The Effect of Age on Dexamethasone Intravitreal Implant (Ozurdex®) Response in Macular Edema Secondary to Branch Retinal Vein Occlusion.

PURPOSE: To investigate the effect of age on dexamethasone intravitreal implant (Ozurdex®) response in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Seventy-three eyes of 73 patients with macular edema secondary to BRVO were recruited in the study. The patients in the study were divided into the following four groups according to their ages: group 1 (<60 years), group 2 (60-69 years), group 3 (70-79 years), and group 4 (≥80 years). Single-dose Ozurdex injection was applied to all patients. The effectiveness of Ozurdex treatment on macular edema is evaluated via optical coherence tomography (OCT) according to the age groups. RESULTS: Two months after Ozurdex injection, mean reduction of central retinal thickness in groups 1, 2, 3, and 4 were -466.4 ± 149.6, -379.7 ± 238.7, -280.1 ± 233.0, and -180.5 ± 81.4 µm, respectively. This reduction of central retinal thickness decreased with aging (p = 0.001). Also, ages of patients were negatively correlated with the mean reduction of central retinal thickness for the whole study group (r = -0.439, p < 0.001). CONCLUSION: Our study revealed that the effectiveness of Ozurdex treatment decreases with aging.

Evaluation of foveal photoreceptor layer in eyes with macular edema associated with branch retinal vein occlusion after ozurdex treatment.

The aim of this study was to evaluate the central retinal thickness (CRT), outer nuclear layer thickness (ONLT), photoreceptor layer thickness (PLT), photoreceptor layer integrity, and the correlation between visual acuity and PLT in eyes with branch retinal vein occlusion (BRVO) 2 months after treatment with intravitreal dexamethasone implant (Ozurdex; Allergan, Inc, Irvine, CA). In this prospective study, 32 eyes of 32 patients were enrolled. A single injection of Ozurdex was administered to all the patients. CRT, ONLT, and PLT were measured using spectral-domain optical coherence tomography before and 2 months after the injection. Best-corrected visual acuity (BCVA [logMAR]) and photoreceptor cell integrity were also evaluated. The average CRT, ONLT, PLT, and BCVA values for the sample group before the treatment were as follows: 707 ± 261, 608 ± 288, 70 ± 25, and 0.96 ± 0.22 µm, respectively. The average CRT, ONLT, PLT, and BCVA values for the sample group 2 months after the Ozurdex injection were as follows: 299 ± 149, 211 ± 138, 77 ± 20, and 0.63 ± 0.30 µm, respectively (p < 0.05). Two months after the Ozurdex injection, BCVA correlated with ONLT and PLT (r = 0.365, p = 0.048 and r = -0.488, p = 0.021, respectively), whereas BCVA was not correlated with CRT (r = 0.239, p = 0.189). Photoreceptor layer is associated with the visual function of eyes with macular edema secondary to BRVO. Also, ONLT seems to be more closely related to visual acuity improvement than CRT decrement.

Accelerated corneal crosslinking for treatment of progressive keratoconus in pediatric patients.

PURPOSE: To evaluate the safety and efficacy of accelerated corneal crosslinking (CXL) in patients with progressive keratoconus aged 18 years or less. METHODS: A total of 28 eyes from 19 patients with progressive keratoconus aged 18 years or less were enrolled. We divided participants into 2 groups according to corneal thickness (CT). Group 1 included 13 eyes of 8 patients with CT ≥450 µm; group 2 included 15 eyes of 11 patients with CT <450 µm. Each participant underwent accelerated CXL using 10-minute ultraviolet A irradiance at 9 mW/cm2 for a total energy dose of 5.4 J/cm2. The efficacy and safety of the procedure were assessed postoperatively at 1, 3, 6, and 12 months with Pentacam and visual acuity. RESULTS: In uncorrected visual acuity, group 1 showed a statistically significant +0.12 logMAR improvement at 3 months postoperatively (p = 0.003), and in group 2, there was a statistically significant +0.3 logMAR improvement at 1 month postoperatively (p = 0.005). In best-corrected visual acuity, there was a +0.15 logMAR (p<0.001) and +0.22 logMAR (p = 0.005) improvement in group 1 and group 2, respectively, at 12 months postoperatively. All mean keratometric values including K1 and K2 dropped by at least 1 D or remained stable (< ± 1 D) in both groups after accelerated CXL treatment. CONCLUSIONS: The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent apparent complications are noted 6 months after accelerated CXL.

