LONG-TERM EFFECTS OF ANTI-VEGF MONOTHERAPY FOR RETINOPATHY OF PREMATURITY ON THE RETINAL AND REFRACTIVE DEVELOPMENT OF EYE.

PURPOSE: To evaluate vascular maturation of retina, axial, refractive, and foveal development after anti-VEGF treatment including bevacizumab, ranibizumab, and aflibercept in infants with treatment requiring retinopathy of prematurity (ROP) in long term. METHODS: This retrospective chart review study included children with a history of any anti-VEGF monotherapy for ROP in Zone 1 or posterior Zone 2 who have reached at least 24 months of corrected age. The records of ophthalmologic examination including strabismus evaluation, visual acuity measurement, refractive and axial measurements, optical coherence tomography, and fundus fluorescein angiography examinations with RetCam III were reviewed. RESULTS: A total of 36 eyes of 18 children met the inclusion criteria. The mean gestational age at birth was 27.8 2.13 (23-30) weeks, and ocular assessments were performed between 33 and 61.5 (mean: 42.58 8.6) months of corrected age. Treatment was with bevacizumab in 10 eyes, with ranibizumab in 14 eyes, and with aflibercept in 12 eyes. The mean spherical equivalent was -0.25 1.82; axial length was 20.81 0.62 mm. There was no significant difference among three anti-VEGF groups regarding the abnormal vascular retinal development ( P = 0.183) or leakage ( P = 0.842) on fluorescein angiography. CONCLUSION: All the anti-VEGF agents provided similar adequate axial and refractive development as well as similar abnormal vascular development in the peripheral retina. The long-term impact of this abnormally vascularized peripheral retina is a curiosity issue. From this point of view, it is an important need to determine the follow-up period and method after the anti-VEGF treatment for ROP.

Use of viscoelastic substance for preventing Descemet's membrane rupture in deep anterior lamellar keratoplasty / Uso de substância viscoelástica na prevenção da ruptura da membrana de Descemet na ceratoplastia lamelar anterior profunda

ABSTRACT Purpose: This study aimed to investigate the effect of using a viscoelastic substance in Descemet's membrane rupture in "double bubble" deep anterior lamellar keratoplasty. Methods: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet's membrane perforation rate was compared between groups. Results: Perforation of the Descemet's membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet's membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). Conclusions: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet's membrane perforation in deep anterior lamellar keratoplasty.(AU)

RESUMO Objetivo: Investigar o efeito do uso de uma substância viscoelástica na ruptura da membrana de Descemet em casos de ceratoplastia lamelar anterior profunda em "bolha dupla". Métodos: Foram avaliados retrospectivamente prontuários e vídeos de cirurgias de 40 pacientes operados entre janeiro de 2014 e julho de 2015. Os pacientes foram divididos em dois grupos: 20 pacientes nos quais a parede posterior do estroma foi puncionada sem a colocação de nenhuma substância viscoelástica (grupo 1) e 20 pacientes nos quais uma substância viscoelástica foi aplicada sobre o estroma posterior ao ser puncionada a parede posterior do estroma (grupo 2). A taxa de perfuração da membrana de Descemet foi comparada entre os grupos. Resultados: Observou-se perfuração da membrana de Descemet em 12 casos (60,0%) no grupo 1 e em apenas 3 casos (15,0%) no grupo 2. Essa diferença foi estatisticamente significativa (p=0,003). Apenas um caso (5%) no grupo 2 teve macroperfuração durante o procedimento, sendo a cirurgia então convertida em uma ceratoplastia penetrante. Onze casos (55,0%) no grupo 1 tiveram macroperfuração da membrana de Descemet e essas cirurgias foram convertidas em ceratoplastias penetrantes. Essa diferença entre os grupos foi estatisticamente significativa (p=0,001). Conclusões: A aplicação de substância viscoelástica sobre o lado posterior do estroma logo antes da punção é um método eficaz para diminuir o risco de perfuração da membrana de Descemet na ceratoplastia lamelar anterior profunda.(AU)

Use of viscoelastic substance for preventing Descemet's membrane rupture in deep anterior lamellar keratoplasty.

