Intraocular pressure effect of anti-vascular endothelial growth factor injection for aggressive posterior retinopathy of prematurity.

PURPOSE: To compare the effect of 0.0125 mL and 0.025 mL doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection on intraocular pressure (IOP) in eyes with aggressive posterior retinopathy of prematurity (ROP). METHODS: In this retrospective cohort study, charts of 52 eyes of 26 consecutive infants were reviewed. The patients received 0.0125 mL (Group 1) or 0.025 mL (Group 2) anti-VEGF agents' intravitreally. The IOP was measured before injection, on the first day, during the first week, and in the first month. After each injection, optic nerve head perfusion was evaluated by a binocular indirect ophthalmoscope. IOP values, complications, use of antiglaucomatous drops, and the effects of anti-VEGF drugs were recorded. RESULTS: The mean baseline IOP before injection was 16.0 ± 3.7 mmHg for Group 1 and 15.5 ± 4.5 mmHg for Group 2 (p = 0.365). The mean value of IOP on the first day was statistically increased in Group 2 (29.2 ± 6.1 mmHg) compared with Group 1 (24.1 ± 6.8 mmHg) (p = 0.013). Moreover, antiglaucomatous drops were needed in 12 eyes for Group 2 compared with seven eyes for Group 1. Anterior chamber paracentesis was not performed after any of the injections. CONCLUSION: This study found that IOP increases after intravitreal injections of anti-VEGF agents for the treatment of ROP. The injection of 0.025 mL anti-VEGF agents increases IOP more than the 0.0125 mL injection in the treatment of infants with aggressive posterior ROP.

Effects of diode laser photocoagulation treatment on ocular biometric parameters in premature infants with retinopathy of prematurity.

AIM: To investigate the effects of diode laser treatment on ocular biometric parameters in premature infants with retinopathy of prematurity (ROP). METHODS: Premature infants who received diode laser treatment for ROP (n=68) and premature infants with spontaneous regressed ROP without treatment (n=50) were performed longitudinal ocular biometric measurements including anterior chamber depth, lens thickness and axial length as follows: 1d prior to laser treatment, and 3, 6, 9, and 12mo after the laser treatment. RESULTS: The mean birth weight, gestational age and initial examination time values were 936.53±302.07 g, 26.66±2.42wk, 36.26±2.73wk in the treatment group and 959.78±260.08 g, 27.28±2.10wk, 36.56±2.54wk in the control group. There was no statistically significant difference in these demographic characteristics of the groups. Anterior chamber depth, lens thickness and axial length demonstrated statistically significant linear increases during the study period in the two groups (P<0.001 for each). There were no statistically significant differences between the two groups in terms of anterior chamber depth after laser treatment. Measurements of the lens thickness at 9th and 12th months (9th month 3.70±0.22 vs 3.60±0.21 mm, P=0.017; 12th month 3.81±0.21 vs 3.69±0.22 mm, P=0.002) and the axial length at 12th month (19.35±0.79 vs 19.13±0.54 mm, P=0.031) after laser treatment were statistically higher in the treatment group. CONCLUSION: Diode laser retinal photocoagulation treatment in premature infants seems to increase the lens thickness and axial length.

Retinal choroidal and retinal nerve fiber layer thickness in former preterm and full-term infants aged 4 to 8 years.

PURPOSE: To compare the retinal thickness at the fovea center, peripapillary retinal nerve fiber layer (RNFL) thickness and choroidal thickness (CT) in former preterm and full-term infants. METHODS: A total of 121 healthy children aged 4-8 years were divided 4 groups: group 1; children born on time, group 2; preterm children without a history of retinopathy of prematurity (ROP), group 3; preterm children with a history of spontaneously regressed ROP and group 4; preterm children who underwent diode laser photocoagulation for ROP. The retinal thickness at the fovea, peripapillary RNFL thickness at global, superior, inferior, nasal and temporal quadrants and submacular CT at 7 different points were measured by using spectral-domain optical coherence tomography. RESULTS: The mean retinal thickness at the fovea center was statistically higher, whereas the mean RNFL thickness values in global, nasal, superior and inferior quadrants were statistically lower in group 4. No difference was found in the mean submacular CT value of any point between the groups. CONCLUSION: Transpupillary diode laser photocoagulation treatment for ROP seems to cause an increase in macular thickness and a decrease in RNFL thickness.

