Interpretable detection of epiretinal membrane from optical coherence tomography with deep neural networks.

This study aimed to automatically detect epiretinal membranes (ERM) in various OCT-scans of the central and paracentral macula region and classify them by size using deep-neural-networks (DNNs). To this end, 11,061 OCT-images were included and graded according to the presence of an ERM and its size (small 100-1000 µm, large > 1000 µm). The data set was divided into training, validation and test sets (75%, 10%, 15% of the data, respectively). An ensemble of DNNs was trained and saliency maps were generated using Guided-Backprob. OCT-scans were also transformed into a one-dimensional-value using t-SNE analysis. The DNNs' receiver-operating-characteristics on the test set showed a high performance for no-ERM, small-ERM and large-ERM cases (AUC: 0.99, 0.92, 0.99, respectively; 3-way accuracy: 89%), with small-ERMs being the most difficult ones to detect. t-SNE analysis sorted cases by size and, in particular, revealed increased classification uncertainty at the transitions between groups. Saliency maps reliably highlighted ERM, regardless of the presence of other OCT features (i.e. retinal-thickening, intraretinal pseudo-cysts, epiretinal-proliferation) and entities such as ERM-retinoschisis, macular-pseudohole and lamellar-macular-hole. This study showed therefore that DNNs can reliably detect and grade ERMs according to their size not only in the fovea but also in the paracentral region. This is also achieved in cases of hard-to-detect, small-ERMs. In addition, the generated saliency maps can be used to highlight small-ERMs that might otherwise be missed. The proposed model could be used for screening-programs or decision-support-systems in the future.

Evaluating the effectiveness of inflammatory markers in pediatric open globe injury using a modified pediatric ocular trauma score.

BACKGROUND: This study aims to assess pediatric patients with Open Globe Injury (OGI) using the Modified Pediatric Ocular Trauma Score (MPOTS) and to investigate the correlation between Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lympho-cyte ratio (PLR) parameters with the prognosis determined by MPOTS. METHODS: In this retrospective study, we included pediatric patients with OGI. Recorded data encompassed demographic details, injury type, duration from injury to surgery, complete ophthalmological examinations, initial and final visual acuities, anterior segment and fundus findings, and NLR and PLR values. Patients were categorized into three groups based on their MPOTS scores: Grade I (≤30 points), indicating high risk; Grade II (35-65 points), moderate risk; and Grade III (≥70 points), low risk. Differences between categories were statistically evaluated. RESULTS: The study comprised 22 patients. In Category I, the duration from injury to surgery was longer (p=0.018). The most common injury type in this category was globe rupture, occurring in four (50%) patients, with a significant difference noted between the groups (p=0.041). Category I exhibited lower final visual acuity and higher NLR and PLR values compared to the other categories (p<0.050 for all values). Both NLR and PLR demonstrated significant negative correlations with MPOTS (respectively, r=-0.869, p<0.001; r=-0.809, p<0.001). CONCLUSION: The Modified Pediatric Ocular Trauma Score is an effective and practical method for assessing the prognosis of pediatric patients with Open Globe Injury (OGI). Furthermore, there is evidence indicating a negative correlation between MPOTS and the increase in NLR and PLR values that often follows OGI in this patient population.

Development and progression of myopia in children during the COVID-19 pandemic in urban area in Turkey.

PURPOSE: To investigate the relationship between digital screen time and the development and progression of myopia during the 2019 coronavirus disease (COVID-19) pandemic. METHODS: Children aged 7-18 years who had regular refractive measurement follow-ups before and after the COVID-19 pandemic were included in the study. They were divided into two groups according to their initial refractive status, emmetropic and myopic. The relationship between spherical equivalent refraction (SER) changes and digital screen time before and after the pandemic was analyzed. RESULTS: A total of 255 children were included in the study. During the pandemic in the emmetropic group, digital screen time increased by 5.98 ± 2.13 h/day, and the mean SER decreased from - 0.02 to - 0.55 D (p < 0.001). During the pandemic in the myopic group, the digital screen time increased by 6.25 ± 2.36 h, and the mean SER decreased from - 1.82 to - 2.72 D (p < 0.001). A significant correlation was found between the increase in digital screen time and the change in SER in the emmetropic and myopic groups (r = - 0.261, p = 0.015, r = - 0.269, p = 0.001, respectively). CONCLUSION: Increased digital screen time during the COVID-19 pandemic is associated with a myopic shift in emmetropic children and myopic progression in myopic children. As a result of COVID-19, increasing cases of myopia should be addressed as a public health concern.

