Decreased peri-parafoveal RPE, EZ and ELM intensity: A novel predictive biomarker for hydroxychloroquine retinal toxicity.

PURPOSE: To evaluate the reflectivities of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) in the central fovea, perifoveal, and parafoveal regions with Optical Coherence Tomography (OCT) and the change in choroid vascular index (CVI) in patients using hydroxychloroquine (HCQ). METHODS: Sixty-one patients underwent HCQ treatment; age and sex-matched 44 control group subjects were included in the study. The RPE, EZ, and ELM reflectivities were measured with the ImageJ program at 5 points, and CVI was calculated. RESULTS: RPE, EZ, and ELM reflectivities in the central fovea were higher in the HCQ group than in the control group (p < 0.001, p = 0.013, p = 0.022). In the HCQ group, there was a decrease in RPE reflectivities in the temporal, nasal parafovea, and nasal perifovea (p = 0.001, p = 0.03, p = < 0.001). EZ and ELM reflectivity in the nasal parafovea and nasal perifovea was lower in the patient group than in the control group (p = 0.007, p = 0.005, p = 0.009, p = 0.001). In the HCQ group, all absolute para and perifoveal reflectivities relative to the fovea decreased significantly more than in the control group (p < 0.05). CONCLUSION: In patients who underwent HCQ treatment, there is a decrease in the reflectivities of the para and perifoveal RPE, EZ, and ELM compared to the fovea. This decrease is more pronounced than the decrease in reflectivity in the para and perifoveal regions compared to the fovea in people who do not use HCQ. This situation can be considered as a sign of toxicity that is a precursor to overt maculopathy.

Evaluation of Anterior Scleral Thickness and Angle Parameters in Eyes with Pseudoexfoliation Syndrome and Glaucoma.

PRCIS: The relationship between anterior scleral thickness and scleral spur length was disrupted in eyes with pseudoexfoliation, and scleral spur length was shorter in eyes with pseudoexfoliative glaucoma. OBJECTIVE: To evaluate anterior scleral thickness (AST) in eyes with pseudoexfoliation (PX) and to examine the relationship between AST and Schlemm's canal (SC), trabecular meshwork (TM), and scleral spur (SS). METHODS: Thirty-eight patients with PX syndrome (PXS), thirty-eight patients with pseudoexfoliative glaucoma (PXG), and thirty-eight healthy subjects were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3 mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated. RESULTS: In all groups, the AST, SC, and TM measurements were similar (P>0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups (P=0.012). There were significant correlations between TM length and AST in the PXG group (P<0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG (P<0.05). There was a significant relationship between AST0 and SS in healthy eyes (P<0.05), but not in other eyes. CONCLUSIONS: The shorter SS length observed in eyes with PXG may be a sign of structural changes. Additionally, disruption of the relationship between AST and SS may be an early sign of pathological processes, especially in eyes with PXS, and may require closer follow-up of these eyes.

Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control.

PURPOSE: As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. METHODS: This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant--Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. RESULTS: Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). CONCLUSION: The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

PURPOSE: To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). METHODS: The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18 mmHg, and (3) IOP ≤ 15 mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. RESULTS: The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4 mmHg and 32.3 ± 8.4 mmHg, respectively, which significantly reduced to 14.5 ± 0.7 mmHg and 11.6 ± 0.6 mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). CONCLUSION: AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control

ABSTRACT Purpose: As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. Methods: This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant--Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. Results: Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). Conclusion: The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.

Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

Background: In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. Objective: To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). Design: This was a retrospective case-control study. Methods: This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. Results: SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively). Conclusions: In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Value of disc topographic measurements for the discrimination of glaucoma suspects from early primary open angle glaucoma cases: A thin discriminative line.

PURPOSE: To determine the diagnostic value of optic nerve head (ONH) topographic parameters measured by swept-source optical coherence tomography (SS-OCT) in differentiating between early glaucoma cases, glaucoma suspects (GSs), and healthy eyes. METHODS: The files of GSs, those with an early primary open angle glaucoma (POAG) diagnosis, and healthy eyes were retrospectively screened. Demographic characteristics, retinal nerve fibre measurements, visual field examinations, and ONH topographic parameters, including rim area, disc area, vertical and horizontal cup-to-disc ratios (CDRs), and cup volume, were compared between the groups. A receiver operating characteristic (ROC) curve analysis was performed on the ONH parameters. RESULTS: A total of 170 eyes from 85 GSs, 114 eyes from 57 patients with a diagnosis of early POAG, and 70 healthy eyes from 48 subjects were included in the study. The median age was 52.1 ± 0.9 years for the POAG group, 60.2 ± 1.1 years for the GS group, and 60.5 ± 1.6 for the controls. In the comparison of the ONH parameters between the groups, only rim area statistically significantly differed between the POAG and GS groups. However, all ONH parameters statistically significantly differed between the GS and control groups (p< 0.05). The mean rim areas of the GS, POAG, and control groups were 1.278 ± 0.055 mm2, 1.073 ± 0.065 mm2, and 1.446 ± 0.055 mm2, respectively, being statistically significantly higher in the controls and lower in the POAG group (p < 0.001). The highest area under the curve (AUC) value belonged to vertical CDR for the discrimination of the eyes with POAG from healthy eyes [0.806 (0.728-0.869, p < 0.001] and rim area for the discrimination of POAG cases and GSs [0.728 (0.650-0.797, p < 0.001]. CONCLUSION: There are significant differences in all ONH parameters between the eyes of GSs and healthy eyes. For the discrimination of early POAG and GS cases, topographic disc parameters may have value. In this study, rim area significantly differed between the GS and POAG groups, and it had the highest AUC value amongst the evaluated ONH parameters in the discrimination of early POAG cases S GSs.

