveal density; superficial and deep capillary plexus (superficial capillary plexus, deep capillary plexus) vessel density, and central macular thickness were evaluated with the intraclass correlation coefficient, coefficient of repeatability, and Bland-Altman plots. RESULTS: Repeatability was evaluated with two consecutive scans taken in the morning. The coefficient of repeatabilities (%) was 5.4; 4.3, and 8.8 for the foveal avascular zone area, perimetry, and foveal density, respectively, with excellent intraclass correlation coefficients. Intraclass correlation coefficient was poor for parafovea (0.33), whereas excellent for fovea (0.97) in superficial capillary plexus-vessel density. Coefficient of repeatability for fovea and parafovea was 19.19% and 10.43%, respectively. Intraclass correlation coefficient values were poor (0.3-0.4) with 10% to 16% measurement differences in deep capillary plexus-vessel density parameters. Coefficient of repeatabilities for central macular thickness was between 1% and 2% with excellent intraclass correlation coefficient. The analysis on diurnal variation yielded comparable results. CONCLUSION: Except for the parafoveal vessel density, optical coherence tomography angiography is a highly reproducible device for measuring foveal avascular zone and vessel density using 6 × 6 scans with undilated pupils. However, variation in optical coherence tomography angiography parameters observed throughout the day could be attributed to test-retest variation rather than diurnal rhythm.

Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and with multiple system atrophy.

BACKGROUND: In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA. METHODS: Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways. RESULTS: When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group. CONCLUSIONS: The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up.

Quantitative analysis of early retinal vascular changes in type 2 diabetic patients without clinical retinopathy by optical coherence tomography angiography.

PURPOSE: To investigate the quantitative differences in optical coherence tomography angiography (OCTA) data between type 2 diabetes patients without clinically detectable diabetic retinopathy (DR) and healthy subjects. METHODS: Thirty-nine patients with type 2 diabetes without DR and 41 age- and sex-matched healthy controls were recruited. The vessel density and foveal avascular zone (FAZ) area in the superficial capillary plexus and deep capillary plexus were measured using Nidek RS-3000 Advance® and compared between patient cohorts. Foveal vessel density (%) and FAZ (%) were also calculated. RESULTS: A significant decrease in vessel density has been observed in the deep capillary plexus of the patients compared to healthy individuals (5.58 ± 0.98 mm2 versus 6.15 ± 0.89 mm2, p < 0.001). However, there were no significant differences in other parameters between cohorts (p > 0.05 in all parameters). Despite the decrease of deep capillary plexus density in the macular region, there was no significant change observed in foveal vessel density (p:0.44). It has also been observed that the duration of diabetes mellitus correlates with vessel density decrease in deep capillary plexus (R:-0.52; p < 0.001). In both groups, all parameters in deep capillary plexus were significantly higher than superficial capillary plexus (p < 0.001 for all parameters). CONCLUSIONS: OCTA can identify quantitative changes in DCP before the manifestation of clinically apparent retinopathy. DCP-VD reduction may be an earlier finding than FAZ enlargement. Despite the reduction of VD, FVD could be preserved for a certain period of time in DM patients.

Evaluation of retinochoroidal tissues in third trimester pregnants: An optical coherence tomography angiography study.

INTRODUCTION: The structural and vascular changes in the retina and choroid in women in the third trimester of pregnancy were analyzed using optical coherence tomography angiography (OCTA). METHODS: Forty women in the third trimester of uncomplicated pregnancy and 40 age-matched healthy women were included. Vascular density (VD) in the superficial and deep capillary plexuses (SCP/DCP), foveal density (FD), and foveal avascular zone (FAZ) area and perimetry measured with OCTA, as well as OCT measurements of central macular thickness (CMT) and choroidal thickness (CT) were compared between the groups. Correlations between structural OCT parameters and vascular OCTA metrics were analyzed. RESULTS: The mean gestational age was 34 (28-41) weeks. Mean age was comparable in the groups (p = 0.732). The pregnant women had significantly higher parafoveal DCP-VD (p = 0.015), FAZ area (p = 0.044), and FD (p = 0.002). Mean subfoveal CT was 21 µm higher in pregnant women but was not significant (p = 0.472). There was no difference in CMT (p = 0.448). FAZ metrics were positively correlated with CT in pregnants and with CMT in the control group (p < 0.05). Parafoveal VD was negatively correlated with CT in the control group (p < 0.05). After adjusting for CT and CMT, the significant difference in VD and FD persisted (p < 0.05), while the difference in FAZ area lost significance (p > 0.05). CONCLUSIONS: Considering the effects of the probable covariant factors CMT and CT, systemic changes in pregnant women in their third trimester may cause an increase in VD in the macula and parafoveal DCP.

