Assessment of Anxiety, Depression, Self-Esteem, and Quality-of-Life in Patients Undergoing Surgical Removal of an Eye.

Objectives: The objective of this study was to compare anxiety, depression, self-esteem, and quality of life in patients who underwent surgical removal of an eye with those of controls as well as to test the correlations of these variables in both groups. Methods: Beck anxiety inventory (BAI), Beck depression inventory (BDI), 36-item short-form health survey (SF-36), and Rosenberg self-esteem scale were administered to 29 patients with surgical removal of an eye and 30 control subjects. Results: The patient group had significantly lower scores on physical functioning, role limitations due to physical and emotional problems, pain, and general health perception domains of SF-36, as well as significantly higher BDI (p=0.004) scores as compared to controls. The study groups did not differ significantly with respect to BAI scores and energy/vitality, mental health, and social functioning domain scores of SF-36 (p>0.05). Conclusion: This population of monocular patients had similar mental health-related and Beck's Anxiety Inventory scores equivalent to the control group despite the surgical removal of one eye. However, lower scores for some SF-36 domains and higher depression levels in this patient group suggest that psychiatric rehabilitation should be considered after eye removal to improve the psychological outcomes and quality of life in these patients.

The Effects of Blepharoptosis Surgery on Meibomian Gland, Tear Film, and Corneal Topography.

Objectives: The objective of this study was to evaluate the Meibomian gland (MG), tear film, and corneal changes in the post-operative period following ptosis surgery using corneal topography. Methods: This non-comparative, case series study analyzed 30 eyes of 23 patients undergoing blepharoptosis surgery with an external approach. Ocular surface and tear film evaluation was performed at baseline and post-operative 3rd month. The corneal topography was used to assess the MG, the noninvasive tear film break-up time (NI-TBUT), K values, astigmatism, and corneal aberrations. For the examination of dry eyes, the I-TBUT, Schirmer, and ocular surface disease index (OSDI) questionnaires were also performed. Results: The study involved patients with a mean age of 55.1±18.11 years. Postoperatively, marginal reflex distance 1 is significantly increased (1.23±1.09 vs. 3.65±0.65; p=0.001). Results revealed no significant changes in Kmean (43.65±1.15 vs. 43.67±1.14; p=0.727), astigmatism (-1±0.74 vs. -0.99±0.68; p=0.910), and corrected distance visual acuity logMAR (0.09±0.1 vs. 0.07±0.11; p=0.497). There was a significant increase in MG loss area postoperatively (5.02±5.04-7.75±6.75; p=0.047), while the degree of MG loss did not significantly change (0.2±0.48 vs. 0.37±0.56; p=0.132). However, no significant differences were detected in Schirmer I test (17.4±4.7 vs. 16.1±5.5; p=0.711), I-TBUT (12.4±3.1 vs. 11.9±4.7; p=0.483), and OSDI questionnaire score (16.7±9.4 vs. 17.9±10.3; p=0.176) between baseline and post-operative measurements. Similarly, no significant changes were found in NI-TBUT (5.73±3.72 vs. 6.58 4.71; p=0.535) and NIAvg-TBUT (6.06±4.8 vs. 7.51±4.43; p=0.322) values. Conclusion: Surgical correction of blepharoptosis affects MG morphology without causing dry eye at the 3rd month. Post-operative corneal topography is useful in demonstrating changes in the MG.

Topical cyclosporine versus allergen specific immunotherapy in perennial allergic conjunctivitis.