Knowledge levels and attitudes of medical faculty students related to whole body donation in Türkiye.

BACKGROUND: Cadaver is a very important educational material for medical faculty students, students of health sciences, residents of any specialty in medicine and specialists. In developed countries, cadavers are mainly obtained by individual donations. However, like in other developing or underdeveloped countries, whole-body donations for cadaveric use in Türkiye are extremely scarce. This study sought to investigate the knowledge and awareness levels of medical faculty students about body donation and the factors that might influence their attitudes to body donation. The aim of the study is, with the results of the questionnaire, to raise public awareness for whole-body donation by creating public spots and by giving place in the official website of the Ministry of Health and make medical faculties to put lectures about body donation and its importance into their anatomy curriculum. METHODS: A 31-item questionnaire with close-ended statements was administered to 291 students at Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty. RESULTS: Only two of the participants (0.7%) stated that they had already donated their bodies to be used as a cadaver. Of note, those who reported considering whole body donation had higher maternal education levels (p = 0.002). The presence or absence of religious belief and the degree of religiosity were also significant factors, for significantly higher rates of non-believers and those who defined themselves as having a low degree of religiosity were in favor of body donation (p < 0.0001). CONCLUSIONS: According to the religion of Islam, we should inform the relevant media that there is no harm in donating a body. In addition, considering the effect of mother's education level on the decisions of young people on this issue, we can state that we see once again how important women's education is in order to make progress in every field.

Clinical and morphological characteristics of patients with idiopathic epiretinal membrane with foveal herniation.

PURPOSE: To analyse the clinical and morphological characteristics of eyes with idiopathic epiretinal membrane (iERM) and foveal herniation (FH). METHODS: Clinical findings and OCT features of patients with iERM and FH were retrospectively analysed. Primary outcome were changes of the best-corrected-visual-acuity (BCVA) and OCT features from baseline to the last visit. FH patients were divided into two groups based on herniated layers: ganglion cell complex (GCC)-group and sub-GCC-group. Surgical outcome was also assessed. RESULTS: In this study, 3882 patients with iERM were screened, of whom 51 (1.3%) were identified with FH. The GCC-group (n = 16) had a better baseline BCVA and thinner central foveal thickness (CFT) in comparison to the sub-GCC-group (n = 35) but without statistical significance (p = 0.330, p = 0.417, respectively). The postoperative BCVA-improvement was similar between the two groups (p = 0.280). Fibrillary surface changes were detected in 42/51 (82.3%) patients, significantly more often in the sub-GCC group (p = 0.020). The baseline BCVA was a predictive factor for the postoperative vision change. CONCLUSION: FH presents with a unique macular morphology in eyes with iERM. Affected eyes experience varying visual disturbances based on the involvement of the inner retinal layers in the foveal herniation. Macular surgery is successful in restoring vision, even though foveal morphology does not fully recover.

The prognostic role of optical coherence tomography in diabetic macular edema patients undergoing early dexamethasone implant shift.

PURPOSE: To determine the prognostic characteristics of optical coherence tomography (OCT) parameters by evaluating diabetic macular edema (DME) patients with early dexamethasone (DEX) shift after three doses of intravitreal ranibizumab (RNB) injection. METHODS: Fifty-four eyes of 34 patients who had DEX implant after three doses of RNB were included in this retrospective study. Early DEX shift includes patients who received direct DEX implant replacement after three doses of RNB load. Baseline OCT values and factors affecting best corrected visual acuity (BCVA) and central macular thickness (CMT) response were analyzed with logistic regression analyses. RESULTS: The presence of subretinal fluid and hyperreflective spot (HRS) >20 were found to be a negative predictive factor for anatomical response. (p = 0.009, p = 0.001, respectively) Low initial BCVA creates a positive effect on visual gain.( p = 0.041) Giant outer nuclear layer cysts, completely disrupted inner segment-outer segment and HRS > 20 have a negative effect on visual gain. (p = 0.025, p = 0.043, p = 0.023, respectively) According to the receiver operating characteristic analysis, the subretinal fluid volume threshold at which >20% reduction in CMT occurs was determined to be 0.85 mm3. (sensitivity 70%, specificity 84% area under the curve 0.817, p = 0.021). CONCLUSION: The presence of high number of HRS and high subretinal fluid volume at the baseline negatively affect prognosis even in patient groups with early DEX shift.

