Optic disc tilt and rotation effects on positions of superotemporal and inferotemporal retinal nerve fibre layer peaks in myopic Caucasians.

CLINICAL RELEVANCE: In myopic eyes, the optic disc may become tilted and rotated, making glaucoma diagnosis more difficult. BACKGROUND: To determine the presence of tilted optic disc, the degree of optic disc rotation, and their effects on the angular location of superotemporal and inferotemporal retinal nerve fibre layer (RNFL) peaks in healthy myopic Caucasians. METHODS: Non-glaucomatous healthy myopic Caucasian eyes with an axial length > 24 mm were evaluated. ImageJ was used to quantify optic disc tilt and torsion on red-free fundus photography. The RNFL was scanned using spectral-domain optical coherence tomography. The angle of the superotemporal and inferotemporal peaks with the vertical-horizontal meridian was measured. RESULTS: Fifty-four eyes of 54 individuals were evaluated. The axial length was correlated with the angular location for both the superotemporal (r = -0.549, p < 0.001) and inferotemporal (r = -0.415, p = 0.002) RNFL peaks; they were placed more temporally in eyes with higher axial lengths. For each 1 mm increase in axial length, the angle between the superotemporal peak and the temporal horizontal meridian decreased by 3.976°, and the angle between the inferotemporal apex and the temporal horizontal meridian decreased by 3.028°. The angle between the inferotemporal peak and the temporal horizontal meridian decreased by 0.231° for each 1° increase in optical disc torsion (R2 = 0.09 Regression coefficient = -0.231, p = 0.027). CONCLUSIONS: The temporal shift of superior and inferior peaks, the thickening of temporal and nasal RNFL, the presence of tilted optic disc, and optic disc rotation may cause misinterpretation of the RNFL in myopic Caucasians. When evaluating peripapillary RNFL thickness in myopic individuals, it would be better to consider these to avoid misinterpretation.

Glaucoma Detection in Myopic Eyes: Structural and Vascular Assessment by Optic Coherence Tomography Methods.

PRCIS: Retinal nerve fiber layer (RNFL) thickness is helpful in the diagnosis of glaucoma in myopic eyes but neuroretinal rim (NRR) thickness is the most valuable measure. However, changes in optical coherence tomography angiography (OCT-A) parameters are insufficient for the diagnosis of mild to moderate glaucoma in myopia. PURPOSE: To detect how a multimodal evaluation, which includes RNFL, NRR thickness, and optic nerve head (ONH) OCT-A, affects glaucoma diagnosis in myopic patients. MATERIALS AND METHODS: Parameters of healthy myopic and myopic glaucoma eyes with an axial length of ≥24 mm were compared. The ONH structural features and peripapillary RNFL thickness were determined with Cirrus 5000 HD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA). The Cirrus 5000 HD-OCT with AngioPlex was utilized to perform OCT-A imaging. The sensitivity and specificity levels were calculated by the best cut-off values with area under curve (AUC). RESULTS: One hundred healthy myopic and 54 myopic glaucoma eyes were evaluated. In all areas, myopic glaucoma patients exhibited lower RNFL and NRR thickness than healthy myopic individuals ( P <0.05), with the exception of nasal quadrant RNFL thickness ( P =0.152). The mean entire and 4 quadrants of global radial peripapillary capillary (RPC)-perfusion and global RPC flux index (FI) were significantly lower in the group of myopic glaucoma patients except for the nasal quadrant mean RPC perfusion ( P =0.224). The average RNFL and NRR thickness had a significant difference in AUC for the diagnosis of glaucoma in myopic individuals ( P =0.001, for each). The average NRR showed excellent diagnostic performance, whereas the average RNFL showed good diagnostic performance. Average RPC perfusion and average RPC FI showed poor diagnostic ability. The average NRR AUC was more significant than average RPC perfusion and average RPC FI AUC ( P <0.001). CONCLUSIONS: Although RNFL thickness was helpful to diagnose glaucoma in patients with myopia, the diagnostic power of NRR thickness performed best. OCT-A parameters showed poor diagnostic accuracy for glaucoma and the observed perfusion decrease in myopic glaucoma eyes was not sufficiently discriminative compared with NRR and RNFL thickness measurements.

The Effect of Latanoprost on Choroidal Vascularity Index in Glaucoma and Ocular Hypertension.