PURPOSE: Symptom control in the long-term with less side effects is important in perennial allergic conjunctivitis, since would improve quality of life. This study aimed to assess the clinical efficacies of topical cyclosporin A and subcutaneous allergen immunotherapy (SCIT) in terms of sign control in perennial allergic conjunctivitis. METHODS: This retrospective study included 20 adult patients with perennial allergic conjunctivitis and confirmed sensitization to house dust mites with skin prick test. Patients were assigned to either topical cyclosporine A treatment or SCIT. The participants were followed for 6 months, and signs scores were recorded at 1, 3 and 6 months. RESULTS: Overall, both cyclosporine and immunotherapy groups showed significant improvements in papillary reaction (p = 0.011 and 0.003, respectively), limbal involvement (p = 0.031 and 0.001), and conjunctival hyperemia (p = 0.001 and p < 0.001) scores during the 6-month follow-up. However, only cyclosporine group showed a significant improvement in corneal involvement scores (p = 0.015) during the study period. When scores at different time points were compared, significant improvement in conjunctival hyperemia was evident at 6 months in both groups when compared to baseline (cyclosporine group, 0.7 ± 0.68 vs. 2.4 ± 0.84, 70.8% decrease, p = 0.01; immunotherapy group, 0.3 ± 0.48 vs. 2.3 ± 0.95, 87.0% decrease, p = 0.004), whereas for limbal involvement such an improvement was only evident in the immunotherapy group (0.1 ± 0.32 vs. 1.3 ± 0.95, 92.3% decrease, p = 0.01). CONCLUSIONS: Allergen immunotherapy and cyclosporin A treatment may provide effective sign relief in perennial allergic conjunctivitis. It may represent an encouraging treatment option particularly for cases with perennial allergic conjunctivitis refractive to other treatments and positive skin prick test to a specific allergen (house dust in the present study). Long-term relief by SCIT would reduce the side effects of polypharmacotherapy. Larger studies with longer follow-up are warranted to confirm our findings.

Evaluation of Peripapillary and Macular Vascular Flow Changes with OCT-A in Patients with Superficial Optic Disk Drusen.

Objectives: The purpose of this study was to compare the peripapillary and macular vascular flow changes between healthy adults and adult patients with superficial optic disk drusen (ODD), as evaluated by optical coherence tomography angiography (OCT-A). Methods: In this retrospective study, 44 eyes of 22 patients with superficial ODD followed-up in our neuro-ophthalmology unit and 54 eyes of 27 healthy individuals admitted to our clinic for routine ophthalmological examination were included in the study. The superior, inferior, nasal, and temporal radial peripapillary capillary plexus (RPC) vessel density (VD) values; superior, inferior, nasal, and temporal parafoveal and foveal region superficial capillary plexus (SCP) and deep capillary plexus (DCP) VD values; and choriocapillaris flow (CCF) area and foveal avascular zone area were evaluated by OCT-A. Results: There was no statistically significant difference between groups in terms of age and sex. While there was a significant decrease in the temporal RPC VD values in cases with ODD (p=0.02), no significant difference was observed in other quadrants. No significant differences in either parafoveal zone four quadrant, foveal SCP and DCP VD values, or foveal avascular zone measurements were found between groups, while CCF area values were significantly higher in the study group (p=0.012). Conclusion: Compared to healthy controls, our results showed a decrease in the RPC temporal quadrant VD values, and an increase in CCF area in cases with superficial ODD. To evaluate the effects of ODD on optic nerve head and macular perfusion, and to understand its underlying mechanisms and secondary complications, longer follow-up studies with larger case series are needed.

Success Rate Comparis on of External Dacryocystorhinostomy with 5-FU Application or Silicone Tube Intubation.

Aims: To compare anatomical and functional success rates in patients with primary acquired nasolacrimal duct obstruction undergoing external dacryocystorhinostomy (EX-DCR) either with adjunctive 5-fluorouracil (5-FU) or silicone tube intubation. Methods: In this retrospective comparative study, 37 eyes in 32 patients who underwent EX-DCR with adjunctive 5-FU (5-FU group) and 43 eyes in 40 patients who underwent EX-DCR with silicone intubation (controls) between 2018 and 2019 were included. Results: The mean age of patients in 5-FU and control groups was 59.8 ± 9.4 and 57.0 ± 15.3 years, respectively. The mean follow-up was 18.70 ± 3.47 months in the 5-FU group and 21.38 ± 7.76 months in the control group. Anatomical success was determined based on patency rates at the time of irrigation and recurrence, while subjective symptoms (improvement in tearing) were used to evaluate the functional success. Lacrimal patency rates in 5-FU and control groups were 83.3% and 86.0%, respectively, while recurrence was observed in 16.2% of 5-FU and 14.0% of control subjects. The two groups were comparable in terms of patency and recurrence rates (p=0.777) as well as rates of epiphora (p=0.212). Conclusion: Both EX-DCR procedures were effective in the management of nasolacrimal duct obstruction. Our results suggest that EX-DCR augmented with 5-FU may represent a more feasible and cost-effective therapeutic option as compared to silicone tube placement in these patients.