PURPOSE: This study aimed to investigate the effect of using a viscoelastic substance in Descemet's membrane rupture in "double bubble" deep anterior lamellar keratoplasty. METHODS: The medical records and videos of surgeries of 40 patients who underwent surgery between January 2014 and July 2015 were retrospectively evaluated. The patients were divided into two groups: 20 patients whose perforation of the posterior stromal wall was performed without administration of any viscoelastic substance (group 1) and 20 patients whose perforation of the posterior stromal wall was performed with administration of viscoelastic substance onto the posterior stroma (group 2). The Descemet's membrane perforation rate was compared between groups. RESULTS: Perforation of the Descemet's membrane was observed in 12 (60.0%) patients in group 1 and only three (15.0%) patients in group 2. This difference was statistically significant (p=0.003). Only one (5%) patient in group 2 had macroperforation during the procedure, and the surgery was converted to penetrating keratoplasty. Eleven (55.0%) patients in group 1 had macroperforation of Descemet's membrane, and surgeries were converted to penetrating keratoplasty. This difference between the groups was statistically significant (p=0.001). CONCLUSIONS: Administering a viscoelastic substance onto the posterior stromal side just before puncture is an effective method to decrease the risk of Descemet's membrane perforation in deep anterior lamellar keratoplasty.

Evaluation of Foveal Avascular Zone and Capillary Plexus in Smokers Using Optical Coherence Tomography Angiography.

PURPOSE: To evaluate the macular microvasculature in smokers in comparison to healthy subjects using optical coherence tomography angiography (OCTA). METHODS: Fifty chronic, regular smokers and 50 healthy non-smokers, as a control group, were recruited for the study. Foveal avascular zone (FAZ) area (mm2) and vessel density (VD) (%) in the superficial (SCP) and deep capillary plexus (DCP) were evaluated. RESULTS: FAZ area was 0.424 ± 0.100 mm2 in the smoker group and 0.333 ± 0.093 mm2 in the non-smoking control group (P = 0.002). The deep foveal VD was 31.76 ± 6.33% in the smoker group and 53.09 ± 5.88% in the non-smoking control group (P = 0.006). Superficial foveal and parafoveal, deep parafoveal VD were not statistically different between the groups (P = 0.120), (P = 0.337), (P = 0.287), respectively. CONCLUSION: In our study, there was an enlargement of FAZ and reduction of foveal VD at DCP in the eyes of smokers compared with non-smoking adults.

Cardiovascular assessment after treatment for retinopathy of prematurity: a comparative study between anti-VEGF agent (aflibercept) and laser.

OBJECTIVE: The aim of this study was to compare the cardiac effects and aortic arterial indices following intravitreal aflibercept treatment or diode laser photocoagulation for the treatment of retinopathy of prematurity (ROP) in infants. METHODS: This single-centre, retrospective study was conducted in infants who were administered laser photocoagulation (LPC) or intravitreal aflibercept (IVA) treatment as initial treatment and had completed at least one year of corrected age. The patients were evaluated in terms of aortic elastic parameters, right and left ventricular systolic and diastolic function using conventional, pulsed Doppler and tissue Doppler imaging (TDI) echocardiographic parameters. RESULTS: Fifteen infants were in the LPC group, 16 in the IVA group, and 20 in the control group. Although there were some statistically significant differences in terms of pulsed and TDI echocardiographic parameters between the treatment and control groups, these values could not clearly be adopted as a diastolic dysfunction and myocardial performance indices were not influenced. The aortic elastic parameters were impaired in both LPC and IVA groups compared to the control group. Consequently, we observed only minor differences between the treatment groups, which may suggest subtle changes due to the anti-angiogenic treatment. CONCLUSIONS: Although favourable and promising outcomes were obtained with intravitreal injection of anti-vascular endothelial growth factor agents for the treatment of ROP, concerns have been raised about potential systemic side effects, including potential cardiovascular side effects caused by these agents. The small reduction in right ventricular Doppler velocities could probably be explained by the use of anti-angiogenic or laser treatment in infants.