PRCIS: The choroidal vascularity index (CVI) is a new marker for the choroid. The decrease in CVI following latanoprost use can provide a better understanding of the pathogenesis of the posterior segment side effects of latanoprost such as cystoid macular edema and central serous choroidopathy. PURPOSE: The purpose of this paper is to evaluate the changes in the CVI, total choroidal area (TCA), stromal area (SA), luminal area (LA), and choroidal thickness (CT) following latanoprost therapy in patients with primary open angle glaucoma and ocular hypertension. MATERIALS AND METHODS: Patients with newly diagnosed primary open angle glaucoma or ocular hypertension who had never received antiglaucoma therapy were included. Each patient received latanoprost 0.005% once daily. Enhanced depth imaging mode of spectral-domain optical coherence tomography scans was taken before the start of latanoprost therapy and in the first and third months. Subfoveal CT, CVI, TCA, LA, and SA for the submacular area, and 4 quadrants of the peripapillary area were calculated from the scans. RESULTS: A total of 36 eyes of 18 patients were analyzed. Subfoveal CT increased significantly ( P =0.007). Mean TCA ( P =0.008) and SA ( P <0.001) in the first and third months were higher than baseline in the submacular regions. Mean CVI was lower in the first and third months ( P <0.001). There was an increase in the mean TCA and SA in the peripapillary temporal ( P =0.001 and 0.028) and inferior ( P =0.002 and <0.001) quadrants and a decrease in mean CVI in the temporal ( P =0.027) and inferior ( P =0.003) peripapillary quadrants. A negative correlation was found between the rate of decrease in intraocular pressure and the macular region CVI. CONCLUSIONS: Following latanoprost use for several months, the CVI was significantly decreased in newly treated patients with glaucoma or ocular hypertension, among other changes to the choroid. These findings may contribute to a better understanding of the effects of prostaglandins on the posterior segment of the eye.

Evaluation of post phacoemulsification inflammation in eyes with and without pseudoexfoliation syndrome according to phaco parameters via laser flare photometry.

BACKGROUND: To compare the changes in anterior chamber laser flare after phacoemulsification and intraocular lens implantation according to phaco parameters in eyes with and without pseudoexfoliation syndrome. METHODS: Patients (39 without pseudoexfoliation (PEX), 28 with pseudoexfoliation) who underwent the surgery with the same device (Centurion System, Alcon Laboratories, USA) and same experienced surgeon were divided according to the presence of PEX. Anterior chamber laser flare was assessed using a laser flare meter (Kowa-FM700, Kowa Company, Japan) by the same blinded researcher. RESULTS: Total CDE, total U/S time, total torsional amplitude on time, average longitudinal power, average longitudinal power (FP3), equivalent average ultrasonic power (FP3) were higher in eyes with pseudoexfoliation (p<0.05 for each). The linear regression model suggested that presence of pseudoexfoliation and total CDE had a positive-correlation with the difference between postoperative day 1 and preoperative anterior chamber laser flare. There were significant differences in preoperative anterior chamber laser flare and those measured on postoperative days 1 and 30 between two groups (p<0.05). CONCLUSIONS: Early-postoperative anterior chamber laser flare is affected by the phaco parameters and there is a positive correlation between intraoperative phaco parameters and anterior chamber laser flare. Anterior chamber laser flare was significantly higher in eyes with pseudoexfoliation both pre- and postoperatively. Patients with pseudoexfoliation especially with high intraoperative total CDE should be followed carefully for early postoperative inflammation.

Evaluation of peripapillary - macular microvascularity and choroidal vascularity index after refractive surgery.

BACKGROUND: To evaluate the microvascularity and choroidal vascularity index (CVI) using optical coherence tomography angiography (OCTA) and OCT following femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) procedures. METHODS: Patients with myopia (<-6.0D sphere) or myopic astigmatism (<-4.0D astigmatism) were enroled. The percentage of vessel density and foveal avascular zone (FAZ) size, optic disc flux index and perfusion were noted and the CVI was calculated before and after surgery. RESULTS: Twenty-nine eyes of 16 patients in the FS-LASIK group and 30 eyes of 16 patients in the SMILE group were enroled. Macular vessel density, FAZ size, and optic disc flux index were significantly higher on postoperative 1st day compared to preoperative day (p = 0.001, p = 0.007, and p < 0.001, respectively). There was no significant difference in terms of macular and peripapillary CVI between postoperative 1st day and preoperative day (p > 0.05). All microvascular parameters were similar on postoperative 7th day and preoperative day (p > 0.05). CONCLUSIONS: It was detected that there is a transient alteration in macular and peripapillary microvascularity after FS-LASIK/SMILE, whereas choroidal circularity is not significantly affected by these refractive surgeries.