Quantification of retinal vein and artery trajectories using second-order polynomial equation in eyes with vitreomacular traction.

BACKGROUNDS: To measure the degree of curvature of the retinal artery trajectory (RAT) and retinal vein trajectory (RVT) in the eyes of patients with vitreomacular traction (VMT) and compare them with their healthy fellow eyes. METHODS: This was a retrospective, cross-sectional, case-control study of 58 eyes of 29 patients with unilateral VMT. The participants were divided into two groups. Group 1 VMT was defined as having only morphological changes, while group 2 VMT was defined as morphological changes accompanied by the presence of a cyst or hole to quantify the severity of the disease. The RATs and RVTs were assessed from the color fundus photographs using the ImageJ program. The fundus photographs were rotated 90°. The course of the retinal arteries and veins were marked on a color fundus photograph and fitted to a second-degree polynomial curve (axe[x]/100+bx+c). The coefficient ''a'' was the width and steepness of the trajectories. The comparison between the RAT and RVT of VMT and healthy fellow eyes was investigated and the association between the RAT and RVT and the severity of disease were determined using the Image J program. RESULTS: Eleven subjects were male, and 18 subjects were female. The mean ± SD age was 70.6 ± 7.6 years. Eighteen of the eyes had VMT in the right and 11 of the eyes had VMT in the left eye. Eleven eyes were in group 1 and 18 eyes were in group 2. Axial length (AL) was similar between the two groups (22.63 ± 1.20 mm vs 22.45 ± 1.45 mm p = 0.83) (Table 1). The mean RAT was 0.60 ± 0.18 in eyes with VMT and 0.51 ± 0.17in healthy eyes (p = 0.063). The mean RVT was 0.74 ± 0.24 in eyes with VMT and 0.62 ± 0.25 in healthy eyes for the whole group (p = 0.02). In group 1, the mean RVT of the eyes with VMT was statistically significantly higher than the healthy eyes (p = 0.014). There was not any statistically significant difference for the other parameters evaluated between eyes with VMT and healthy eyes according to the groups and the whole group. (Tables 2-4) CONCLUSION: Unlike other vitreoretinal interface diseases such as epiretinal membrane and macular hole, VMT may be characterized by a narrower RVT, which is characterized by a larger "a" value.

Choroidal thickness measurements of subjects with pseudoexfoliative syndrome and pseudoexfoliative glaucoma: A contralateral eye study.

AIM: In this study, we aimed to investigate the peripapillary choroidal thickness (PPCT) and macular choroidal thickness (MCT) in pseudoexfoliation (PEX) syndrome and compare the data of the contralateral eyes according to the presence of biomicroscopic eye involvement and glaucoma. METHOD: In this cross-sectional case-control study, PPCT and MCT measurements were analyzed in 162 eyes of 81 subjects with PEX syndrome, diagnosed biomicroscopically with the detection of PEX material. The sample included 63 eyes with pseudoexfoliation glaucoma (PG), 49 eyes with visible PEX material alone without glaucoma (PM), 50 fellow eyes without biomicroscopically visible PEX material (F), and 48 eyes of 24 healthy individuals (controls) without any sign of PEX in the detailed ophthalmologic examination. The PEX syndrome group consisted of 25 PM-F, 25 PG-F, 19 PG-PG, and 12 PM-PM eye pairs. The PPCT and MCT values were compared between the eye-pairs of the subjects with the PEX syndrome. RESULTS: The mean PPCT measurements were 183.3 ± 8.1 µm, 158.5 ± 5.4 µm, 167.8 ± 5.9 µm, and 149.9 ± 5.5 µm for the eyes in the control, F, PM, and PG groups, respectively. The eyes in the PG group had statistically significantly lower measurements than those in the control group (p < 0.01). In the contralateral eye comparison of the subjects with PEX syndrome, no significant difference was found in relation to the mean PPCT and MCT measurements between the PM-F, PG-F, and PG-PG eye pairs (p > 0.05 for all). CONCLUSION: Although the eye groups with PEX syndrome had lower mean PPCT measurements than the controls, the contralateral eye analysis of the asymmetrically involved eye pairs showed no significant differences.