A comparative study of type 1 neovascularization: Neovascular age-related macular degeneration versus pachychoroid neovasculopathy.

PURPOSE: This study aimed to compare type 1 choroidal neovascularization (CNV) characteristics in eyes with pachychoroid neovasculopathy (PNV) and neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). METHODS: Treatment naive 23 eyes of 23 patients with PNV and 24 eyes of 24 patients with nAMD were evaluated. The height of pigment epithelial detachment (PED) and the central macular thickness were determined. OCTA sensitivity, CNV area, morphological patterns, and retinal superficial capillary plexus vessel density (SCP-VD) values were compared. The frequency of quiescent CNV, subretinal hyperreflective exudation (SHE), subretinal/intraretinal fluid, serous PED, double-layer sign (DLS), and pachyvessels were noted. RESULTS: CNV was detected on OCTA in 83.3% of nAMD eyes and 91.3% of PNV eyes (p = 0.66). Indistinct pattern was more common (74% vs 50%) and the CNV area (mm2) was smaller in PNV (0.77 ± 0.54 vs 1.57 ± 1.43) but did not reach significant levels (p = 0.27 and 0.33 respectively). SCP-VD was similar between the groups (p = 0.38). Statistically significant differences were found between groups in age and subfoveal choroidal thickness (p < 0.05). DLS and pachyvessels were found to be more frequently in PNV (p < 0.05). However, both groups had similar rates of quiescent CNV, SHE, subretinal/intraretinal fluid, and serous PED (p > 0.05). CONCLUSION: Morphological features, area, and activation findings of type 1 CNV may play a limited role in differentiating nAMD and PNV cases.

Comparison of Central Corneal Thickness Measurements by Contact and Non-contact Pachymetry Devices.

AIM AND OBJECTIVE: To compare central corneal thickness (CCT) measurements obtained by handheld contact ultrasound pachymetry (HCUP) and non-contact pachymetry devices. MATERIALS AND METHODS: Ninety eyes of 90 patients (52 male and 38 female) were included in the study. Measurements from two non-contact devices, -specular microscopy (SM, Konan Medical, CA, USA) and Oculus Pentacam (Oculus Inc., Germany)-were compared against HCUP (Pachmate 2, DGH Technology, Inc, PA, USA). Ultrasound measurements were obtained 3 times by the same user and averaged. The differences were calculated by one-way ANOVA. Agreement between measurements were assessed by Bland-Altman plots and intraclass correlation coefficient tests. Coefficient of repeatability (%, CR) was defined as 1.96*standard deviations of the differences between pairs of measurements divided by the average of the means. RESULTS: The mean age was 34.31 ± 14.39 (14-74) years, and the mean intraocular pressure was 16.48 ± 2.63 mm Hg (12-21). Mean CCT measured by HCUP, SM, and Pentacam was 557.76 ± 36.76 µm, 550.29 ± 43.74 µm, and 541.41 ± 35.7 µm, respectively (p < 0.05). In the Bland-Altman plot, 95% limit of agreements were 19.5 and 14.18 µm among HCUP measurements, 34.55 µm between HCUP and Pentacam, 41.49 µm between SM and Pentacam, and 46.98 µm between HCUP and SM. CR values (%) were 3.49, 2.54, 6.28, 7.68, and 8.47, respectively. CONCLUSION: There were significant differences between the mean CCT values of the measurement devices. CLINICAL SIGNIFICANCE: Contact and non-contact devices may not interchangeable in the clinical assessment of CCT. HOW TO CITE THIS ARTICLE: Mayali H, Altinisik M, Diri I, et al. Comparison of Central Corneal Thickness Measurements by Contact and Non-contact Pachymetry Devices. J Curr Glaucoma Pract 2021;15(1):28-31.