Cardiovascular assessment after treatment for retinopathy of prematurity: a comparative study between anti-VEGF agent (aflibercept) and laser

The aim of this study was to compare the cardiac effects and aortic arterial indices followingintravitreal aflibercept treatment or diode laser photocoagulation for the treatment of retinopathy of prematurity (ROP) in infants.Methods:This single-centre, retrospective study was conducted in infants who were administered laser photocoagulation (LPC) or intravitreal aflibercept (IVA) treatment as initialtreatment and had completed at least one year of corrected age. The patients were evaluated in terms of aortic elastic parameters, right and left ventricular systolic and diastolic function using conventional, pulsed Doppler and tissue Doppler imaging (TDI) echocardiographic parameters.Results:Fifteen infants were in the LPC group, 16 in the IVA group, and 20 in the control group. Although there were some statistically significant differences in terms of pulsed and TDI echocardiographic parameters between the treatmentand control groups, these values could not clearly be adoptedas a diastolic dysfunction and myocardial performance indices were not influenced. The aortic elastic parameters were impaired in both LPC and IVA groups compared to the control group. Consequently, we observed only minor differences between the treatment groups, which may suggest subtle changes due to the anti-angiogenictreatment.Conclusion:Although favourable and promising outcomes were obtained with intravitreal injection of anti-vascular endothelial growth factor agents for the treatment of ROP,concerns have been raised about potential systemic side effects, including potential cardiovascular side effects caused by these agents. The small reduction in right ventricular Doppler velocities could probably be explained by the us of anti-angiogenic or laser treatment in infants

Evaluation of Foveal Avascular Zone and Capillary Plexuses in Diabetic Patients by Optical Coherence Tomography Angiography.

PURPOSE: To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. METHODS: Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm²), deep VD (%) and deep AVZ area (mm²) were evaluated via optic coherence tomography angiography. RESULTS: Superficial AVZ was 0.438 ± 0.05 mm² in the DM group, 0.246 ± 0.022 mm² in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm² in the DM group, and 0.342 ± 0.022 mm² in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm² in the DM group, and 34.86 ± 0.75 mm² in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm² in the DM group, and 33.47 ± 0.56 mm² in the control group (p < 0.001). CONCLUSIONS: In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.

Comparison of clinical outcomes of intravitreal ranibizumab and aflibercept treatment for retinopathy of prematurity.

PURPOSE: To compare the results of ranibizumab and aflibercept treatment in infants with treatment-requiring retinopathy of prematurity (ROP) in the posterior zone. METHODS: In this single-center, retrospective study, the records of the infants, who were treated between January 2015 and June 2017 in a tertiary center for screening and treatment of ROP, were reviewed. Infants who were administered ranibizumab or aflibercept as initial treatment and completed at least 1 year of corrected age were included. The patients were evaluated in terms of regression, progression or recurrence of the disease, vascularization of the peripheral retina, and ocular complication profile in early or late period. RESULTS: Fifty-four eyes of 27 infants who received ranibizumab treatment (ranibizumab group) and 72 eyes of 36 infants who received aflibercept treatment (aflibercept group) were enrolled. The rate of recurrence was 48.1% in ranibizumab group and 13.9% in aflibercept group. The mean recurrence times were at 8.2 ± 0.92 weeks following the injection of ranibizumab and at 14.2 ± 1.03 weeks following the injection of aflibercept. There were significant statistical differences between the groups in the rate of ROP recurrence, the time of recurrence, and the time of vascularization of peripheral retina (p = 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION: Although both ranibizumab and aflibercept are effective therapies for the treatment of ROP, more frequent and much earlier recurrences can be seen with ranibizumab treatment. Further studies are needed to obtain ideal options for the treatment of ROP.

Macular thickness and retinal nerve fiber thickness analysis in ocular dominance / Espessura macular e fibra nervosa da retina análise de espessura no domínio ocular

Abstract Objective: To compare macular and peripapillary retinal nerve fiber layer thicknesses of dominant eye and non-dominant eye using optical coherence tomography (OCT). Methods: 104 eyes of 52 healthy young adults were included. Ophthalmological examinations; including measuring refraction, best corrected visual acuity, intraocular pressure (IOP) measurement, slit-lamb biomicroscopy, dilated fundus examination, measuring of central macular thickness (CMT), and peripapillary retinal nerve fiber layer (PRNFL) thickness were performed on each subject. Hole-in-the-card test was used to detect the ocular dominance. Results: There were 25 females (48%) and 27 males (52%) in the study. Eight participants had left eye dominance (15%), forty-four participants had right eye dominance (85%). Mean CMT was 192.5µm in dominant group and 191.9 µm in non-dominant group. There was no statistically significant difference between dominant eye group and non-dominant eye group in either macular thickness or peripapillary retinal nerve fiber layer thickness. Conclusions: No difference between macular and peripapillary retinal nerve fiber layer thicknesses were detected in dominant and non-dominant groups. Further evaluation is needed.