Evaluation of early and late COVID-19-induced vascular changes with OCTA.

OBJECTIVE: To evaluate vascular changes in the early period after coronavirus disease 2019 (COVID-19) infection and at 6-month follow-up. METHODS: This study included 50 eyes of 25 patients who had been hospitalized for polymerase chain reaction-positive COVID-19 infection and 50 eyes of 25 healthy individuals. All subjects underwent optical coherence tomography angiography using a 6 × 6 macular protocol in the early period after hospital discharge and 6 months later. Foveal vessel density (VD) and parafoveal VD values were measured from 4 quadrants (superior, inferior, nasal, and temporal) of the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). The choriocapillaris (CC) flow area and the foveal avascular zone area also were measured. The OCTA measurements of the patient group were compared both between time points and with the control group at each time point. RESULTS: COVID-19 patients showed lower VD values than control subjects in all parafoveal quadrants of both the SCP (superior, p = 0.01; inferior, p = 0.048; nasal, p = 0.003; temporal, p = 0.048) and the DCP (superior, p = 0.001; inferior, p = 0.011; nasal, p = 0.012; temporal, p = 0.018) at the initial checkup and in all parafoveal quadrants of the SCP (superior, p = 0.0001; inferior, p = 0.007; nasal, p = 0.001; temporal, p = 0.017) and in 2 of the parafoveal quadrants of the DCP (superior, p = 0.003; inferior, p = 0.016) at 6-month follow-up. CC flow area values were significantly lower at the 6-month follow-up than at the initial examination (p = 0.044). CONCLUSION: It is important to perform appropriate follow-up for COVID-19 patients because retinal vascular flow changes may persist in the long term.

Optical Coherence Tomography Angiography for Evaluation of Retinal Vascular Changes in Patients with Psoriasis according to Disease Severity.

OBJECTIVES: To investigate foveal avascular zone (FAZ) area and retinal vascular density (VD) in patients with psoriasis according to disease severity using optical coherence tomography angiography (OCTA). METHODS: Twenty-seven patients with mild psoriasis (Group 1), 28 with moderate to severe psoriasis (Group 2) and 30 healthy controls (Group 3) were evaluated with OCTA. Foveal and parafoveal VD and FAZ area were measured and compared. RESULTS: FAZ values were significantly higher in Group 2 (0.20 ± 0.1, 0.31 ± 0.07, 0.20 ± 0.09; P < .001, respectively.). The mean VD value were significantly lower in the deep capillary plexus in parafoveal area in Group 2 (35.5 ± 8.7, 28.7 ± 4.6, 35.0 ± 3.5; P < .001, respectively.). These changes showed significant correlation with Psoriasis Area and Severity Index (PASI) scores of patients. CONCLUSIONS: Our results suggest that OCTA may have a future role as alert of potentially more severe disease in cases clinically classified as mild disease.

Optical coherence tomography findings and choroidal neovascular membrane detectability with optical coherence tomography angiography in different subtypes of pattern dystrophy.

