Comparison of ranibizumab, aflibercept, and dexamethasone implant monotherapy in treatment-naive eyes with diabetic macular edema: A 12-month real-life experience.

PURPOSE: To compare the functional and anatomical outcomes of ranibizumab, aflibercept, and dexamethasone implant monotherapy in treatment-naive eyes with diabetic macular edema (DME) in real-life conditions. METHODS: In this retrospective cohort study, data were obtained from the hospital database of treatment-naive patients diagnosed with DME with at least 12 months of follow-up. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, third month, sixth month, ninth month, and 12th month were recorded. In addition, a subgroup analysis was performed based on having good (below 0.4 log of minimum angle of resolution [logMAR]) or poor (0.4 logMAR and above) vision. RESULTS: A total of 219 eyes of 142 patients were included in the study. The change in the mean BCVA from baseline to 12th month was from 0.62 logMAR to 0.42 logMAR (P < 0.001) in the ranibizumab group, from 0.56 logMAR to 0.39 logMAR (P < 0.001) in the aflibercept group, and from 0.46 logMAR to 0.5 logMAR (P = 0.653) in the dexamethasone group. There was no significant difference between the treatment groups at any time point (P > 0.05). The mean amount of CRT change was statistically significant at 12 months in all groups (ranibizumab: -175.4 µm, aflibercept: -153.3 µm, dexamethasone: -71.4 µm) (P < 0.05). In eyes with initially good vision, the final BCVA at 12 months was significantly better in the ranibizumab group compared to the dexamethasone group (P = 0.008). The aflibercept group had better visual acuity than the dexamethasone group, but there was no statistically significant difference (P = 0.059). There was no significant difference in final BCVA in eyes with initially poor vision. No serious ocular/systemic complications were noted. CONCLUSION: At the 12th month, a significant decrease in CRT was achieved in all treatment groups, whereas only ranibizumab and aflibercept groups had a significant BCVA increase. In eyes with initially good vision, the final BCVA at 12 months was better in the ranibizumab group compared to the dexamethasone group, whereas it was similar in all groups having initially poor vision.

Investigation of the recurrent vitreous hemorrhage risk factors after early 25G vitrectomy in diabetic vitreous hemorrhage.

Vitreous hemorrhage (VH) is one of the main causes of vision loss in diabetic retinopathy (DRP). Early surgery increases the visibility of the retina, allowing early recognition of DRP complications and additional treatments. One of the most important reasons affecting success after surgery is recurrent vitreous hemorrhage (RVH). We aimed to investigate the risk factors for RVH after early 25G vitrectomy in diabetic VH. Eighty eyes of eighty patients who underwent early 25G PPV surgery with a diagnosis of VH due to proliferative diabetic retinopathy (PDR) were included in this retrospective study. Vision acuity changes and intraocular pressure (IOP) changes were compared. The effect of arterial hypertension (HT), coronary artery disease (CAD), preoperative antiglaucomatous usage, and anticoagulant usage on RVH was investigated. A value of P < .05 was accepted as statistically significant. Postoperative RVH was observed in 18 (22.5%) patients. There was no correlation between the age of the patients and the development of postoperative RVH (r = -0.197, P = .08). The rate of HT and the mean HbA1C levels were found to be higher in the patients who developed RVH than in those who did not (P = .04 and < 0.001, respectively). The presence of CAD, preoperative glaucoma disease, and the use of anticoagulants did not have any effect on RVH (P = .229, 0.843, 0.932, respectively). HT and increased HbA1c were found to be risk factors for RVH in VH patients who underwent 25G vitrectomy in the early period in our study.

Association of inner retinal reflectivity with qualitative and quantitative changes in retinal layers over time in diabetic eyes without retinopathy.