Quantitative Analysis of the Activity in Choroidal Neovascularizations after a Single Anti-VEGF Injection: OCT Versus OCT Angiography.

PURPOSE: To analyze early quantitative changes in the choroidal neovascularization (CNV) area observed with optical coherence tomography angiography (OCTA) after single anti-vascular endothelial growth factor (anti-VEGF) injection. MATERIALS AND METHODS: Treatment-naive patients with CNV secondary to neovascular age-related macular degeneration were analyzed immediately before and ~4 weeks after anti-VEGF injection. The primary endpoints of the study included changes in CNV total and vascular area. Secondary endpoints were best-corrected visual acuity (BCVA), central macular thickness (cMT), central total macular thickness (cTMT), and subfoveal choroidal thickness (SFCT). RESULTS: A total of 27 patients (69.19 ± 5.91 years, 21 men/6 women, 14 type 1 NV, 11 type 2 NV, and 2 type 3 NV) were included in the study. There was a significant increase in BCVA and decreases in cMT, cTMT, and SFCT after treatment (p<0.05 for all). CNV total and vascular area changed by -11.55 ± 44.26% (95% confidence interval [CI]: -29.06 and 5.95; p=0.269) and -21.06 ± 41.2% (95% CI: -36.45/-5.67; p=0.786), respectively. The cases with decreased cTMT were accompanied by a decrease in CNV area only in 37% of the cases. No significant correlation was detected between cTMT and CNV total and vascular area percentage changes (r = -0.06, p=0.74; r = 0.02, p=0.9, respectively). CONCLUSIONS: Changes in CNV total and vascular area seem to have limited sensitivity as a biomarker in terms of activation, as wide variability was observed in CNV area after anti-VEGF injection.

Multimodal ocular evaluation in hemodialysis patients.

PURPOSE: To evaluate choroidal thickness, intraocular pressure (IOP), axial length, central corneal thickness (CCT), lens thickness, anterior chamber depth, and ocular pulse amplitude (OPA) in hemodialysis patients. MATERIALS AND METHODS: The patients with end-stage renal disease and undergoing hemodialysis were included in the study. Immediately before and 1 hour after hemodialysis, all patients underwent measurement of choroidal thickness with spectral domain optical coherence tomography (SD-OC, Cirrus HD-OCT; Carl Zeiss Meditec Inc., Dublin, CA), IOP and OPA with Pascal dynamic contour tonometry (Ziemer Ophthalmic Systems AG, Port, Switzerland), and anterior chamber depth, lens thickness, and axial length with optical biometry (LenStar LS900; Haag-Streit AG, Koeniz, Switzerland). Data from the patients' right eyes were included in the statistical analysis. RESULTS: The patient group included 8 (36.4%) males and 14 (63.6%) females with a mean age of 56, 14 ± 9, 96 (40-70) years. The mean subfoveal choroidal thickness before and after hemodialysis was 255.21 ± 6.15 (245-263) µm and 234.95 ± 7.89 (220-247) µm, respectively (p < 0.001). Mean choroidal thickness at 1500 µm and 3000 µm nasal and temporal of the fovea also decreased significantly after hemodialysis (p < 0.001). Mean OPA values before and after hemodialysis were 2.14 ± 1.07 (0.6-4) mmHg and 1.6 ± 0.86 (0.5-3.2) mmHg, respectively (p < 0.001). There was a statistically significant correlation between OPA and choroidal thickness measurements (p < 0.001, R = 0.923). IOP increased from 15.11 ± 2.58 (11-20) to 15.99 ± 2.21 (13-20) mmHg, but the change did not reach statistical significance (p = 0.05). There was no statistically significant change in mean axial length, anterior chamber depth, lens thickness, or CCT after hemodialysis (p > 0.05 for all). CONCLUSION: Although choroidal thickness and OPA may be decreased immediately after hemodialysis, there may be no significant changes in IOP or avascular ocular structures such as the lens and cornea.