Investigation of the effects of systemic isotretinoin treatment on retinal nerve fiber layer and macula.

PURPOSE: To investigate the effects of systemic isotretinoin therapy on retina by measuring retinal nerve fiber layer (RNFL) and macular thicknesses. METHOD: This prospective, cross-sectional study was conducted in patients prescribed systemic isotretinoin therapy. Seventy-two eyes of 36 patients were included in the study. The patients were followed during three months. Detailed ophthalmologic examination including anterior and posterior segment examination, best corrected visual acuity and intraocular pressure measurement, RNFL and macular thicknesses measurement by Spectral Domain Cirrus Optical Coherence Tomography Model 400 (Carl Zeiss Meditech, Jena, Germany) were performed at baseline, first, second and third months after the beginning of systemic isotretinoin therapy in ophthalmology clinic. RESULT: Thirty (83.3%) of the 36 patients were women and six (16.7%) of them were men. Mean age was 21.17 years. Mean RNFL thickness in the temporal quadrant at first, second, third months after beginning of treatment were found as significantly lower compared to baseline (p = .001). Mean macular thicknesses in superior outer, nasal outer and temporal outer quadrants at second and third months after beginning of treatment were found to be significantly lower compared to baseline and first month after beginning of treatment (p ≤ .001, .002 and .001, respectively). Macular thicknesses in superior inner quadrant at first, second and third months were found to be significantly lower than baseline values (p< .01). No significant difference was detected between groups in other quadrants (p> .05). CONCLUSION: The effect of oral isotretinoin therapy may cause regional thinning in RNFL and macula, directly visible part of central nervous system.

Choroidal changes in pre-eclampsia during pregnancy and the postpartum period: comparison with healthy pregnancy.

PURPOSE: To investigate subfoveal choroidal thickness (SFCT) in patients with pre-eclampsia using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: A sample of 73 pregnant women was studied over 28 weeks of gestation. The sample was divided into two groups: one comprising pre-eclamptic pregnant women (n=32), and the other comprising healthy pregnant women (n=41). The SFCT was determined for all patients using EDI-OCT during pregnancy and at the third month of the postpartum period. RESULTS: The SFCTs in pre-eclamptic pregnant women were 351.97 ± 22.44 and 332.28 ± 20.32 µm during the pregnancy and postpartum periods (p<0.001), respectively, whereas these values in healthy pregnant women were 389.73 ± 49.64 and 329.78 ± 22.36 µm (p<0.001), respectively. During pregnancy SFCT in pre-eclamptic pregnant women was significantly thinner than that in healthy pregnant women (p<0.001). However, there was no statistically significant difference during the postpartum period (p=0.623). CONCLUSIONS: The results suggest that SFCT is significantly decreased in pre-eclamptic pregnant women than in healthy pregnant women, despite no statistically significant difference in SFCT existing between the groups during the postpartum period.

Evaluation of anterior segment parameters in patients with neurofibromatosis type 1.

PURPOSE: To evaluate anterior segment parameters in patients with neurofibromatosis type 1 (NF1) in comparison to healthy individuals. METHODS: A total of 34 eyes from 17 patients with NF1 and 34 eyes from 17 age- and sex-matched healthy individuals were included in this study. Each participant underwent a comprehensive ophthalmic assessment including best-corrected visual acuity, slit-lamp biomicroscopy, stereoscopic fundus examination, and intraocular pressure. Central corneal thickness, corneal volume, corneal curvatures (K1 and K2), anterior chamber depth, anterior chamber volume, iridocorneal angle, and pupil size values were measured by Pentacam Scheimpflug camera. RESULTS: The mean anterior chamber depth, iridocorneal angle, and anterior chamber volume measurements revealed significantly lower values when compared with the control group (p<0.001, p<0.001, and p = 0.041, respectively). However, the mean pupil size was significantly larger when compared with the control group (p = 0.008). Central corneal thickness, corneal volume, K1, and K2 values were similar between the study and control groups (p = 0.875, p = 0.549, p = 0.066, and p = 0.166, respectively). CONCLUSIONS: Our results reveal that NF1 is associated with statistically significant alterations in anterior chamber depth, iridocorneal angle, anterior chamber volume, and pupil size in patients with NF1 when compared with healthy controls.