Resumo Objetivo: Comparar as espessuras da camada de fibras nervosas da retina macular e peripapilar do olho dominante e não dominante usando a tomografia de coerência óptica (OCT). Métodos: 104 olhos de 52 adultos jovens saudáveis foram incluídos. Exames oftalmológicos; incluindo medidas de refração, melhor acuidade visual corrigida, medição da pressão intraocular (PIO), biomicroscopia de fenda-cordeiro, exame do fundo dilatado, medição da espessura macular central (CMT) e espessura da camada de fibras nervosas da retina peripapilar (PRNFL) foram realizadas em cada sujeito. O teste Hole-in-the-card foi usado para detectar a dominância ocular. Resultados: houve 25 mulheres (48%) e 27 homens (52%) no estudo. Oito participantes tinham deixado a dominância do olho (15%), quarenta e quatro participantes tinham dominância do olho direito (85%). A CMT média foi de 192,5 µm no grupo dominante e 191,9 µm no grupo não dominante. Não houve diferença estatisticamente significativa entre o grupo dominante de olho e o grupo de olho não dominante tanto na espessura macular quanto na espessura da camada de fibras nervosas da retina peripapilar. Conclusões: Não houve diferença entre as espessuras das camadas de fibras nervosas da retina macular e peripapilar nos grupos dominante e não dominante. Mais avaliações são necessárias.

Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative complications and clinical results.

PURPOSE: To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon. METHODS: Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups. RESULTS: The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients' corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1. CONCLUSIONS: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.

Descemet membrane endothelial keratoplasty (DMEK): intraoperative and postoperative complications and clinical results / Queratoplastia endotelial da membrana de Descemet (DMEK): complicações intraoperatórias e pós-operatórias com resultados clínicos

ABSTRACT Purpose: To evaluate the complications and clinical results of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial failure that occurred during the learning curve of a surgeon. Methods: Fifty eyes of 50 patients with DMEK and ≥6 months of follow-up were included. The patients were divided into the first 25 (group 1) and the second 25 (group 2) procedures performed by the surgeon. Best corrected visual acuity (BCVA), central corneal thickness (CCT), unfolding time of the Descemet membrane (DM) graft, and intraoperative and postoperative complications were compared between groups. Results: The differences in postoperative increase of BCVA (p=0.595) and decrease of CCT (p=0.725) in the two groups were not significant. The unfolding time of the DM was longer in group 1 than in group 2 (p=0.001). Primary graft failure occurred in three patients in group 1 and none in group 2. At the last visit, 42 (85.7%) of patients' corneas were clear, with significant difference between groups (p=0.584). A patient in group 1 with a history of pars plana vitrectomy, inferior iridectomy, and fluid as a tamponade experienced drop of the DM graft into the iridectomy space. All other intraoperative complications occurred in group 1. Conclusions: Occurrence of intraoperative and postoperative complications was increased in patients with coexisting ocular pathology or complicated endothelial dysfunction and during the surgeon's learning curve of DM endothelial keratoplasty procedures.

RESUMO Objetivo: Avaliar as complicações e os resultados clínicos da queratoplastia endotelial da membrana de Descemet (DMEK) em indivíduos com insuficiência endotelial, durante a curva de aprendizado de um cirurgião. Métodos: Cinquenta olhos de 50 pacientes submetidos ao procedimento queratoplastia endotelial da membrana de Descemet com pelo menos 6 meses de acompanhamento foram incluídos neste estudo. Os pacientes foram divididos em dois grupos: como os primeiros 25 casos do cirurgião (grupo 1) e como os 25 casos seguintes (grupo 2). A melhor acuidade visual corrigida (MAVC), a espessura corneana central (ECC), o tempo de desdobramento do enxerto da membrana de Descemet (MD), as complicações intraoperatórias e pós-operatórias foram apresentadas e comparadas entre os grupos. Resultados: Os grupos não diferiram estatisticamente em relação ao aumento pós-operatório de melhor acuidade visual corrigida (p=0,595) ou à diminuição da espessura corneana central (p=0,725). O tempo de desdobramento dos enxertos de membrana de Descemet no grupo 1 foi maior do que no grupo 2 (p=0,001). Falha do enxerto primário foi observada em 3 pacientes do grupo 1 e em nenhum do grupo 2. Na última visita, 42 (85,7%) das córneas dos pacientes estavam claras e não foram observadas diferenças estatisticamente significativas entre os grupos (p=0,584). Na cirurgia de um paciente do grupo 1, com história de vitrectomia pars plana (PPV) com iridectomia inferior e fluido como tamponamento, observou-se queda do enxerto de membrana de Descemet no local da iridectomia. Além disso, todas as demais complicações intraoperatórias ocorreram no grupo 1. Conclusões: As complicações intraoperatórias e pós-operatórias foram maiores em pacientes com coexistência de outra patologia ocular ou com disfunção endotelial complicada durante as curvas de aprendizado dos cirurgiões no procedimento queratoplastia endotelial da membrana de Descemet.