Is being small for gestational age a risk factor for strabismus and refractive errors at 3 years of age?

BACKGROUND: Visual problems, cerebral visual impairment, refractive errors and strabismus are commonly found in preterm infants in long-term follow-ups. The aim of this study was to determine the factors that lead to the development of amblyogenic risk factors, such as high refractive errors, anisometropia and strabismus, in the long-term evaluation of preterm infants. METHODS: We retrospectively evaluated children who were screened for retinopathy of prematurity (ROP) and who had a 3rd year ophthalmologic examination. The impacts of sex, gestational age (GA), birth weight (BW), BW for GA, being small for gestational age (SGA), being appropriate for gestational age (AGA), multiple pregnancies and the results of ROP screening on refractive errors and the development of strabismus were evaluated by logistic regression analysis. The SGA and AGA groups were compared in terms of refractive errors and presence of strabismus. RESULTS: Six hundred and eight children, including 317 (52.1%) males and 291 (47.9%) females, were included in the study. The mean GA was 31 ± 3 weeks (24-36), and the mean BW was 1505 ± 435 g (600-2460). The number of SGA-born children was 101 (16.6%). Manifest deviation was detected in 42 (5.6%) children, and optical correction was required in 101 (16.6%) children. Being an SGA infant and multiple pregnancies were risk factors for refractive errors requiring optical correction, and hyperopia (≥3.00 D) was found to be a risk factor for the development of strabismus in the multivariate regression analysis. Additionally, the SGA group was at high risk for strabismus, hyperopia, high astigmatism and the need for optical correction. CONCLUSIONS: We concluded that SGA seems to be associated with an increased risk of strabismus and a high refractive error. It should be taken into consideration during follow-up examinations of SGA infants.

Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline.

AIM: To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. METHODS: One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. RESULTS: Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). CONCLUSION: Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.

Tolerance to systemic isotretinoin therapy in two patients using highly wettable contact lenses.

Purpose. Numerous ocular side effects have been reported with the use of systemic isotretinoin therapy. Herein, we presented two contact lens user patients who did not have contact lens intolerance during systemic isotretinoin therapy. Methods. 25-year-old male and 20-year-old female patients with severe acne vulgaris who were using highly wettable silicone hydrogel contact lenses which increase tear film stability were examined. Tear film function tests including Schirmer tests and tear break up time (TBUT) test and ocular surface staining with fluorescein were done. Subjective ocular complaints were scored with ocular surface disease index (OSDI) questionnaire. Patients were followed up monthly and examinations were repeated at each visit. Results. Both patients completed the therapy after a cumulative dose of 140 mg/kg isotretinoin in 6 months. The OSDI score and tear film function tests before and after treatment were all within normal limits. Discussion. Highly wettable contact lenses that provide increase in the tear film stability may be used during systemic retinoid therapy under close followups. Although isotretinoin affects ocular glands, the differences between tolerances to this retinoid therapy need to be investigated in larger patient groups using contact lenses.

Relationship between skin diseases and extracutaneous complications of diabetes mellitus: clinical analysis of 750 patients.

BACKGROUND: The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear. OBJECTIVE: We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM. METHODS: A total of 750 patients with DM were prospectively enrolled. Demographic and clinical features, skin disorders, glycosylated hemoglobin (HbA1c) levels, and presence of nephropathy, neuropathy, and retinopathy were noted. RESULTS: Of the patients, 38.0% had neuropathy, 23.3% had nephropathy, and 22.9% had retinopathy. Any skin disorder was present in 79.2% (n = 594) of patients. The most common skin manifestations were cutaneous infections (47.5%), xerosis (26.4%), and inflammatory skin diseases (20.7%). The frequency of cutaneous infections, fungal infections, diabetic foot, rubeosis faciei, and pigmented purpuric dermatitis was higher in patients with nephropathy than in those without nephropathy. Cutaneous infections, diabetic foot, rubeosis faciei, and diabetic dermopathy were more common in patients with neuropathy. Fungal infections, diabetic foot, rubeosis faciei, diabetic dermopathy, and pigmented purpuric dermatitis were more frequent in patients with retinopathy. Patients with HbA1c ≥8 mmol/mL had more skin disorders than those with HbA1c <8 mmol/mL (P < 0.05 for all). CONCLUSION: Skin disorders may be clues to the presence of associated microvascular complications of DM.