Retinal nerve fiber layer and macular thickness measurement in patients with schizophrenia.

PURPOSE: To investigate the retina and macular thickness in patients with schizophrenia and to compare the results with those of healthy controls. METHODS: Sixty-eight eyes of 34 patients with schizophrenia and 60 eyes of 30 randomly selected healthy volunteers were involved in the study. Measurements of peripapillary retinal nerve fiber layer (RNFL) thickness, macula thickness, and macula volume were taken in both eyes using spectral-domain optical coherence tomography (OCT). Statistical analysis was performed using Statistical Package for the Social Sciences version 20.0. RESULTS: Average and nasal RNFL thicknesses were found to be significantly lower in the patient group than the control group (p = 0.030, p = 0.04, respectively). Macular thicknesses of nasal outer and inferior outer quadrants in the patient group were significantly lower than in the control group (p = 0.009, p = 0.027, respectively). Average macular thickness and macular thicknesses in the superior outer, superior inner, temporal outer, temporal inner, nasal inner, and inferior inner areas were lower in the patient group compared to the control group, but not significantly (p = 1.000, p = 1.000, p = 0.837, p = 1.000, p = 0.279, p = 1.000, p = 0.180, respectively). CONCLUSIONS: We detected RNFL and macular thinning in patients with schizophrenia. Based on these findings and results of other studies evaluating retina using OCT and brain magnetic resonance imaging studies in patients with schizophrenia, a neurodegenerative process may be an underlying pathologic mechanism in this disease.

The assessment of changes in macular thickness in diabetic and non-diabetic patients: the effect of topical ketorolac on macular thickness change after ND:YAG laser capsulotomy.

PURPOSE: The purpose of our study is to assess the changes in macular thickness (MT) in diabetic and non-diabetic patients and to research effects of topical ketorolac (Acular®, Allergan, Irvine, CA) on MT change after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy. MATERIAL AND METHODS: This study involved 88 eyes of 88 patients diagnosed as posterior capsule opacification (PCO). Patients were divided into four groups according to presence of diabetes mellitus (DM) and drugs used after capsulotomy. Group 1: Patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (22 patients). Group 2: Patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy (20 patients). Group 3: Patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (22 patients). Group 4: Patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (24 patients). A plus-shaped capsulotomy was performed using VISULAS® YAGIII (Carl Zeiss) laser microscope. MT measurement with Cirrus SD-OCT (Carl Zeiss Opthalmic System Inc., Model 400, Dublin, CA, Software 5) were done. Measurements were done before laser, and on the first day, first week, first month, third month and sixth month after laser capsulotomy. We compared the four groups for MT change during 6 months. RESULTS: Group 1 involving patients with DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy had increased MT at the first week, and the first, third, and sixth month after laser (p < 0.001). Group 3 involving patients without DM using only 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) had increased MT at the first week, and at the first and third month, there was no statistically significant difference at the sixth month (p > 0.05). There was no statistically significant increase in MT during the follow-up period in group 2 involving patients with DM using 0.5% ketorolac (Acular®) and 0.1 Fluorometholon (FML®, Allergan, Irvine, CA) after capsulotomy and group 4 involving patients without DM using 0.5% ketorolac (Acular®) and 0.1% Fluorometholon (FML®, Allergan, Irvine, CA) (p > 0.05). CONCLUSION: An increase in MT can be observed after Nd:YAG laser capsulotomy, especially in diabetic patients. Adding topical ketorolac (Acular®, Allergan, Irvine, CA) to topical Fluorometholon (FML®, Allergan, Irvine, CA) therapy after YAG laser capsulotomy can prevent this increase.