Effects of age and gender on macular thickness in healthy subjects using spectral optical coherence tomography/scanning laser ophthalmoscopy.

PURPOSE: To examine healthy subjects for normal macular thickness values and determine the effects of gender and age in a Turkish population, using spectral optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO). MATERIAL AND METHOD: Six hundred fourteen eyes of 307 subjects with no history of ocular diseases and normal ophthalmic examination were recruited in this cross-sectional, prospective study. The participants were divided into three groups based on age (between 20 and 29 years: group 1, between 30 and 39 years: group 2, between 40 and 49 years: group 3). All subjects were scanned with spectral OCT/SLO, performed by one examiner to acquire the retinal thickness map in the ETDRS grid, and values were recorded for nine sectors, and effects of age and gender were evaluated. RESULTS: When all the subjects were evaluated, the thicknesses were lower in women than men in all sectors (p < 0.001). When divided in groups based on age, this difference remained only in the outer segments. However, the differences in outer layers, except outer nasal layer, were thicker in women in group 3 when compared to others in group 3. When compared between groups, only central thickness in group 3 was shown to be higher than group 1 (p = 0.06). There was no significant difference of thicknesses in any sector when compared right and left eyes of all subjects. CONCLUSIONS: The study reports the variation in retinal thickness between age and gender in a relatively large sample of a Turkish population. It is important to consider these effects while interpreting the OCT images to make an appropriate diagnosis in retinal diseases.

A comparative study: deep anterior lamellar keratoplasty for corneal dystrophies using two different donor stromal tissues.

PURPOSE: This study aimed to present a comparison of early postoperative results of deep anterior lamellar keratoplasty (DALK) surgery performed using the two different corneal graft sources. MATERIALS AND METHODS: This retrospective clinical study included the surgery performed on 26 eyes of 26 patients who underwent DALK for the stromal dystrophies. At the time of surgery, donor stromal tissue for DALK was sourced using the two different preparatory techniques. For 14 cases (Group 1), the donor grafts were prepared quickly by removing the descemet's membrane (DM) without much care after the exposure of the bare DM in the recipient cornea. For 12 cases (Group 2), the grafts for DALK surgery had already been prepared during a previous descemet's membrane endothelial keratoplasty (DMEK). RESULTS: The groups differed statistically regarding the blue staining of the grafts at the time of surgery and on the first day post-DALK. The first day after surgery, 14 (100%) grafts were clear in Group 1, while eight (66.7%) grafts were clear and four (33.3%) were edematous in Group 2 (p = 0.019). Bubbling was performed in three (25.0% of Group 2) of the four cases on the first day post-DALK, while none of the patients in Group 1 underwent this procedure (p = 0.47). The postoperative increase in visual acuity was higher in Group 1 in the early postoperative period (p = 0.012). CONCLUSION: During the early postoperative period, complications (as graft edema, detachment, re-bubbling) were observed more frequently in the DALK operations performed with stromal tissue having blue stain remaining from the DMEK performed on the same day and in the same session.

Comparing the effects of two different contact lenses on corneal re-epithelialization after corneal collagen cross-linking.

OBJECTIVE: To investigate whether keratoconus (KC) patients who applied the corneal collagen cross-linking (CXL) and two different contact lens (CL) showed any differences in complaints and findings following the CXL. METHODS: This prospective, comparative, double-blind clinical study involved 60 eyes of 60 patients (38 female and 22 male). At the end of the CXL procedure, CL (Balafilcon A) was inserted in 29 patients (Group-1) while CL with different material content (Hioxifilcon A) designed for therapeutic/bandage purposes were inserted in 31 patients (Group-2). RESULTS: On the 1st and 3th day after the CXL, there were no statistically significant differences between the groups in terms of the postoperative symptoms. On the 3th day after the CXL, all cases of both two groups were found to complete the corneal re-epithelialization. There was more PE ratio in the patients who had allergic conjunctivitis. CONCLUSIONS: With the use of Balafilcon A and Hioxifilcon A lens materials, KC patients who underwent the CXL were found to have similar symptoms and clinical findings after the CXL. However, epithelial staining and PE were observed more in KC cases accompanied by allergic conjunctivitis.