CLINICAL RELEVANCE: Optical coherence tomography angiography (OCTA) is a useful method for determining choroidal neovascular membranes (CNVM) in different subtypes of pattern dystrophy. BACKGROUND: We aimed to evaluate the optical coherence tomography (OCT) findings in different subtypes of pattern dystrophy and to detect CNVM not detectable by conventional method using OCTA. METHODS: Of 55 eyes included in this retrospective, cross-sectional study, adult onset vitelliform macular dystrophy was present in 42 eyes (32 eyes vitelliform stage-10 eyes vitelliruptive stage), butterfly-shaped pattern dystrophy in 8 eyes, and multifocal pattern dystrophy simulating fundus flavimaculatus in 5 eyes. Fluorescein angiography (FA), fundus autofluorescence, OCT and OCTA imaging were performed in all cases. RESULTS: The study included 55 eyes of 29 patients, of which 21 were female and 8 were male. On OCT, 25 eyes had hyperreflective dots, 14 eyes had a disruption in the ellipsoid zone (EZ), and 6 eyes had atrophy in the outer retinal layers, and these findings were detected in all subtypes. Findings consistent with CNVM were detected in 1 eye using FA, 3 eyes using OCT and 5 eyes in OCTA. CONCLUSION: In this study, we demonstrated that in different subtypes of pattern dystrophies OCT findings such as hyperreflective dots, disruption in the EZ, atrophy in the outer retinal layers and CNVM can be seen, and that a quiescent CNVM lesion, which cannot be detected by conventional methods, can be detected by OCTA, a new imaging method.

Peripapillary vessel density in pediatric cases with buried optic disk drusen.

BACKGROUND: To evaluate the retinal nerve fiber layer (RNFL) and peripapillary vascular density (VD) changes in the pediatric group with optic disk drusen (ODD). METHODS: Sixty eyes of 30 patients with buried ODD referred by the pediatric or neurology physicians to ophthalmology clinic with a preliminary diagnosis of papillary edema were included in this retrospective study. Sixty eyes of 30 healthy children were included as the control group. Thickness of RNFL (micrometer) and VD percentages (%) of the superior, inferior, nasal, and temporal quadrants of the peripapillary region of all cases were evaluated with optical coherence tomography angiography (OCT-A) device. RESULTS: The study and control groups were homogeneous in terms of age and gender. VD values were significantly lower in the study group for all four quadrants, when compared to controls (p < 0.001, p < 0.001, p = 0.003, and p < 0.001, for inferior, superior, nasal, and temporal quadrants, respectively. For RFNL thickness measurements, a significant difference between groups was only evident for the nasal quadrant, where the study group had significantly higher nasal RFNL thickness (p = 0.001). CONCLUSION: This study detected decreases in peripapillary VD values in all quadrants and peripapillary RNFL thickening in nasal quadrant in pediatric cases with buried drusen compared to healthy controls. Further studies are necessary to reveal the effects of drusen pathogenesis on optic nerve head perfusion and to understand the underlying mechanisms of related complications.

Optical coherence tomography angiography findings in patients with COVID-19.

OBJECTIVE: To examine the changes in choriocapillaris and retina caused by coronavirus disease 2019 (COVID-19) by comparing optical coherence tomography angiography (OCTA) findings of COVID-19 patients and healthy controls. METHODS: The study and control groups consisted of 54 eyes of 27 participants, each. Patients and controls underwent OCTA examination. Foveal zone vessel density and parafoveal zone vessel density (for 4 quadrants: nasal, temporal, superior, inferior) were calculated for both superficial and deep capillary plexuses. Additionally, choriocapillaris flow and foveal avascular zone areas were calculated. RESULTS: For the parafoveal area in the study group, vessel density was significantly lower in the superior and nasal quadrants of the superficial capillary plexus and in all quadrants of the deep capillary plexus compared with controls (p < 0.05 for all). The study group had significantly higher choriocapillaris flow area values compared with controls (p = 0.042). CONCLUSION: Reduced vessel density of the retinal capillary plexus was detected in COVID-19 patients who may be at risk for retinal vascular complications.

Evaluating the Effects of Upper Eyelid Blepharoplasty on Tear Film Quality and Intraocular Pressure.

