Pro re nata anti-VEGF treatment in pachychoroid neovasculopathy compared with age-related macular degeneration based on optical coherence tomography.

PURPOSE: To compare anti-vascular endothelial growth factor (anti-VEGF) treatment in pachychoroid neovasculopathy (PNV) and age related macular degeneration (AMD). METHODS: Cases having pro re nata (PRN) anti-VEGF treatment for choroidal neovascularization were reviewed and grouped as PNV and AMD. Groups were compared according to central foveal thickness (CFT), best corrected visual acuity (BCVA), and total injection over 12 months. The correlation of beginning choroidal thickness, CFT, and BCVA with final BCVA was analyzed. RESULTS: Forty-seven PNV and 65 AMD cases were reviewed. Both the PNV group (p = 0.0001) and the AMD group (p = 0.003) had a significant improvement in BCVA and a significant decrease in CFT (p = 0.0001). However, BCVA was better at the 3-, 6-, and 12-month follow-up in PNV (p = 0.003, 0.002, 0.02). No significant CFT difference was observed between groups. The total number of injections was 5.7 ± 1.7 for PNV and 5.2 ± 1.5 for AMD (p = 0.09). Beginning BCVA was positively correlated with final BCVA in both groups. CONCLUSION: The PRN treatment regimen was effective for PNV and AMD in terms of visual and anatomical outcomes. Visual response was better in PNV with PRN treatment with the same number of injections.

There is no association between serum endotoxin levels and inflammation in asthma.

BACKROUND: Endotoxin, in lipopolysaccharide structure (LPS), is the main component of the outer membrane of gram negative bacteria. LPS levels were associated with inflammatory disease. Asthma is a chronic inflammatory disease involving many different cell types and cellular elements. The association between LPS serum levels and the asthma is not well known. The aim of this study was to investigate the association between the LPS serum levels and the severity of asthma, demographic data and laboratory parameters. METHODOLOGY: The study included 67 patients aged >18 years with a diagnosis of asthma, and 15 healthy volunteers with no history of chronic disease as a control group. The Asthma Control Test (ACT), Respiratory Function Tests (RFTs), fractional exhaled nitric oxide (FeNO), and endotoxin levels were measured and compared between the groups. The endotoxin measurements were performed using the ELISA method. RESULTS: The mild-moderate asthma group included 33 patients and the severe asthma group, 34 patients. The endotoxin level was measured as 17.78 (range 3.59 to 304.55) EU/ml in the patient group and 15 (range 4.01 to 74.06) EU/ml in the control group with no statistically significant difference determined between the groups. In the subgroups, the endotoxin level was measured as 15.21 (range 3.69 to 304.55) EU/ml in the mild-moderate group and 14.46 (range 3.59 to 278.86) EU/ml in the severe asthma group with no statistically significant difference determined between the groups. CONCLUSION: The results of this study showed no relationship between serum endotoxin level and asthma or asthma severity.

Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography.

AIM: To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and non-diabetic patients with epiretinal membrane (ERM) with the help of optical coherence tomography angiography (OCT-A) and compare them with healthy control subjects. METHODS: In this prospective, cross-sectional study, a total of 165 eyes were evaluated, including 50 eyes of patients with diabetic ERM, 54 eyes of idiopathic ERM (iERM) patients, and 61 eyes of healthy controls. Macula and disc angiography was performed by OCT-A. Macular vessel density (VD) ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region. Statistical calculations were evaluated at the 95% confidence interval. RESULTS: Macula superficial VD values of ERM cases were lower than that in the control group, while foveal VD was higher in ERM cases. Macula deep VD values of ERM cases were lower in all quadrants, except the fovea. The width of the foveal avascular zone (FAZ) area was significantly lower in the ERM groups, and the FAZ width was lowest in iERM group. Macula superficial VD ratio was significantly higher in the ERM groups, but there was no significant difference between ERM groups. Macula deep VD ratio was significantly higher in the iERM group than in the control group. CONCLUSION: Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation, as well as their effect on retinal vascular structures. If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A, then, OCT-A can be used as a guide for ERM prognosis.

The prevalance of congenital optic disc anomalies in Turkey: a hospital-based study.

PURPOSE: The aim of this study was to investigate the prevalence of congenital optic disc anomalies in Turkey. METHODS: The 11,123 eyes of 5570 patients were screened for optic disc anomalies. All patients were underwent a complete ophthalmic examination including best corrected visual acuity, refraction, spherical equivalent, slit lamp biomicroscopy, intraocular pressure measurements, dilated stereoscopic fundus examination. Data analyses were performed by using SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL, United States). RESULTS: 11,123 eyes of 5570 participants were screened. Of the 5570 participants who underwent optic disc examination, 246 eyes of 174 patients (3.12%, 95% CIs 2.66-3.58%) had optic disc anormalies. 92 (52.9%) were female, 82 (47.1%) were male and the mean of age was 44.25 ± 15.67 years. 72 (41.4%) patients were bilateral, 102 (58.6%) patients were unilateral involvement. The tilted disc was the most common anomaly and was found at least one eye in 46 patients (75 eyes) and 0.83% of all screened patients. Peripapillary myelinated nerve fibers was the second common anomaly and was found at least one eye in 31 subjects (35 eyes) and 0.56% of all screened subjects. Peripapillary atrophy was the third common anomaly, and was found in at least one eye in 24 patients (37 eyes) and 0.43% of all screened subjects. CONCLUSION: To our knowledge, this is the first study that the prevalences of all congenital optic disc anomalies from Turkey. The prevalence of congenital optic disc anomalies is higher than in other countries.

