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.

The inner diameter of the optic disc pit decreases with pars plana vitrectomy.

To report a patient with optic disc pit who showed decreased inner diameter of the optic disc pit along with resolution of recurrent macular detachment after pars plana vitrectomy. Pneumatic retinopexy and peripapillary laser photocoagulation was performed in a 28-year-old female with optic disc pit and serous macular detachment. Two months after the initial therapy, serous macular detachment recurred. Then, pars plana vitrectomy with removal of the posterior hyaloid was performed, and intraocular perfluoro-octane (C3F8) tamponade was used. Fundus photography and ocular coherence tomography were obtained at each visit. The patient was followed up for 1 year. Visual acuity was 20/400 (Snellen) at first presentation, improved to 20/40 at 2 weeks after pneumatic retinopexy and peripapillary laser treatment. Then, 2 months later visual acuity decreased to 20/200, improved to 20/40 at 2 weeks after the vitreoretinal surgery, and stayed stable during the 1-year follow-up. It was also noticed on clinical examinations as well as fundus photographs that the inner diameter of the optic disc pit had decreased significantly. Vitreous traction plays an important role in the formation of serous macular detachments with optic disc pits. In these patients, pars plana vitrectomy and posterior hyaloid removal may be an effective treatment for reduction of the inner diameter of the optic pit and resolution of the serous macular detachments.

Tear osmolarity in unilateral pseudoexfoliation syndrome.

PURPOSE: The aim was to evaluate tear osmolarity of patients with clinically unilateral pseudoexfoliation (PEX) syndrome and to compare the values with otherwise normal subjects. METHODS: Sixty-two eyes of 31 patients with unilateral PEX syndrome and 31 eyes of 31 normal subjects were studied. The TearLab osmolarity system (OcuSense, Inc, San Diego, CA, USA) was used to measure tear osmolarity. Eyes were grouped as normal eyes of patients having unilateral PEX syndrome (group A), eyes of patients having unilateral PEX syndrome with deposits of PEX material (group B) and eyes of normal subjects (group C). Differences in tear osmolarity were compared among groups A, B and C. Independent t-tests and paired t-tests were used for statistical analysis. RESULTS: The mean tear osmolarity was 298.7 ± 7.8 mOsm/l (range 285 to 306) in the control group (group C), 306.3 ± 6.6 mOsm/l (range 290 to 314) in the eyes of patients having PEX syndrome with deposits of pseudoexfoliative material (group B) and 301.4 ± 7.1 mOsm/l (range 284 to 305) in the fellow eye of these patients (group A). There was a significant difference between tear osmolarity of groups C and B (independent t-test, p = 0.011). Also, there was a significant difference between the osmolarity of each eye of patients with unilateral PEX syndrome (groups A and B) (paired t-test, p = 0.001). The difference between tear osmolarity of groups A and C was not statistically significant (independent t-test, p = 0.146). CONCLUSION: In conclusion, tear osmolarity is higher in both eyes of patients when compared with normal subjects, using the independent t-test (although highest in clinically positive eyes of these patients). Both eyes of patients having PEX syndrome could be more prone to the development of dry eye syndrome.

Diurnal variation of the tear osmolarity in normal subjects measured by a new microchip system.

PURPOSE: To show the diurnal variation of tear osmolarity in normal subjects. METHODS: Thirty volunteers were recruited. Tear osmolarity was measured with TearLab osmolarity system at 3-hour regular intervals between 8:00 am and 5:00 pm. One-way analysis of variance test was used for statistical analysis. RESULTS: Thirty healthy volunteers (all men) with a mean age of 29.6 ± 4.3 years (range 18-45) were recruited. The difference between measurements at 8:00 am and 11:00 am, 8:00 am and 2:00 pm, 8:00 am and 5:00 pm, 11:00 am and 2:00 pm, 11:00 am and 5:00 pm, and 2:00 pm and 5:00 pm were not statistically significant (one-way analysis of variance test, p>0.05). CONCLUSIONS: In normal subjects, tear osmolarity seems to have a stable profile during the daytime.

Comparison of non-contact methods for the measurement of central corneal thickness.