OBJECTIVE: To assess the course of neurodegeneration based on retinal layer thickness and integrity analysis in diabetic patients without retinopathy and to evaluate its association with inner retinal reflectivity. METHODS: This retrospective case-control study included 80 eyes of 80 patients with DM without retinopathy and 40 eyes of 40 healthy subjects with a follow-up of ≥1 year. SD-OCT was used for assessment of retinal reflectivity and macular layer thicknesses. Optical intensity ratios (OIRs) were defined as the mean OCT reflectivity of ganglion cell and inner nuclear layer to the mean reflectivity of RPE. RESULTS: After Bonferroni correction, thinning in pericentral, superior and nasal sectors in total retina, superior ganglion cell, pericentral and nasal inner plexiform, and superior inner retinal layers, as well as thickening in inferior and pericentral outer plexiform layer remained significant in the study group (p < 0.0125). Ganglion cell layer OIR significantly correlated with the changes in superior retina (r = 0.278, p = 0.013), central inner retina (r = 0.247, p = 0.027), and pericentral retinal thickness (r = 0.240, p = 0.032), and no eyes had disruption of retinal layers in the study group initially or finally. CONCLUSION: Ganglion cell layer reflectivity significantly correlated with the amount of pericentral retinal thinning during the time course in the diabetic group, which was more prominent in the inner retinal layers.

Association of retinal biomarkers and choroidal vascularity index on optical coherence tomography using binarization method in retinitis pigmentosa.

PURPOSE: To investigate the association of retinal biomarkers with the choroidal parameters in retinitis pigmentosa (RP). METHODS: This prospective study included 69 eyes of 36 patients with RP. Choroidal vascularity index (CVI) was defined as the ratio of luminal area to stromal area after binarization on EDI-OCT images. Choroidal thickness (CT); peripapillary CT, the disruptions of the ellipsoid zone (EZ) and external limiting membrane (ELM); and the existence of disorganization of the retinal inner layers (DRIL) and epiretinal membrane (ERM) in central 1000 µm were noted. RESULTS: Having DRIL and the disruption of EZ and ELM was significantly associated with higher CVI (p < 0.001, p = 0.001, and p = 0.002 respectively) and lower peripapillary CT in temporal sector (p = 0.031, p = 0.012, and p = 0.043 respectively). Having ERM, the disruption of EZ and ELM was significantly associated with lower visual acuity (VA) (p = 0.044, p < 0.001, and p < 0.001 respectively). The eyes with ERM had significantly lower peripapillary retinal nerve fiber thickness (pRNFLT) (p = 0.040). The mean peripapillary CT significantly and positively correlated with the temporal, nasal, superonasal, and the mean pRNFLT (r = 0.258, p = 0.036, r = 0.252, p = 0.041, r = 0.260, p = 0.035, r = 0.280, p = 0.023 respectively). VA did not significantly correlate with CT, peripapillary CT, or CVI (p > 0.05). CONCLUSION: The disruption outer retinal segment integrity was significantly associated with higher CVI and lower peripapillary CT in temporal segment. ERM and disruption of ELM and EZ were associated with worse VA. VA did not significantly correlate with CT, peripapillary CT, or CVI.

THE THICKNESSES OF CHOROID, MACULAR SEGMENTS, PERIPAPILLARY RETINAL NERVE FIBER LAYER, AND RETINAL VASCULAR CALIBER IN HIV-1-INFECTED PATIENTS WITHOUT INFECTIOUS RETINITIS.