Characteristics of work-related eye trauma in construction and manufacturing industries.

CLINICAL RELEVANCE: Knowledge of work-related eye trauma in the construction and manufacturing industries will facilitate planning of policies and practices to protect against such occurrences. BACKGROUND: The aim of this study was to compare demographic, epidemiological, and clinical characteristics of work-related eye trauma in workers in the construction and manufacturing industries. METHODS: Medical board disability reports of subjects who experienced work-related eye trauma were investigated in this retrospective comparative study. Subjects were separated into two groups - construction and manufacturing - and the demographic, epidemiologic, and clinical characteristics within the two groups were compared. RESULTS: The construction group included 138 eyes of 132 subjects and the manufacturing group included 82 eyes of 77 subjects. Demographic characteristics of the groups were similar (p > 0.05). The number of work-related eye trauma incidents was found as decreased during winter in construction (p < 0.001), but a similar trend was not found in manufacturing (p > 0.05). Head traumas as reason for work-related eye trauma (p < 0.001), and concomitant systemic diseases including bone fracture and traumatic brain injuries (p < 0.001 and p = 0.012) were significantly associated with eye trauma in manufacturing. Open globe injury was more common in construction (p = 0.046), and chemical injury was more common in manufacturing (p < 0.001). Retinal detachment was more prevalent in construction (p = 0.042). Hand motion or worse final visual acuity was more prevalent in manufacturing (p = 0.007) and the final visual acuity better than 6/60 was more prevalent in construction (p = 0.045). CONCLUSION: Chemical injuries are more common in manufacturing, whereas open globe injuries and retinal detachments occur more frequently in construction. Permanent low vision and blindness are more commonly associated with work-related eye trauma in manufacturing.

Risk of intervertebral disc joint puncture during lumbar puncture.

OBJECTIVE: Penetration of intervertebral disc joint during lumbar puncture might be unnoticed during procedure. However, accelerated degeneration of the disc joint is a long-term consequence of inadvertent penetration. In this paper, we aimed to demonstrate and evaluate the risk of disc puncture during standard lumbar puncture. PATIENTS AND METHODS: 50 human cadavers were used in this study. Disc puncture risk was assessed by using worst case scenario model. Lumbar puncture was performed in a standard fashion using midline route at L3-4, L4-5 and L5-S1 levels. The needle was advanced until it hit resistance from the bone. Lateral X-ray was used to visualize the needle position. Needle ended up in two possible locations - posterior vertebral body wall and intervertebral disc space. RESULTS: The probability of puncturing the joint was 20 % for L3-4, 38 % for L4-5, 16 % for L5-S1. Total probability of disc penetration was 25 %. Statistical analysis revealed significantly increased risk for performing LP at L4-5 level in comparison with L5-S1 (p = 0.023). CONCLUSION: Lumbar puncture carries significant risk of intervertebral disc penetration. This complication is not realized during the procedure and lead to accelerated joint degeneration.

Surgical Anatomy of the Posterior Intermuscular Approach to the Brachial Plexus.

Background: First rib resection and scalenectomy is a well-established treatment option for thoracic outlet syndrome. The posterior approach is rarely used due to extensive muscle sacrifice resulting in significant procedural morbidity. In this paper, we report the surgical anatomy of modified and less-invasive muscle-sparing posterior approach. Methods: Eleven human cadavers were used in this study. With specific care to preserve muscles' integrity, the brachial plexus was exposed by dissecting through the posterior neck musculature. A muscular triangle was found under the trapezius muscle, which provided direct access to deeper structures. Four anatomical reference points were identified to denote a 3-dimensional space enclosing proximal brachial plexus. Results: A muscular triangle was found under the trapezius muscle in all cadavers. It was bordered infero-medially by rhomboid minor, supero-medially by splenius capitis, and laterally by levator scapula muscles. The inferomedial border (rhomboid) was 55 mm (48-80), superomedial border (splenius capitis) was 60.5 mm (42-89), and the lateral border (levator scapulae) was 99 mm (60-130). A consistent vein was present inside the triangle and could be used as an anatomical landmark. The 4 reference points were C5, T1 intervertebral foramina, transverse tubercle, and scalene tubercle of the first rib. Removal of the first rib could be performed without brachial plexus retraction. The latter was exposed from neural foramina to lateral border of the first rib. Conclusions: The posterior approach provides ample space to for exposure and manipulation with the first rib and proximal brachial plexus.