BACKGROUND AND OBJECTIVE: This study examined the repeatability of and agreements between central corneal thickness measurements obtained by four different non-contact pachymetry devices. PATIENTS AND METHODS: Seventy-eight eyes of 39 subjects were included. Central corneal thickness of each eye was measured by Visante optical coherence tomography (OCT) (Carl Zeiss Meditec Inc., Dublin, CA), Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), Orbscan IIz topography (Bausch & Lomb Surgical Inc., San Dimas, CA), and slit-lamp OCT (SL-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Inter-device agreements and correlations and repeatability of each device were examined. RESULTS: All measurement methods correlated well with each other with a correlation coefficient greater than 0.90 and P value of less than .001 for all comparisons. However, Pentacam overestimated central corneal thickness: 546.7 ± 38.2, 535.5 ± 42.7, 531.7 ± 37.6, and 531.2 ± 36.0 µm for Pentacam, Orbscan IIz, Visante OCT, and SL-OCT, respectively (P < .001 for all comparisons versus Pentacam). Despite good correlation, magnitude of differences was high and this bias was proportional (ie, not constant across a range of corneal thickness values) for the following pairs: Orbscan versus Visante OCT, Orbscan versus SL-OCT, and Orbscan versus Pentacam (P < .001 for all comparisons). CONCLUSION: Although measurements obtained by various non-contact methods correlate well, numerical agreement of the results may not be sufficient for their interchangeable use in clinical practice.

Assessment of anterior chamber depth using Visante optical coherence tomography, slitlamp optical coherence tomography, IOL Master, Pentacam and Orbscan IIz.

AIMS: To assess and compare the anterior chamber depth (ACD) by different anterior segment imaging techniques. METHODS: Eighty healthy eyes of 40 patients were recruited, and 3 consecutive measurements of ACD were determined prospectively utilizing Visante optical coherence tomography (OCT), slitlamp (SL) OCT, IOL Master, Pentacam and Orbscan IIz. The statistical significance of interdevice differences between measurements was evaluated by one-way ANOVA and Bland-Altman analysis. The repeatability of 3 consecutive measurements was analyzed by repeated-measures ANOVA. RESULTS: The mean ACD was 2.98 ± 0.29, 2.85 ± 0.29, 3.33 ± 0.42, 2.93 ± 0.30 and 2.80 ± 0.29 mm with Visante OCT, SL-OCT, IOL Master, Pentacam and Orbscan IIz, respectively. All devices displayed a high intrasession repeatability (repeated-measures ANOVA, p > 0.05). ACD measurements obtained by the IOL Master were significantly greater compared to other devices. ACD values detected by Visante OCT and SL-OCT, Pentacam and Orbscan IIz were not clinically interchangeable, even though no statistically significant difference was detected. CONCLUSION: Although noncontact ACD measurements using all modalities were easy to handle and demonstrated good repeatability, the tested devices were not regarded as compatible. Hence, the clinician should take the different modalities into consideration during ACD assessment using various devices.

Assessment and comparison of anterior chamber dimensions using various imaging techniques.

BACKGROUND AND OBJECTIVE: To assess and compare the horizontal dimensions of the anterior chamber by different anterior segment imaging techniques. PATIENTS AND METHODS: Eighty eyes of 40 patients without any ocular disease or previous ocular surgery were recruited and three consecutive measurements of internal anterior chamber diameter and white-to-white distance (WTW) parameters were determined. RESULTS: Mean internal anterior chamber diameter was 11.80 +/- 0.39, 11.56 +/- 0.47, and 11.61 +/- 0.58 mm with Visante-OCT, SL-OCT, and Pentacam, respectively. Mean WTW distance was 11.87 +/- 0.35 and 11.65 +/- 0.32 mm by IOLMaster and OrbscanIIz, respectively. There was no significant difference between Visante-OCT and Pentacam, IOLMaster, and OrbscanIIz (P = .125, .918, and .314). However, detection of mean internal anterior chamber diameter was significantly greater by Visante-OCT than SL-OCT (P = .026). All devices displayed a high intrasession repeatability (repeated measured ANOVA, P > .05). CONCLUSION: Internal anterior chamber diameter measurements using Visante-OCT, SL-OCT, and Pentacam, and WTW measurements using IOLMaster and OrbscanIIz were easy to handle and demonstrated good repeatability. Although similar results of horizontal anterior chamber diameter were determined by Visante-OCT, Pentacam, IOLMaster, and OrbscanIIz, the inter-device differences should be considered during clinical practice.

Assessment of anterior chamber angle using Visante OCT, slit-lamp OCT, and Pentacam.