The vascularization process after intravitreal ranibizumab injections for aggressive posterior retinopathy of prematurity.

PURPOSE:: To evaluate the retinal vascularization process after intravitreal ranibizumab was administered to infants with aggressive posterior retinopathy of prematurity (AP-ROP). METHODS:: Twenty-six eyes of 13 infants with AP-ROP who received 0.25 mg intravitreal ranibizumab were retrospectively investigated. The patients were evaluated at weekly follow-up visits, and the findings were analyzed after retinal vascularization was complete. RESULTS:: The results showed regression in the AP-ROP of all the patients within the first 48-72 h. Average time for complete vascularization of the nasal quadrant (zone II) was postmenstrual week 45 (range 41-56), and vascularization of the temporal quadrant (zone III) was completed in the postmenstrual week 56 (range 50-65). Reactivation was observed in seven patients, on average at postmenstrual week 42; two of these patients underwent additional treatment. Two patients presented with avascular areas in the peripheral retina despite being 1 year old. CONCLUSION:: These results showed that retinal vascularization following intravitreal ranibizumab was completed after a delay in patients with AP-ROP. Further studies are necessary to evaluate when and how vascularization occurs after intravitreal anti-vascular endothelial growth factor treatments.

Results of intravitreal ranibizumab treatment for retinopathy of prematurity in infants.

PURPOSE: To assess the results of intravitreal ranibizumab treatment for retinopathy of prematurity (ROP) in infants. METHODS: A single-institution, retrospective consecutive case series. RESULTS: Thirty-one patients who received ranibizumab treatment for ROP were evaluated in this study. The mean follow-up time was 14 ± 1.37 months. Vascularization of the peripheral retina had completed with delay in the majority of cases and also avascular areas were present in the peripheral retinas of five infants at one year of age. Although recurrence of ROP developed in 14 infants after single-dose ranibizumab treatment, only four infants received additional treatment due to recurrence of ROP requiring treatment. No serious ocular complications were reported, but, two infants died in this series. CONCLUSION: Even so ranibizumab treatment is an effective therapy for ROP in early period, close monitoring after injection is necessary due to the high incidence of recurrence. In addition, questions remain regarding the systemic safety of ranibizumab. Further studies are needed to study the systemic and ocular side effects of ranibizumab.

The vascularization process after intravitreal ranibizumab injections for aggressive posterior retinopathy of prematurity / Processo de vascularização após injeções intravítreas de ranibizumab para retinopatia da prematuridade posterior agressiva

ABSTRACT Purpose: To evaluate the retinal vascularization process after intravitreal ranibizumab was administered to infants with aggressive posterior retinopathy of prematurity (AP-ROP). Methods: Twenty-six eyes of 13 infants with AP-ROP who received 0.25 mg intravitreal ranibizumab were retrospectively investigated. The patients were evaluated at weekly follow-up visits, and the findings were analyzed after retinal vascularization was complete. Results: The results showed regression in the AP-ROP of all the patients within the first 48-72 h. Average time for complete vascularization of the nasal quadrant (zone II) was postmenstrual week 45 (range 41-56), and vascularization of the temporal quadrant (zone III) was completed in the postmenstrual week 56 (range 50-65). Reactivation was observed in seven patients, on average at postmenstrual week 42; two of these patients underwent additional treatment. Two patients presented with avascular areas in the peripheral retina despite being 1 year old. Conclusion: These results showed that retinal vascularization following intravitreal ranibizumab was completed after a delay in patients with AP-ROP. Further studies are necessary to evaluate when and how vascularization occurs after intravitreal anti-vascular endothelial growth factor treatments.