The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema.

PURPOSE: To investigate the usefulness of systemic inflammatory markers [i.e., white blood cell and platelet counts, mean platelet volume, and their ratios] as diagnostic markers of the pathogenesis of diabetic macular edema. METHODS: The study cohort included 80 diabetic macular edema patients (40 with diabetic retinopathy and 40 without) and 40 healthy age- and sex-matched controls. Neutrophil, lymphocyte, monocyte, and platelet counts, and the mean platelet volume were determined from peripheral blood samples, and the monocyte/lymphocyte, platelet/lymphocyte, and mean platelet volume/lymphocyte, and neutrophil/lymphocyte ratios were calculated and compared among groups. RESULTS: The mean neutrophil/lymphocyte ratio of the diabetic macular edema and non-diabetic macular edema groups was higher than that of the control group, and the value of the diabetic macular edema group was higher than that of the non-diabetic macular edema group (p<0.001 in diabetic macular edema vs. control, p=0.04 in non-diabetic macular edema vs. control, and p=0.03 in diabetic macular edema vs. non-diabetic macular edema). A neutrophil/lymphocyte cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with a sensitivity of 85% and specificity of 74%. The mean platelet volume of the diabetic macular edema group was higher than those of the non-diabetic macular edema and control groups, while those of the non-diabetic macular edema and control groups were similar (diabetic macular edema vs. non-diabetic macular edema, p=0.08; diabetic macular edema vs. control, p=0.02; and non- diabetic macular edema vs. control, p=0.78). All other parameters were similar between groups (all p>0.05). CONCLUSION: The neutrophil/lymphocyte ratio and mean platelet volume of the diabetic macular edema group were higher than those of the non-diabetic macular edema and control groups. A neutrophil/lymphocyte ratio cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with high sensitivity and specificity. Moreover, the neutrophil/ lymphocyte ratio of the non-diabetic macular edema group was higher than that of the control group.

The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema / A utilidade de marcadores inflamatórios sistêmicos como indicadores diagnósticos da patogênese do edema macular diabético

ABSTRACT Purpose: To investigate the usefulness of systemic inflammatory markers [i.e., white blood cell and platelet counts, mean platelet volume, and their ratios] as diagnostic markers of the pathogenesis of diabetic macular edema. Methods: The study cohort included 80 diabetic macular edema patients (40 with diabetic retinopathy and 40 without) and 40 healthy age- and sex-matched controls. Neutrophil, lymphocyte, monocyte, and platelet counts, and the mean platelet volume were determined from peripheral blood samples, and the monocyte/lymphocyte, platelet/lymphocyte, and mean platelet volume/lymphocyte, and neutrophil/lymphocyte ratios were calculated and compared among groups. Results: The mean neutrophil/lymphocyte ratio of the diabetic macular edema and non-diabetic macular edema groups was higher than that of the control group, and the value of the diabetic macular edema group was higher than that of the non-diabetic macular edema group (p<0.001 in diabetic macular edema vs. control, p=0.04 in non-diabetic macular edema vs. control, and p=0.03 in diabetic macular edema vs. non-diabetic macular edema). A neutrophil/lymphocyte cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with a sensitivity of 85% and specificity of 74%. The mean platelet volume of the diabetic macular edema group was higher than those of the non-diabetic macular edema and control groups, while those of the non-diabetic macular edema and control groups were similar (diabetic macular edema vs. non-diabetic macular edema, p=0.08; diabetic macular edema vs. control, p=0.02; and non- diabetic macular edema vs. control, p=0.78). All other parameters were similar between groups (all p>0.05). Conclusion: The neutrophil/lymphocyte ratio and mean platelet volume of the diabetic macular edema group were higher than those of the non-diabetic macular edema and control groups. A neutrophil/lymphocyte ratio cutoff value of ≥2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with high sensitivity and specificity. Moreover, the neutrophil/ lymphocyte ratio of the non-diabetic macular edema group was higher than that of the control group.