Systemic endothelial function in cases with wet-type age-related macular degeneration.

BACKGROUND: Choroidal endothelial dysfunction plays key role in wet-type age-related macular degeneration (AMD). Peripheral vascular endothelial function is not known in wet AMD. OBJECTIVE: We aimed to analyze peripheral vascular endothelial function in cases with wet-type age-related macular degeneration by measuring flow-mediated dilatation (FMD). MATERIALS AND METHODS: The study included 20 cases with wet AMD (Group 1, mean age 65.9 ± 7.2 years) and 24 healthy individuals (Group 2, mean age 62.0 ± 11.9 years). In all cases, a cardiologist assessed the responses of endothelial function by measuring the FMD following brachial artery occlusion. RESULTS: Mean FMD, an indicator of endothelial function was found to be 6.4 ± 2.7 % in Group 1 and 15.6 ± 7.3 % in Group 2 (p < 0.001). There was no significant difference between patient and control groups regarding age, sex, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, ESR and CRP. CONCLUSION: Reduced FMD is present in patients with wet AMD, suggesting that impaired peripheral endothelial function may be involved in its pathogenesis.

Effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.

AIM: To evaluate the effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections. METHODS: Seventy-two eyes of 36 patients [36 eyes in control group, 36 eyes in intravitreal injection (IVI) group] were enrolled in the study. All the eyes had at least one IVI and had diabetic macular edema (DME) or age-related macular degeneration (ARMD). Moxifloxacin was prescribed to all the patients four times a day for five days following injection. Conjunctival cultures were obtained from the lower fornix via standardized technique with every possible effort made to minimize contamination from the lids, lashes, or skin. Before the application of any ophthalmic medication, conjunctival cultures were obtained from both eyes using sterile cotton culture. An automated microbiology system was used to identify the growing bacteria and determine antibiotic sensitivity. RESULTS: The bacterial cultures were isolated from 72 eyes of 36 patients, sixteen of whom patients (44.4%) were male and twenty (55.6%) were female. Average age was 68.4±9.0 (range 50-86). The average number of injections before taking cultures was 3.1+1.0. Forty-eight (66.7%) of 72 eyes had at least one significant organism. There was no bacterial growth in 8 (20.5%) of IVI eyes and in 16 (44.4%) of control eyes (P=0.03). Of the bacteria isolated from culture, 53.8% of coagulase negative staphylococci (CoNS) in IVI eyes and 47.2% CoNS in control eyes. This difference between IVI eyes and control eyes about bacteria isolated from culture was not statistically significant (P=0.2). Eleven of 25 bacteria (44.0%) isolated from IVI eyes and 11 (57.9%) of 19 bacteria isolated from control eyes were resistant to oxacillin. The difference in frequency of moxifloxacine resistance between two groups was not statistically significant (12.0% in IVI eyes and 21.1% in control eyes) (P=0.44). There were no cases of resistance to vancomycin, teicoplanin and linezolid. CONCLUSION: There was no difference in species of bacteria isolated from cultures, or in the frequency of resistance to antibiotics between eyes that had recurrent IVI followed by moxifloxacin exposure compared with control eyes. However, the number of eyes that had bacterial growth was higher in IVI group than in the control group.

Systemic endothelial function in primary open-angle glaucoma.

Objective. We aimed to assess peripheral vascular endothelial function in open-angle glaucoma (POAG) by measuring flow-mediated dilatation (FMD). Materials and Methods. The study included 20 cases with POAG (group 1, mean age 58.68 ± 13.3 years) and 30 healthy individuals (group 2, mean age 58.68 ± 13.6 years). In all cases, responses of endothelial function were assessed by a cardiologist through measurement of FMD following brachial artery occlusion. Results. Mean percent of FMD, an indicator of endothelial function, was found to be 11.9 ± 4.2% in group 1 and 12.3 ± 4.4% in group 2 (P = 0.86). Conclusion. No impairment in systemic vascular function of cases with POAG suggests that POAG could be a local disorder rather than being a component of systemic disease.