PURPOSE: To assess and compare the anterior chamber angle (ACA) by different anterior segment imaging techniques. METHODS: Forty healthy eyes of 40 normal subjects were recruited and 3 consecutive measurements of ACA were determined prospectively utilizing Visante optical coherence tomography (OCT), slit-lamp OCT (SL-OCT), and Pentacam. Statistical significance of interdevice differences between measurements was evaluated by Wilcoxon signed rank test and Bland-Altman analysis. The repeatability of 3 consecutive measurements was analyzed by repeated measured analysis of variance. RESULTS: Mean nasal and temporal ACA were detected as 31.2+/-8.7 and 32.1+/-8.5 degrees by Visante OCT; 41.6+/-5.9 and 41.8+/-5.2 degrees by Pentacam; and 42.9+/-10.0 and 43.3+/-10.1 degrees by SL-OCT. All devices displayed a high intrasession repeatability (Scheffe multiple comparison, p>0.05). ACA detected by Visante OCT were found significantly different from ACA calculated by Pentacam and SL-OCT (p<0.05). On the other hand, ACA data obtained by Pentacam and SL-OCT were found to be statistically similar (p>0.05). CONCLUSIONS: Although noncontact ACA measurements using all modalities were easy to handle and demonstrated good repeatability in healthy participants, the tested devices were not regarded as comparable. Hence, the clinician should take the different modalities into consideration during ACA assessment using various devices.

Comparison of IOP measurement by ocular response analyzer, dynamic contour, Goldmann applanation, and noncontact tonometry.

PURPOSE: To assess the agreement among ocular response analyzer (ORA), dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT), and noncontact tonometry (NCT), and to determine the effects of central corneal thickness (CCT) and corneal hysteresis (CH) on intraocular pressure (IOP) measurements with these devices. METHODS: Sixty healthy volunteers were recruited. The average of ORA (corneal compensated IOP [IOP-ORAcc] and Goldmann-correlated IOP [IOP-ORAg]), DCT, GAT, and NCT levels were compared and the devices were examined with respect to CCT and CH. One-way analysis of variance and Pearson correlation tests were used for statistical analysis. RESULTS: Mean CCT was 543.28+/-36.2 mum and mean CH was 10.87+/-1.27 mmHg. Mean IOP obtained using DCT was 16.4+/-2.9 mmHg, whereas those provided by ORA were 15.8+/-2.9 mmHg for IOPORAcc and 15.1+/-2.8 mmHg for IOP-ORAg. The mean IOPs obtained using GAT and NCT were 14.8+/-3.1 mmHg and 14.7+/-2.8 mmHg. The differences between the measurements of DCT and GAT, NCT, and IOP-ORAg were statistically significant (p=0.002, p=0.002, and p=0.015, respectively), but not between DCT and IOP-ORAcc (p=0.263). We did not detect a significant correlation between DCT and CCT, and IOP-ORAcc and CCT (p=0.081 and p=0.093). No correlation was observed between IOP-ORAg and CCT (p=0.067). We found a significant correlation between GAT and CCT, and NCT and CCT (p=0.004 and p=0.001). CH was detected to be correlated only to IOP-ORAcc (p=0.017). CONCLUSIONS: IOP readings detected by DCT and IOP-ORAcc were not found to be clinically interchangeable with GAT and NCT readings. IOP-ORAcc and DCT readings may be regarded as comparable and independent of CCT, in the range of the normal IOP.

Diurnal variation of corneal biomechanics and intraocular pressure in normal subjects.

PURPOSE: To assess and investigate the relationship between diurnal variations in intraocular pressure (IOP) and biomechanical properties of cornea. METHODS: Sixty-two healthy volunteers were recruited. Corneal compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF), and corneal hysteresis (CH) parameters were recorded by the Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured using an ultrasonic pachymeter. Three consecutive measurements of IOPcc, IOPg, CRF, CH, and CCT were recorded at 8:00 am, 11:00 am, 2:00 pm, and 5:00 pm. One-way analysis of variance and Pearson correlation tests were used for statistical analysis. Intra device repeatability was evaluated using Scheffe multiple comparison. RESULTS: IOPcc, IOPg, CRF, CH, and CCT measurements displayed a stable profile during daytime acquisitions and no statistically significant variation was noted (p>0.05). All measurements of IOPcc, IOPg, CRF, and CH recorded by ORA at 8:00 am, 11:00 am, 2:00 pm, and 5:00 pm were all found to be highly repeatable (p>0.05). There was a statistically significant and inverse correlation between IOPcc and CH (p=0.001), and a positive correlation was detected between IOPcc and CRF (p=0.001). CRF and CH were both found to be positively correlated to CCT (p=0.001). CONCLUSIONS: IOPcc readings and recordings of corneal biomechanics were constant throughout the day in healthy eyes. CRF and CH seem to exert different effects on IOPcc as diverse correlations were detected between CRF, CH, and IOPcc. Assessment of IOP and corneal biomechanics using ORA was found to be a highly repeatable.