RESUMO Objetivo: Avaliar o processo de vascularização da retina após injeção intravítrea de ranibizumab aplicada em crianças com retinopatia da prematuridade posterior agressiva (AP-ROP). Métodos: Vinte e seis olhos de 13 crianças com AP-ROP que receberam 0,25 mg de ranibizumab intravítreo foram investigados retrospectivamente. Os resultados foram avaliados após a completa vascularização da retina, observada em acompanhamentos semanais. Resultados: Verificou-se que houve regressão na AP-ROP de todos os pacientes durante as primeiras 48 a 72 horas. Na média, a vascularização do quadrante nasal (zona II) foi concluída na semana 45 pós-menstrual (variação 41-56), enquanto a vascularização do quadrante temporal (zona III) foi concluída na semana 56 pós-menstrual (variação 50-65). Sete pacientes (7/13) apresentaram reativação, que aconteceram em média a 42,14 semanas pós-menstruais, dois pacientes receberam tratamento adicional. Dois pacientes apresentaram áreas avasculares na retina periférica apesar de terem um ano de idade. Conclusões: O presente estudo mostrou que a vascularização da retina após a injeção intravítrea de ranibizumab foi concluída com atraso na AP-ROP. Ensaios clínicos randomizados são necessários para avaliar quando e como a vascularização acontece após tratamentos com injeções intravítreas de anti-VEGF.

Symptomatic Treatment of Subepithelial Infiltrates after Viral Conjunctivitis: Loteprednol or Dexamethasone?

PURPOSE: To compare the efficiency and ocular side-effect profile of topical loteprednol applied to one eye and topical dexamethasone applied to the other eye in the early period on the same patient who has subepithelial infiltrates (SEI). METHODS: The patients who developed bilateral SEI following epidemic keratoconjunctivitis (EKC) were applied topical loteprednol on one eye (group 2) and topical dexamethasone on the other (group 1). RESULTS: Decrease in the symptoms was faster in the dexamethasone group, but this difference between the groups was not statistically significant (p = 0.073). Both groups were found to have substantial recurrence. However, the difference between the groups was not statistically significant (p = 0.131). CONCLUSIONS: The study has found that in the treatment of SEI, which developed after EKC, statistically similar results can be obtained with loteprednol, which is known to have fewer adverse effects.

Occurrence of intraocular air bubbles during intravitreal injections for retinopathy of prematurity.

This study aims to present five cases with retinopathy of prematurity (ROP) who were found to have intraocular air bubbles after intravitreal injection (IVI) treatment. The medical records of 148 infants who underwent IVI for ROP were retrospectively reviewed and the ones who demonstrated post-injection intraocular air bubble formation were recruited. Of the 148 patients (31 babies received ranibizumab, 20 babies received aflibercept, 97 babies received bevacizumab), five were found to have intraocular air bubbles right after the IVI. Two infants received intravitreal ranibizumab and three received intravitreal bevacizumab injections. Although intraocular pressure increased temporarily, no intraocular sterile or infective reactions were observed in the postoperative period. The air bubble was found to resorb spontaneously within 72 h. The occurrence rate of the intravitreal air bubbles in our series was 3.37 % despite previously not been reported in the literature. Due to the intravitreal air injection risk, it is important to be more careful while preparing the intravitreal medication before treatment in premature babies.

Results of therapeutic penetrating keratoplasty for bacterial and fungal keratitis.

PURPOSE: This study aimed to report the results of therapeutic penetrating keratoplasty (TPKP) performed at early and late stage of keratitis. METHODS: The study involved patients who underwent TPKP surgery due to bacterial, fungal, or mixed (bacterial and fungal) keratitis. The patients were divided into two groups. Group 1 (13 patients) was the patients operated at early stage of corneal abscess formation or in 15 days after the start of keratitis and group 2 (12 patients) was the patients operated at late stage of keratitis or after at least 15 days after the initial appearance of symptoms. Preoperative clinical signs and postoperative results were presented. RESULTS: At the end of the follow-up period, 13 (100 %) of grafts in the early TPKP group and 10 (83.3 %) of grafts in the late TPKP group remained clear (p = 0.125). Recurrence of infection at last visit after TPKP was 0 (0 %) of cases in group 1, and was 2 (16.7 %) of cases in group 2 (p = 0.125) Therapeutic success was achieved and the eyes were preserved in 23 patients of both groups. Evisceration was performed for a case and phthisis bulbi was seen in a case in group 2. The groups were statistically different regarding the presence of postoperative complications (p = 0.015). CONCLUSION: TPKP performed in cases that do not respond medical treatment, in the early phase of the disease, before the lesions reach to limbus and without waiting corneal perforation, may yield better clinical results and less postoperative complications.