A novel missense mutation in the UBE2A gene causes intellectual disability in the large X-linked family.

BACKGROUND: X-linked intellectual disability type Nascimento (XIDTN) is a disorder of the ubiquitin-proteasome pathway of protein degradation controlled by the UBE2A gene. The disease is characterized by intellectual disability, speech impairment, dysmorphic facial features, skin and nail anomalies, and, frequently, seizures. Eight affected males from a four-generation family who have intellectual disability and speech disorders were examined within an extended family of 57 individuals. Methods A number of methods were used for the molecular diagnosis. Conventional karyotype analyses, array-based comparative genomic hybridization (aCGH), whole exome swquencing (WES), sanger sequencing were performed. Results First, the conventional karyotype analyses were normal, and the results of the aCGH analyses were normal. Then, WES revealed a novel missense mutation of the UBE2A gene at exon 4 NM_003336.3: c.182A>G (p.Glu61Gly). Seven affected individuals and nine carriers in the multigenerational, large family were diagnosed through Sanger sequencing. CONCLUSIONS: We identified the mutation causing intellectual disability in the large family and demonstrated its phenotypic effects. Our cases showed that dysmorphic features could be considered mild, whereas intellectual disability and speech disorders are common features in XIDTN. The structure and function of the gene will be better understood in the novel UBE2A mutation. The genotype-phenotype correlation and phenotypic variations in XIDTN were identified through a literature review. Accordingly, XIDTN should be considered in individuals who exhibit an X-linked pedigree pattern and have intellectual disability and speech disorders.

Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device.

PURPOSE: To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells. SETTING: Department of Ophthalmology, Celal Bayar University, Manisa, Turkey. DESIGN: Prospective randomized controlled trial. METHODS: Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE. RESULTS: This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 µm at postoperative 1 month in both groups (P = .296). CONCLUSIONS: PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.

RETRACTED ARTICLE: Evaluation of macular thickness and visual pathways using optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome.

AIM: The present study aimed to investigate and compare possible changes in amplitude and latency of pattern visual evoked potentials (PVEP) and thickness of quadrants of the macula (TQM) using optic coherence tomography (OCT). MATERIALS AND METHODS: According to polysomnography examinations, 30 mild, 30 severe, 30 controls were included in the study after approval from the ethics committee. RESULTS: No significant difference was found in age and gender between the groups (p = 0.184 and p = 0.954). Significant difference was found between external and internal superior TQM, mean thickness of ganglion cell layer in comparison of all three groups (p = 0.011, p = 0.047, p = 0.030). In comparison between severe OSAS and control groups, significant difference was found in internal nasal, internal superior and external superior TQM (p = 0.048, p = 0.033, p = 0.014) while no significant difference was found TQM in comparison between the mild OSAS and control groups. In comparison between the group of severe OSAS and controls, significant increase was found in P100 as well as N145 latencies whereas only P100 latency was found to increase when mild OSAS was compared with controls. No significant correlation was found between TQM and PVEP parameters in mild and severe OSAS patients. DISCUSSION: Latency and amplitude of PVEP altered in OSAS because edema and inflammation was remarkable in mild as well as severe stages of the disease. Furthermore, thinning in the macula was observed only in severe stages of the disease, explained with level of atrophy and exposure to extended hypoxia.

Unintentional Staining of the Anterior Vitreous with Trypan Blue During Cataract Surgery.

During phacoemulsification and intraocular lens (IOL) implantation surgery, the trypan blue dye used to stain the anterior capsule passed into vitreous cavity and stained the anterior capsule and anterior vitreous in 6 patients. There was history of trauma in 2 patients, uveitis in 1 patient, mature cataract in 1 patient, and no risk factors in the other patients. IOL was implanted in-the-bag without problem in 5 patients. In the patient with iris and zonular defects due to trauma, a sutured IOL was implanted in the same session. The migration of trypan blue into the vitreous cavity through damaged or intact lens zonules is a rare but important complication that makes subsequent surgical steps substantially more difficult.