Anterior chamber laser flare photometry after diode laser cyclophotocoagulation.

BACKGROUND: The aim of this study was to evaluate changes in intraocular inflammation according to energy delivered per eye during transscleral diode laser cyclophotocoagulation (TDLC) in refractory glaucoma using laser flare (LF) photometry and to investigate the relationship between the change in anterior chamber flare values ​​and the success of TDLC. METHODS: Patients who underwent TDLC for refractory glaucoma and had LF photometry data were analyzed retrospectively. We recorded the best-corrected visual acuity, intraocular pressure (IOP) with Goldmann applanation tonometer, number of anti-glaucoma medications, LF photometry values (ph/ms) on pre-and postoperative days 1, 10 and 30. RESULTS: The mean laser power applied during TDLC procedure was 2.45±0.35 W. The mean laser duration was 2.09±0.28 s. The mean total energy applied per eye was 114.69±16.13 J, the mean number of pulses was 22.43±4.3. While the mean LF value was 49.71±11.99 ph/ms preoperatively, it was 63.94±12.41 ph/ms at the postoperative 30th day. Possible predictors of success of TDLC were investigated using linear regression analysis (R adjusted 0.454 p = 0.001). The IOP decrease at postoperative 30th day was significantly related to the difference between the postoperative 1st day and the preoperative LF (p = 0.025, B/95% CI -0.358/-0.107- -0.008), and total cyclodiode energy delivered per eye (joules) (p = 0.016, B/95% CI -0.396/-0.287 to -0.031). CONCLUSIONS: Anterior chamber flare values increases after TDLC, though it does not regress to the preoperative level on the postoperative 30th day. Total cyclodiode energy delivered per eye and the difference between the postoperative 1st day and the preoperative LF can be used to predict TDLC response.

Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results.

PURPOSE: The aim is to report long-term graft survival rates and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK). METHODS: In this study 150 eyes that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK) surveilled for 7 years at 6 time points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation. RESULTS: Overall, the estimated survival probability of 95% confidence interval at 7 years of post-DMEK was 0.58 (0.72-0.77), and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (log rank 26.87, [p = 0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p = 0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%. CONCLUSION: Although DMEK is effective and safe in long term, visual results and graft survival rates are better in cases with FECD.

Retinal optical coherence tomography angiography findings of acute anterior uveitis.

PURPOSE: To evaluate the changes in retinal microvasculature in eyes with anterior uveitis (AU) using optical coherence tomography angiography. METHODS: Foveal avascular zone (FAZ) of superficial capillary plexus (SCP) and deep capillary plexus (DCP), vessel density (VD) of SCP, DCP, and choriocapillaris, and central macular thickness (CMT) and central foveal thickness (CFT) were calculated from 34 healthy and 41 uveitic eyes. The parameters were compared between the two groups. RESULTS: The deep FAZ was significantly smaller in the eyes with AU during the attack than after recovery and the control group (p = 0.001 and p = 0.003, respectively). The VD in deep capillary plexus (DCP) in eyes with AU during the attack was significantly higher than the control group (p = 0.048). The VD in the foveal sector of DCP in eyes with AU during the attack and after recovery was significantly higher than the control group (p = 0.001 and p = 0.031, respectively). There was no significant difference regarding CMT, CFT, VDs of each segment and each sector, and superficial and deep FAZ between eyes with first uveitis attack and those with recurrent uveitis during the attack and after recovery (p > 0.05). CONCLUSION: The results of this study show that there is a reduction in the FAZ and an increase in the VD of the DCP of the retina during active AU, and these findings are reversible. Acute AU may affect the macular microvasculature, which is usually temporary, especially in the DCP.

Effect of phacoemulsification surgery on intraocular pressure and function of bleb after trabeculectomy.