RESUMO Objetivo: Investigar a utilidade de marcadores inflamatórios sistêmicos (ou seja, contagem de glóbulos brancos e plaquetas, volume médio de plaquetas e suas proporções) como marcadores de diagnóstico da patogênese do edema macular diabético. Métodos: A coorte do estudo incluiu 80 pacientes com edema macular diabético (40 com retinopatia diabética e 40 sem) e 40 controles saudáveis de acordo com a idade e sexo. As contagens de neutrófilos, linfócitos, monócitos, plaquetas e valores do volume plaquetário médio foram determinados a partir de amostras de sangue periféricdo, e as proporções de monócitos/linfócitos, plaquetas/linfócitos, volume plaquetário médio/linfócitos e neutrófilos/linfócitos foram calculadas e comparadas entre os grupos. Resultados: A proporção média de neutrófilos/linfócitos dos grupos com edema macular diabético e não-diabético foi maior que a do grupo controle, e o valor do grupo com edema macular diabético foi maior que o do grupo com edema macular não diabético (p<0,001 no com edema macular diabético vs. controle, p=0,04 no com edema macular não diabético vs. controle e p=0,03 no com edema macular diabético vs. o com edema macular não-diabético). Um valor de corte de neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com sensibilidade de 85% e especificidade de 74%. O volume plaquetário médio do grupo com edema macular diabético foi maior que o dos grupos com edema macular não-diabético e controle, enquanto os do grupo de edema macular não-diabético e controle foram semelhantes (edema macilar diabético vs. Edema macular não-diabético, p=0,08; com edema macular diabético vs. controle, p=0,02; e com edema macular não-diabético vs. controle, p=0,78). Todos os outros parâmetros foram semelhantes entre os grupos (todos p>0,05). Conclusão: A proporção de neutrófilos/linfócitos e o volume plaquetário médio do grupo com edema macular diabético foram superiores aos do grupo com edema macular não-diabético e controle. Um valor de corte da razão neutrófilos/linfócitos ≥2,26 foi identificado como um indicador da patogênese do edema macular diabético com alta sensibilidade e especificidade. Além disso, a proporção de neutrófilos/linfócitos do grupo com edema macular não-diabético foi superior à do grupo controle.

Effect of topical pilocarpine on refractive surgery outcomes.

PURPOSE: To investigate the effect of topical pilocarpine on topical cycloplegia and on the results of refractive surgery. METHODS: The study included 100 eyes of 100 patients who underwent laser-assisted in situ keratomileusis. Group 1 comprised patients who wanted to undergo surgery on the same day after cycloplegic examination and were applied with 2% pilocarpine hydrochloride; group 2 comprised patients whose pupils spontaneously went into the natural position. Corneal thickness, mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), pupil diameter, pupil center shift and high-order aberrations (HOAs) were compared between the two groups. RESULTS: There were no statistically significant differences between the groups in respect of preoperative age, gender, corneal thickness, MRSE, UDVA and CDVA. The pupil diameter was not statistically significant between the groups. Pupil diameter after pilocarpine was not statistically significant when compared with the natural pupil diameter. There were no statistically significant differences in postoperative HOA between the two groups. CONCLUSIONS: The pupillary dilatation and the associated pupillary shift were reduced with pilocarpine. Postoperative refractive values and aberrations showed no difference between the groups.

Comparison of Samfilcon A and Lotrafilcon B silicone hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy.

PURPOSE: To compare the efficacy of Samfilcon A and Lotrafilcon B bandage contact lenses after photorefractive keratectomy (PRK). METHODS: In this study, patients with bilateral PRK were assigned for the fitting of Lotrafilcon B lens and Samfilcon A lens. The patients were examined on the day of surgery and on postoperative days 1, 2 and 3. Slit biomicroscopy was performed to assess epithelial defect size in the postoperative examinations. The subjective evaluation of pain and visual symptoms was recorded on postoperative days 1, 2 and 3. RESULTS: Analysis was made of 68 eyes of 34 patients who fulfilled the criteria and had PRK for correction of low to moderate myopia/astigmatism. On postoperative days 1 and 2, pain and epiphora scores were significantly lower in eyes with Samfilcon A lens (p < 0.001 for all), and on postoperative day 3, the differences were not significant (p = 0.414 and p = 0.180, respectively). There was no significant difference between the two lenses in respect of the levels of photophobia. The difference in epithelial defect size was statistically lower in eyes with Samfilcon A lens compared to Lotrafilcon B on day 1 (16.89 mm2 vs. 21.07 mm2; p = 0.003) and day 2 (1.49 mm2 vs. 2.46 mm2; p < 0.001). The difference was not significant on day 3. (0.05 mm2 vs. 0.05 mm2; p = 1.000). CONCLUSIONS: The Samfilcon A lens is superior to the Lotrafilcon B lens in reducing postoperative pain and accelerating re-epithelialization.