Quantitative assessment of anterior chamber volume using slit-lamp OCT and Pentacam.

PURPOSE: To quantitatively assess and compare the anterior chamber volume (ACV) by different anterior segment imaging techniques. METHODS: Forty healthy eyes of 40 patients were recruited and three consecutive measurements of ACV were determined prospectively utilizing SL-OCT and Pentacam. Statistical significance of interdevice differences between measurements was evaluated by unpaired t test and Bland-Altman analysis. The repeatability of three consecutive measurements was analyzed by repeated measured analysis of variance. RESULTS: Eighty eyes of 40 patients (18 female, 22 male) with a mean spherical error of -0.55+/-1.4 diopters were included in the study. Mean ACV were detected as 163.34+/-29.76 mm3 by Pentacam and 164.14+/-28.44 mm3 by SL-OCT (unpaired t test, p=0.872). Pentacam and SL-OCT displayed a high intrasession repeatability (repeated measured analysis of variance, p>0.05). ACV values detected by SL-OCT were clinically interchangeable with Pentacam. CONCLUSIONS: Noncontact measurements of ACV using SL-OCT and Pentacam were easy to handle and demonstrated good repeatability. The tested devices were regarded as compatible in measuring ACV.

Corneal biomechanical properties and intraocular pressure changes after phacoemulsification and intraocular lens implantation.

PURPOSE: To evaluate corneal viscoelastic and intraocular pressure (IOP) changes measured by an ocular response analyzer (ORA) after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Yeditepe University Department of Ophthalmology, Istanbul, Turkey. METHODS: Fifty-one eyes scheduled for cataract surgery were included in the study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured by ORA preoperatively and 1 week and 1 and 3 months postoperatively. Central corneal thickness (CCT) was measured using the ORA's integrated handheld ultrasonic pachymeter. RESULTS: The mean preoperative CCT (537 microm+/-46 [SD]) did not change significantly by the end of 1 month postoperatively. The mean preoperative IOPcc (17.2+/-3.0 mm Hg) decreased significantly by 3 months postoperatively (15.2+/-3.7 mm Hg) (P= .018). The mean CH decreased from 10.36+/-1.48 mm Hg preoperatively to 9.64+/-1.26 mm Hg at 1 week (P= .028); it increased to preoperative values at the end of 1 month (10.20+/-1.70) and 3 months (10.74+/-1.54) (P>.05). The mean CRF decreased from 10.94+/-2.54 mm Hg preoperatively to 9.99+/-1.77 at 1 week (P= .026); it increased to preoperative values at 1 month (10.26+/-1.59) and 3 months (10.35+/-1.46) (P>.05). CONCLUSIONS: Although CH and the CRF decreased in the early postoperative period, the parameters increased and reached preoperative values by 3 months postoperatively, showing that corneal biomechanical properties are influenced by phacoemulsification and IOL implantation.

Prospective, paired comparison of laser in situ keratomileusis and laser epithelial keratomileusis for myopia less than -6.00 diopters.

PURPOSE: To compare visual and refractive results, contrast sensitivity, and tear stability after laser in situ keratomileusis (LASIK) in one eye and laser epithelial keratomileusis (LASEK) in the fellow eye for low myopia. METHODS: Patients diagnosed with low myopia, with a maximum difference of 1 D between their two eyes, were randomly assigned to receive LASEK on one eye and LASIK on the other eye. A total of 64 eyes of 32 patients with a mean age of 26.83 +/- 5.33 years were included in the study. Preoperative myopia ranged from -1.00 to -6.00 D. Follow-up was 6 to 12 months. Uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), Schirmer test results, tear break-up time, corneal asphericity, corneal uniformity index, predicted corneal acuity, and contrast sensitivity values were compared with preoperative values. A Wilcoxon test was used for statistical comparisons and a P-value less than .05 was considered significant. RESULTS: At 6 months after surgery, there was no statistically significant difference in UCVA, BSCVA, spherical and cylindrical refractive error, Schirmer test, or tear break-up time between groups. Contrast sensitivity values in the LASIK eyes were lower in comparison to preoperative values, but there was no change in the LASEK group. CONCLUSIONS: Based on 6-month results, LASEK for low myopia was safe and effective with predictable results, offered early refractive stability, and may be considered an alternative for LASIK.