Factors defining the intraocular pressure-lowering effect of phacoemulsification and laser peripheral iridotomy in patients with primary angle closure : Factors defining IOP lowering effect of PE and LPI in PAC.

To identify whether gonioscopic ciliary body visibility and factors including anterior chamber depth (ACD), axial length (AL), acute attack history, and preoperative intraocular pressure (IOP) had any effect on IOP decrease in primary angle closure (PAC) and primary angle-closure glaucoma (PACG) after phacoemulsification (PE) and/or laser peripheral iridotomy (LPI). This retrospective-design study was conducted with 81 eyes with PAC and PACG; 33 eyes whose IOP was controlled with LPI and PE constituted group 1, and 48 eyes whose IOP was controlled using LPI alone comprised group 2. The effects on preoperative and last-visit IOP levels, ciliary body visibility, ACD, AL, and acute attacks were analyzed. Eyes within the groups were similar in AL, ACD, and preoperative IOP except for acute attack history, which was found to be higher in group 1. For group 1, none of the factors was found to have a differentiative effect on IOP decrease after PE, except eyes with preoperative IOP > 21 mm Hg, which had significantly more IOP reduction. For group 2, no difference was found in ciliary body visibility, and higher or lower ACD. However, eyes with AL ≥ 22 mm, positive acute attack history, and higher preoperative IOP were associated with significantly better IOP reduction. We found no relationship between ciliary body visibility and an IOP-reducing effect of PE and LPI. Although we found PE effective in IOP reduction in all eyes, we determined LPI to have a lesser IOP-reducing effect in eyes with IOP ≤ 21 mm Hg and AL < 22 mm.

Long-Term Clinical Results of Trabectome Surgery in Turkish Patients with Primary Open Angle Glaucoma and Pseudoexfoliative Glaucoma.

Objectives: The objectives of the study were to analyze the long-term results of trabectome surgery in Turkish patients with primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) and to characterize the risk factors for failure. Methods: This single-center retrospective non-comparative study included 60 eyes of 51 patients diagnosed with POAG and PEXG, who underwent trabectome alone or phacotrabeculectomy (TP) surgery between 2012 and 2016. Surgical success was defined as a 20% decrease in intraocular pressure (IOP) or IOP≤21 mmHg and no further glaucoma surgery. Risk factors for further surgery were analyzed with the Cox proportional hazard ratio (HR) models. The cumulative success analysis was undertaken with the Kaplan-Meier method based on the time to further glaucoma surgery. Results: The mean follow-up period was 59.4±14.3 months. During the follow-up period, 12 eyes required additional glaucoma surgery. The mean pre-operative IOP was 26.9±6.8 mmHg. The mean IOP at the last visit was 18.8±4.7 mmHg (p<0.01). IOP decreased 30.1% from the baseline to the last visit. The average number of antiglaucomatous drug molecules used was 3.4±0.7 (range 1-4) preoperatively and 2.5±1.3 (range 0-4) at the last visit (p<0.01). The risk factors for further surgery requirement were determined as a higher baseline IOP value (HR: 1.11, p=0.03] and the use of a higher number of preoperative antiglaucomatous drug molecules (HR: 2.54, p=0.09). The cumulative probability of success was calculated as 94.6%, 90.1%, 85.7%, 82.1%, and 78.6% at three, 12, 24, 36, and 60 months, respectively. Conclusion: The success rate of trabectome was 67.3% at 59 months. A higher baseline IOP value and the use of a higher number of antiglaucomatous drug molecules were associated with an increased risk of further glaucoma surgery requirement.

Posterior pole analysis and ganglion cell layer measurements in Alzheimer's disease.

AIM: To compare posterior pole analysis and ganglion cell layer (GCL) of patients with Alzheimer's disease (AD) and controls. METHOD: Patients diagnosed with mild and moderate AD included in the study. Posterior pole analysis and GCL measurements were investigated by dividing the macula into superior and inferior hemifields and 5 corresponding zones. RESULTS: There were no significant differences between groups for retinal thickness measurements in any retinal zone. GCL measurements showed lower measurements in moderate AD group for GCL thickness in the superior zone 2 (p:0.025) and inferior zone 2 (p = 0.048) compared to mild AD and controls. A moderate AD status was found to cause a decrease of 5.349 µm in the GCL-SZ2 value [p:0.037]. CONCLUSION: GCL measurements in the moderate AD group show significant thinning in superior and inferior Zone 2, which may be a biomarker for AD.