Bilateral postoperative ultrasound-guided erector spinae plane block in open abdominal hysterectomy: a case series and cadaveric investigation.

We anticipated that bilateral Erector spinae plane (ESP) block, which was applied in 10 patients starting from lower thoracic levels (T9) might provide effective postoperative analgesia in open abdominal hysterectomies. In addition, we aimed to obtain anatomic observation of the local anaesthetic (LA) spread in the ESP block by injecting methylene blue on 4 cadavers. All the patients had excellent pain relief. There was an extensive spread to the erector spinae muscle (ESM) involving several segmental levels on cadavers. We observed the spread of dye on the ventral and dorsal rami in the paravertebral space and as an additional finding, the dye had extended to the canal vertebralis. There was a spread of dye on the dura mater. ESP block can be used with new indications and it is an effective technique for major abdominal surgery when is applied to the lower vertebral levels. Randomized controlled trials are required to explore the clinical implications of our findings.

The Relationship of Neutrophil to Lymphocyte Ratio with Vitreomacular Traction Syndrome.

This study was conducted to reveal the role of systemic low-grade inflammation by calculating the Neutrophil/Lymphocyte Ratio (NLR) in Vitreomacular Traction Syndrome (VMTS) of different etiologies. A retrospective examination was made of the medical records at a tertiary referral hospital. The study included 31 patients with diabetic VMTS, 27 patients with idiopathic VMTS, and 35 healthy subjects as the control group. The White Blood Cell (WBC) counts and Neutrophil-to-Lymphocyte Ratio (NLR) was compared. There were insignificant differences between the groups in terms of mean age and female/male ratio (P>0.05). The mean ± Standard Deviation (SD) of NLR was calculated as 2.43 ± 0.83 in the diabetic VMTS group, 2.38 0.96 in the idiopathic VMTS group, and 1.83 WBC: White blood cell; VMTS: Vitreomacular traction syndrome; SD: standard deviation; µL: microliter; fL: femtolitre; n: number. 0.52 in the control group (P=0.007). The values of the diabetic and idiopathic VMTS groups were significantly higher than those of the control group (P=0.002 and P=0.032, respectively). However, differences between the diabetic and idiopathic VMTS groups were insignificant (P=0.651). This study found significantly higher NLR in patients with diabetic and idiopathic VMTS than the control group. Elevated NLR could therefore be a potential indicator of VMTS, irrespective of the etiology.

Optic disk pits and optic disk pit maculopathy: A review.

Optic disk pit, one of the optic disk cavitary anomalies, is generally congenital and unilateral and occurs equally in males and females. Optic disk pit maculopathy is characterized by intraretinal and subretinal fluid at the macula, causing visual deterioration. The origin of the macular fluid and the mechanism of transition to the subretinal space in optic disk pit maculopathy pathophysiology are not yet fully understood. With the evolution of imaging modalities, especially optic coherence tomography, our knowledge of this disorder continues to increase. Although many different treatments have been tried, there is no consensus on the most effective.

Effect of accelerated corneal crosslinking on ocular response analyzer waveform-derived parameters in progressive keratoconus / Efeito do crosslimking corneano acelerado nos parâmetros derivados da forma de onda do analisador de resposta ocular no ceratocone progressivo

ABSTRACT Purpose: To evaluate the effect of accelerated corneal crosslinking on corneal biomechanics with an ocular response analyzer in patients with progressive keratoconus. Methods: In this retrospective study, 50 eyes of 45 patients with progressive keratoconus who underwent accelerated corneal crosslinking were evaluated with ocular response analyzer waveform parameters before and one year after corneal crosslinking. Paired two-tailed Student's t-test was performed to compare the parameters before vs. after corneal crosslinking. Results: Mean patient age was 17.6 ± 3.6 (range 9-25) years. A significant increase was observed in p1 area, p2 area, h2, and dive2 values. No significant difference in corneal hysteresis, corneal resistance factor, or other waveform-derived parameters was observed at one year postoperatively. Conclusion: For estimating the effect of accelerated corneal crosslinking on corneal biomechanics, parameters such as p1 area, p2 area, h2, and dive2 are more sensitive than corneal hysteresis and corneal resistance factor. These results may help us to find out which corneal crosslinking method is most effective for stiffening the cornea.