PURPOSE: To evaluate the effect of phacoemulsification (PE) surgery on intraocular pressure (IOP) control and morphology of filtering bleb in eyes that have previously had trabeculectomy in the long-term. METHODS: This retrospective study included 98 eyes of 93 patients who had undergone trabeculectomy first and then PE surgery. The IOP, morphology of bleb, the number of glaucoma medication of each patient before PE, and 1 day, 1 month, 3 months, 1 year, 2 years after PE, and at the last visit were recorded. The need for additional glaucoma medication or glaucoma surgery were noted. Surgical success was defined as 6 mmHg ≤ IOP ≤ 21 mm Hg at the 3rd month, 1st year, and 2nd year follow-up visit, without additional medication or surgery. RESULTS: Before PE the IOP was ≤ 21 mmHg in all of the eyes. At the last visit, the IOP was ≤ 21 mmHg in 6 eyes with fewer glaucoma medication, in 24 eyes with the same number, and in 36 eyes with more. There was an increase in the number of glaucoma medications on each visit (p < 0.05). There was a statistically significant difference in bleb morphologies between before PE and each visit after PE (p < 0.001). Surgical success after PE was obtained in 52 eyes, additional glaucoma medication was needed in 36 eyes, and additional surgical procedures were required in 14 eyes. CONCLUSION: Phacoemulsification surgery may increase the number of glaucoma medications and the mean IOP and also may reduce the function of bleb in eyes that underwent trabeculectomy.

The Effect of Cone Localization on Higher Order Aberrations After Corneal Crosslinking for Keratoconus.

OBJECTIVES: This study was designed to evaluate the effects of corneal collagen cross-linking (CXL) on topographic parameters, visual acuity, and corneal high-order aberrations according to the preoperative cone location in keratoconus. METHODS: This retrospective study assessed patients with keratoconus who underwent CXL between March 2016 and February 2019. Patients with a history of corneal surgery, corneal hydrops, corneal scar tissue, delayed epithelial healing, and a corneal thickness of <400 µm were excluded. The included eyes were divided into 2 groups according to the preoperative cone location: maximum K in the central 3-mm optical zone (group 1) or the central 3-mm to 5-mm optical zone (group 2). The preoperative and postoperative 24-month, best-corrected visual acuity (BCVA), intraocular pressure, K max, symmetry index front, corneal thickness, and high order aberration findings were recorded. RESULTS: The study included 67 eyes of 67 patients with keratoconus: 39 in group 1, and 28 in group 2. There were statistically significant differences between the groups in the preoperative BCVA values (p=0.04). There was no significant difference between the preoperative and postoperative mean K max between the 2 groups (p=0.08). The mean difference in corneal thickness between preoperative and postoperative measurements was significantly lower in group 2 than in group 1 (p=0.03). The preoperative and postoperative mean spherical aberration was significantly higher in group 1 than in group 2 (p=0.001 and p=0.005, respectively). CONCLUSION: The preoperative cone location in keratoconus may affect CXL outcomes. At the end of the second year, CXL was found to have a similar efficacy on visual acuity and keratometry parameters in the central and paracentral cone groups, and the recovery in terms of a spherical aberration among high-order aberrations after CXL in the central cone group was better than that of the paracentral cone group.

Regulation of human organic cation transporter hOCT2 by PKA, PI3K, and calmodulin-dependent kinases.

Properties and regulation of the human organic cation (OC) transporter type 2 (hOCT2) expressed in HEK-293 cells were extensively characterized using the fluorescent OC 4-[4-(dimethylamino)styryl]-N-methylpyridinium (ASP(+)). ASP(+) uptake was electrogenic and inhibited by TPA(+) (EC(50) = 2.7 microM), tetraethylammonium (EC(50) = 35 microM), cimetidine (EC(50) = 36 microM), or quinine (EC(50) = 6.7 microM). Stimulation with carbachol or ATP decreased initial uptake by 44 +/- 3 (n = 14) and 34 +/- 4% (n = 21), respectively, independently of PKC but dependent on phosphatidylinositol 3-kinase (PI3K). PKA stimulation decreased uptake by 18 +/- 4% (n = 40). Inhibition of calmodulin (CaM), Ca(2+)/CaM-dependent kinase II, or myosin light chain kinase decreased uptake by 63 +/- 2 (n = 15), 40 +/- 4 (n = 30), and 31 +/- 4% (n = 16), respectively. Inhibition of CaM resulted in a significant change in the EC(50) value for the inhibition of ASP(+) uptake by tetraethylammonium. In conclusion, we demonstrate that the hOCT2 is inhibited by PI3K and PKA and activated by a CaM-dependent signaling pathway, probably via a change in substrate affinity.