PURPOSE: To evaluate choroidal, macular, peripapillary retinal nerve fiber layer (RNFL) thicknesses and retinal vascular caliber alterations in HIV-1-infected patients without opportunistic infections. METHODS: This cross-sectional study included 45 HIV-1-infected patients and 47 healthy subjects. Spectral domain optical coherence tomography was used for assessment of choroidal, macular, peripapillary RNFL thicknesses and retinal vascular caliber alterations. RESULTS: The mean CD4 count was 426 ± 226 cells per milliliter and the mean HIV-1 RNA level was 1.8 × 10 ± 3.6 × 10 copies/mL in HIV-infected group. Central inner plexiform, superior photoreceptor, superior and nasal retinal pigment epithelium layers were thinner in HIV-infected patients compared with control subjects (P < 0.05). The differences in sectoral retinal thicknesses lost their significance after Bonferroni correction (P < 0.01). The average thickness of pericentral retina within 3 mm was thinner in the photoreceptor layer in HIV-infected patients compared with control subjects (P = 0.033). The differences in peripapillary RNFL thickness, choroidal thickness, and retinal vascular caliber were not significant between the groups. Choroidal thickness and pericentral outer plexiform were thinner, whereas peripapillary RNFL was thicker in newly diagnosed cases (16 patients) compared with patients having treatment for at least 4 months or longer (27 patients, P < 0.05, Mann-Whitney U test). HIV-1 RNA showed negative correlation with choroidal thickness (r = -0.435, P = 0.003) and positive correlation with peripapillary RNFL in central (r = 0.323, P = 0.032) and superonasal (r = 0.369, P = 0.014) sectors. CONCLUSION: Choroidal thickness was thinner in newly diagnosed patients compared with patients on treatment. Viral load showed negative correlation with choroidal thickness. Retinal segmental alterations occurred in HIV-infected patients compared with control subjects.

Automated macular segmentation with spectral domain optical coherence tomography in the fellow eyes of patients with unilateral retinal vein occlusion.

PURPOSE: To assess the change in the macular layers in the fellow eyes of unilateral retinal vein occlusion (RVO) patients and to evaluate whether certain layers are more affected based on RVO type. METHODS: This retrospective study included 87 fellow eyes of patients with unilateral RVO (26 central, 61 branch) and 105 eyes of 105 subjects without RVO. Spectral domain optical coherence tomography was used for automatized retinal segmentation. The thicknesses of retinal nerve fiber layer (RNFL), ganglion cells, inner plexiform, inner nuclear, outer plexiform, outer nuclear, photoreceptor layers, overall inner retinal layers and retinal pigment epithelium (RPE) were documented. RESULTS: Inner plexiform layer was thinner in inferior sector in RVO group compared with the control group (p = 0.047). The subgroup analysis showed that the retina was thinner in RVO group compared with the controls without systemic diseases in some sectors of the following layers: inferior retina, RNFL, ganglion cell layer, inner plexiform layer, inner retinal layers and RPE (p < 0.05). Retinal thickness was decreased in the fellow eyes of branch RVO group compared to that in the central RVO group in the some sectors (p < 0.05). CONCLUSIONS: The fellow eyes of unilateral RVO patients did not show major structural differences compared with the controls; however, they revealed significant sectoral thinning in many retinal layers when compared with the eyes of healthy subjects without systemic diseases. Central macula was thinner in the fellow eyes of patients with branch RVO compared to that in central RVO.

Corneal and Anterior Chamber Morphology in Human Immunodeficiency Virus-1-Infected Patients Without Opportunistic Infections.

OBJECTIVES: To evaluate corneal and anterior chamber morphology as measured by Pentacam HR in human immunodeficiency virus (HIV)-infected patients without opportunistic infections and to search for signs of accelerated aging. METHODS: This prospective study included 41 eyes of 41 HIV-1-infected patients (study group) and 50 eyes of 50 healthy subjects (control group). Specular microscope and Pentacam HR were used for corneal and anterior chamber morphology evaluation. Corneal endothelial cell density (CECD), hexagonal cell ratio, coefficient of variation, corneal thickness, density and volume, maximum keratometry, anterior chamber volume (ACV), and anterior chamber depth (ACD) measurements were recorded for analysis. RESULTS: The mean CD4 count was 428.3±231.9 (36-950) cells/mL, and the time since diagnosis was 27.5±34.1 months in the study group. The difference in anterior segment parameters was not significantly different between the study and the control groups (P>0.05). Age significantly correlated with CECD (r=-0.436, P=0.004), ACV (r=-0.570, P<0.001), ACD (r=-0.471, P=0.002), and corneal density (r=0.424, P=0.006) in the study group, whereas it did not show a significant correlation with any ocular parameters in the control group (Pearson correlation). CONCLUSION: Corneal density, CECD, ACV, and ACD showed significant correlation with age in HIV-1-infected patients. Further studies are needed to show whether ocular parameters may serve as useful tools to monitor HIV-related accelerated aging.