OBJECTIVES: To evaluate tear film quality and intraocular pressure (IOP) changes after upper eyelid blepharoplasty. METHODS: This retrospective study included 42 eyes of 21 patients who underwent upper eyelid blepharoplasty for dermatochalasis between January 2018 and June 2018 in our clinic. Schirmer's and tear break-up time (TBUT) values and IOP were measured preoperatively and postoperatively at first day, 1 month, and 3 months in all patients. The ocular surface staining pattern was evaluated according to Oxford scale. Effects of upper eyelid blepharoplasty on tear film quality and IOP were evaluated. RESULTS: All patients were female and their mean age was 53.28±7.98. The postoperative Schirmer's test scores at postoperative 3 months were significantly (p<0.01) lower than all previous preoperative measures. Similarly, the postoperative 1-week measurements were significantly (p<0.01) higher than the postoperative 1-month and 3-month measurements. In terms of TBUT, the postoperative 1-week measurement was significantly (p<0.05) higher than the postoperative 1-month measurement and the preoperative value than the postoperative 1-month measurement. There was no significant (p>0.05) difference between the measurements in terms of IOP values. Of the 42 eyes evaluated according to Oxford scale, 28 (66%) had mild symptoms, 10 (23%) had moderate symptoms, and 4 (9%) had marked symptoms. No patient with severe symptoms was detected. CONCLUSION: Upper eyelid blepharoplasty may have a negative effect on tear film quality in early postoperative period; however, it does not affect IOP at any period. Understanding the effects of surgery performed specifically on ocular surface through larger case series may necessitate ophthalmologic examination for preoperative evaluation and postoperative follow-up of dermatochalasis cases.

Evaluation of Treatment Models in the Treatment of Retinopathy of Prematurity.

OBJECTIVES: This study aims to evaluate the treatment modalities applied for retinopathy of prematurity (ROP) and to determine the efficacy and results of treatment modalities. METHODS: Premature babies, who needed treatment for ROP and followed-up in the Neonatal Intensive Care Unit (NICU) of our hospital or external centers, were retrospectively evaluated between January 2012 and January 2017. According to the criteria determined by the International ROP committee, the zones and stages of the cases were recorded. In this study, patients were evaluated in three groups. Group 1: plus disease with any stage in zone 1, group 2: plus disease in zone 2, together with stage 2 or 3, group 3: classified as aggressive posterior retinopathy (APROP). The birth weight, gestational age, treatment weeks and treatments that were administered were recorded. Regression in plus disease, macular dragging and retinal detachment did not develop were evaluated as successful treatment. RESULTS: 1746 preterm babies were examined. 65 (3.7%) preterm babies were included in this study, 31 female and 34 male. 126 eyes of preterm babies were intervened. The mean birth weight was 1159 (535-2200) grams, and the mean gestational age was 28.4±2.5 (24-34) weeks. Group 1 had 33 eyes (26.1%), group 2 had 71 eyes (56.3%), and group 3 had 22 eyes (17.4%). 94 eyes (74.6%) were treated once, 26 eyes (20.6%) were treated twice, 6 eyes (4.8%) received treatment three times. The first treatment was applied at 36±2.4 (32-41) weeks. The first treatment was performed with intravitreal bevacizumab (IVB) in 75.8% of group 1 and 95.5% of group 3, and with diode laser photocoagulation (LPC) in 78.9% of group 2. There was a significant correlation between birth week and birth weight and first treatment week. Re-treatment was applied to 32,8% in LPC group and 19.2% in the IVB group due to recurrence. 5 eyes which were applied LPC+IVB did not need any re-treatment. Stage 4a retinal detachment developed in both eyes of 1 patient from group 1. Macular traction was developed in 2 eyes of 1 patient in group 2. After the treatments, success in 122 eyes (96.8%) was obtained. CONCLUSION: ROP can be controlled by convenient and effective treatment. Although conventional LPC is still the first treatment option for ROP, IVB alone or combination with LPC is a highly effective treatment option for zone 1 disease and APROP. IVB reduces the number of ROP treatments.