RESUMO Objetivo: Avaliar o efeito do cross-linking corneano acelerado na biomecânica corneana com analisador de resposta ocular em pacientes com ceratocone progressivo. Métodos: Neste estudo retrospectivo, 50 olhos de 45 pacientes com ceratocone progressivo submetidos à cross-linking corneano acelerado foram avaliados com os parâmetros da forma de onda do analisador de resposta ocular antes e um ano após o tratamento com cross-linking corneano. O teste t de Student pareado bicaudal foi realizado para comparar os parâmetros antes e depois do cross-linking corneano. Resultados: A média de idade dos pacientes foi de 17,6 ± 3,6 (variação de 9 a 25) anos. Um aumento significativo foi observado nos valores de p1area, p2area, h2 e dive2. Nenhuma diferença significativa foi encontrada na histerese da córnea, fator de resistência da córnea ou outros parâmetros derivados da forma de onda foi observada em um ano de pós-operatório. Conclusão: Para estimar o efeito do cross-linking corneano acelerado na biomecânica corneana, parâmentros como p1area, p2area, h2 e dive2 são mais sensíveis que histerese da córnea e fator de resistência corneana. Esses resultados podem nos ajudar a descobrir qual método cross-linking corneano é mais eficaz no enrijecimento da córnea.

The Optimal Cutoff Value of Neutrophil/Lymphocyte Ratio for Severe Grades of Diabetic Retinopathy.

OBJECTIVES: The aim of this study was to define the optimal cutoff value of the neutrophil/lymphocyte ratio (NLR) to predict severe grades of diabetic retinopathy (DR). METHODS: A total of 40 patients with proliferative DR (PDR) and 40 patients with severe non-proliferative DR (NPDR) were included this prospective, case control study, and 35 age- and sex-matched healthy subjects were recruited as a control group. White blood cell (WBC) count mean values and ratios were compared between the groups. RESULTS: The groups were statistically similar in terms of age and sex. The neutrophil, lymphocyte, monocyte, platelet counts, and main platelet volume (MPV) values were similar in all 3 groups (all p values >0.05). The mean NLR was 2.67±1.02 in the PDR cases, 2.16±0.58 in severe NPDR, and 1.85±0.49 in the control group, which represented a statistically significant difference between the 3 groups (p=0.003). In post-hoc analysis, the NLR of the PDR and severe NPDR groups was statistically significantly greater than that of the control group (p=0.002 and p=0.048, respectively), but there was no statistically significant difference between the PDR and severe NPDR groups (p=0.083). The monocyte/lymphocyte, platelet/lymphocyte, and MPV/lymphocyte ratios were also similar in all 3 groups (all p values >0.05). CONCLUSION: An NLR value of 2.11 or more predicted DR (PDR or severe NPDR) with a sensitivity of 76% and a specificity of 80%.

The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value.

PURPOSE: To assess the impact of symptom duration on the recurrence of rhegmatogenous retinal detachment (RRD) and to determine the threshold symptom duration for recurrence. PATIENT AND METHODS: In this non-comparative, observational case series, a retrospective evaluation was made of the records of patients with RRD at baseline and during the postoperative follow-up period, in respect of postoperative anatomic outcome, prognostic factors for recurrent retinal detachment and the cutoff value of symptom duration. RESULTS: Recurrent retinal detachment was detected in 33 (17.8%) of 185 patients following primary retinal detachment surgery. The surgery type in phakic patients and preoperative symptom duration had a significantly high odds ratio for evidence of surgical failure. According to the ROC analysis, the threshold preoperative symptom duration was 20.5 days. CONCLUSION: Our results showed that early reattachment surgery is necessary to lower the risk of retinal redetachment. The threshold at which RRD recurrence significantly increases is 20.5 days.