Evaluation of effects of positive airway pressure treatment on retinal fiber thickness and visual pathways using optic coherence tomography and visual evoked potentials in the patients with severe obstructive sleep apnea syndrome.

INTRODUCTION: Hypoxia during sleep in obstructive sleep apnea syndrome (OSAS) increases intracranial pressure, decreases cerebral perfusion pressure, and alters vascular supply to the optic nerve. Pattern visual evoked potential (pVEP) has revealed that it causes alterations in the optic nerve, and optic coherence tomography has shown that it causes alterations in the retinal and macular layers. OBJECTIVES: To detect and compare possible alterations in macula and peripapillary retinal nerve fiber thickness (pRNFL) using OCT and in the optic nerve pathways using pVEP before and after positive airway pressure (PAP) in the patients with severe OSAS. MATERIALS AND METHODS: Thirty patients who were diagnosed as having severe OSAS in the neurology-sleep outpatient clinic and 30 healthy control subjects were included in the study. Ophthalmic examinations were performed prior to (month 0) and after (month 6) PAP treatment, and pVEP (peak time [PT] and amplitude) and OCT parameters (peripapillary retinal-macular layers) were compared. RESULTS: In the comparison between the severe OSAS (before treatment) and control groups, thinning was found in pRNFL (average, nasal, inferior) and in the macular layers (external and internal superior quadrants) (p < 0.05). pVEP investigation revealed increased PT in P100 and N145 waves and decreased amplitude of N75-P100 waves. In the comparisons before and after PAP treatment, a decrease in PT of N75 and P100 waves and increase in N75-P100 amplitudes were found. In the pRNFL, significant thickening was found in the layers with thinning before treatment, whereas no significant thickening was found in macular layers, except for the fovea. DISCUSSION: It was shown that PAP treatment in patients with severe OSAS prevents hypoxia without causing alterations in intraocular pressure and thus reduces inflammation and causes thickening in the pRNFL and macular layers.

Anterior Chamber Migration of Ozurdex Implants.

We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases was vitrectomized eyes. Four of the patients had sutured intraocular lens (IOL) implantation due to complicated cataract surgery, one had combined retinal detachment surgery with sutured IOL implantation, and one had vitrectomy for diabetic intravitreal hemorrhage cleaning and uncomplicated cataract surgery. Anterior chamber implant migration caused corneal edema in all cases and elevated intraocular pressure in three cases. In two cases, the dexamethasone implant was directed into the vitreous cavity after maximum pupillary dilation and corneal manipulation with cotton tip applicator with the patient in reverse Trendelenburg position. There was no other complication until dexamethasone implant degradation, with clear cornea at final examination. In two cases, the implant was removed from the anterior chamber by aspiration, but keratoplasty surgery was planned due to endothelial cell loss and persistent corneal edema during follow-up. In the last two cases, the dexamethasone implant was redirected into the vitreous chamber with a 23-gauge catheter and anterior chamber maintainer but they migrated into the anterior chamber again. In one of these patients, the implant was aspirated by catheter and corneal transplantation was performed due to corneal edema, while the other patient's implant was redirected into the vitreous chamber with no further anterior migration. The risk of dexamethasone implants migrating into the anterior chamber of vitrectomized eyes and those with sutured IOL implantation should be kept in mind and the patient should be informed and advised to see an ophthalmologist immediately before permanent corneal endothelial damage occurs.

Evaluation of retinal fiber thickness and visual pathways with optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome.

PURPOSE: To investigate the possible changes in retinal nerve fiber layer (RNFL) by optic coherence tomography and in the amplitudes and peak times (PTs) in pattern visual evoked potential (pVEP) and to compare them in obstructive sleep apnea syndrome (OSAS). METHODS: This prospective study included patients with mild OSAS (n = 30), severe OSAS (n = 30), and 30 control subjects. All patients were assessed after obtaining the approval from our hospital's ethics committee. RESULTS: There was no difference in age and gender between the groups (p = 0.184, p = 0.954). By analysis of variance, there was a significant difference in RNFL values among patients with mild OSAS, severe OSAS, and control for three measures of RNFL (average p = 0.044, nasal p = 0.003, inferior p = 0.027). In severe OSAS group, nasal and inferior quadrants of the RNFL were found to be thinner than the control group (p = 0.008, p = 0.031). We showed that the PT of P100 and N145 was prolonged in severe OSAS compared to the control group (p < 0.001) and that PT of P100 was prolonged in mild OSAS compared to the control group (p < 0.05). The amplitude of N75-P100 was significantly decreased in patients with both severe OSAS and mild OSAS compared to the control group (p < 0.001). Correlation of RNFL and pVEP values showed that the inferior quadrant RNFL thickness is correlated with both P100 and N145 PTs (r = 0.271*, p = 0.036 and r = 0.290*, p = 0.043, respectively) and N75-P100 amplitude (r = 0.378**, p = 0.003) in severe OSAS group. CONCLUSIONS: In mild and severe stages of the disease, edema and inflammation were evident and VEP PT and amplitudes were affected in both groups. Furthermore, thinning in RNFL in the severe stage of the disease might be associated with higher atrophy levels and prolonged exposure to hypoxia.

Should we worry about the eyes of celiac patients?

PURPOSE: In this article, we evaluate subfoveal choroidal thickness in celiac patients with respect to adherence to the gluten-free diet and nonadherence to the gluten-free diet, comparing with age and sex matched healthy controls using spectral-domain optical coherence tomography. MATERIALS AND METHODS: A case-control study among 42 celiac patients and 42 healthy participants was conducted in the Department of Pediatric Gastroenterology. Celiac patients of our policlinics compliant with spectral-domain optical coherence tomography examination enrolled in the study. Celiac patients had been asked verbally about their adherence to gluten-free diet, were evaluated according to negative or positive EmA and anti-TG2 for defining adherence, and were divided into two groups (adherence to gluten-free diet and nonadherence to gluten-free diet). RESULTS: Subfoveal choroidal thickness was thinner in EmA (+) or anti-TG2 (+) eyes than EmA(-) or anti-TG2 (-) eyes in celiac patients, but it was not statistically significant. The mean subfoveal choroidal thickness values in eyes with celiac disease, whose diagnosis time was longer than 60 months, were thinner than shorter group. Longer duration of gluten-free diet was associated with adherence difficulty and thinner choroidal thickness (r = -0.15, p = 0.34). Adherence to gluten-free diet was 88.2% for children below the age of 60 months and 57.1% for children older than 60 months. CONCLUSION: In conclusion, in addition to other extraintestinal manifestations of celiac disease, diagnosis time longer than 60 months in pediatric celiac patients, nonadherence to the gluten-free diet, and antibody positivity should be focused on during ophthalmologic examination and choroid measurement.

A multimodal ophthalmic analysis in patients with systemic sclerosis using ocular response analyzer, corneal topography and specular microscopy.

PURPOSE: To conduct a multimodal ophthalmic evaluation of systemic sclerosis (SSc) in patients using ocular response analyzer (ORA), Pentacam, and specular microscopy (SM). METHODS: Thirty-one SSc patients and a group of age- and sex-matched controls were enrolled in this cross-sectional study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with ORA. Anterior chamber depth (ACD), central corneal thickness (CCT), and corneal volume (CV) measurements were obtained using Pentacam. Corneal endothelial cell density (ECD) and CCT were evaluated by SM. RESULTS: SSc patients had significantly lower CH, ACD, and ECD values compared to the control group (p = 0.018; < 0.001; < 0.001, respectively). There was no significant difference regarding CRF, IOP, CV, or CCT measurements acquired by Pentacam and SM. Regarding CCT, SM and Pentacam showed relatively better agreement in SSc patients. CONCLUSIONS: Multimodal imaging can provide more comprehensive and useful information regarding the ocular involvement of systemic diseases. The multimodal evaluation in our study demonstrated that the pathologic effects of SSc may manifest as reductions in ACD, corneal elasticity, and ECD before there are any detectable changes in corneal thickness or IOP.

Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis

Objectives: To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK). Materials and Methods: From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results: Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143). Conclusion: Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.