Value of C-reactive Protein/Albumin Ratio for Predicting Ischemia in Myocardial Perfusion Scintigraphy

Objectives: Several studies demonstrate the relationship between coronary artery disease and inflammatory parameters. Nevertheless, there is paucity of data regarding the role of high sensitivity (hs)-C-reactive protein (CRP) to albumin ratio (CAR) in patients with ischemia on gated single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). This study was aimed at demonstrating the relationship between CAR and the occurrence of ischemia on gated SPECT MPI. Methods: We retrospectively evaluated 2.048 referred patients for gated SPECT MPI from a cardiology outpatient clinic between October 2017 and June 2019. After applying exclusion criteria and measuring serum CRP and albumin levels, we included 126 patients in the study. We then classified subjects into different groups according to the absence or presence of ischemia on gated SPECT MPI. Results: According to laboratory findings, hs-CRP and CAR were significantly higher in the ischemia group, while the serum albumin was significantly lower in ischemia group (p<0.05 for each). The independent predictors of presence of ischemia in multivariate analysis were hypertension and CAR (CAR; odds ratio: 5.720, 95% confidence interval: 2.697-12.133, p<0.001). The optimal value of CAR for presence of ischemia was 0.96 with 76% sensitivity and 71% specificity. Conclusion: We found CAR values as a predictor for ischemia before MPI.

The relationship between nocturnal blood pressure drop and body composition indices among hypertensive patients.

Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6 ± 12.1 years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6 ± 12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6 ± 11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.

Anti-interferon alpha antibodies and autoantibodies in patients with Behçet's disease uveitis treated with recombinant human interferon alpha-2a.

BACKGROUND: Recombinant human (rh) interferon alpha2a (IFN-α2a) therapy is successfully used for the treatment of Behçet's disease (BD) uveitis refractory to conventional immunosuppressive treatment. PURPOSE: Our aim in this study was to investigate the frequency and clinical significance of anti-IFN-α antibodies and autoantibodies during recombinant human rhIFN-α2a therapy in patients with BD uveitis. METHODS: This comparative, cross-sectional, serological screening study included 30 BD patients treated with rhIFN-α2a (Group 1), 29 BD patients treated with conventional immunosuppressive agents (Group 2), 29 BD patients who received only colchicine (Group 3), and 30 healthy subjects (Group 4). Anti-IFN-α-binding antibodies and autoantibodies, including anti-nuclear antibody, anti-thyroid peroxidase antibody, and anti-cardiolipin antibody, were measured in serum samples. Antibody seropositivity was compared between study groups. Retrospective clinical data were compared between antibody-positive and antibody-negative patients. RESULTS: A significantly higher proportion of patients in Group 1 had anti-interferon-α (26.6 %) and autoantibody (30 %) seropositivity compared to the other groups. No correlation was found between seropositivity for anti-interferon-α and other autoantibodies. No significant difference was found in cumulative dose of IFN-α, duration of IFN-α therapy, time to first uveitis attack, or attack rate between anti-interferon-α antibody-positive and antibody-negative patients in Group 1. Uveitis attacks were observed in 22 % of autoantibody-positive and 71 % of autoantibody-negative patients in Group 1 (p = 0.018). CONCLUSIONS: Patients with BD uveitis develop anti-IFN-α-binding antibodies and autoantibodies during treatment with rhIFN-α2a. While the clinical relevance of anti-IFN-α-binding antibodies remains unclear in this study, induction of autoimmunity was found to be associated with a tendency for better therapeutic response.

Preliminary anatomical and neurodevelopmental outcomes of intravitreal bevacizumab as adjunctive treatment for retinopathy of prematurity.

PURPOSE: To evaluate the two-year follow-up of patients with type 1 retinopathy of prematurity (ROP) who received intravitreal bevacizumab (IVB) as adjunctive treatment. MATERIALS AND METHODS: We conducted a longitudinal follow-up study of premature infants who received 0.625 mg IVB therapy in addition to standard laser photocoagulation therapy. For comparison of the ophthalmological and neurological assessment outcomes of these infants, a control group was formed with 13 birth weight- and gestational age-matched infants who were treated with laser therapy alone for type 1 ROP. The neurological status of the study group and the control group was examined systematically, and neurodevelopmental evaluation was assessed by the Bayley Scales of Infant Development (BSID-III). RESULTS: A total of 18 eyes of 13 infants were included in the study. Anatomical success was obtained in 14 eyes (78%) and retinal detachment was observed in 4 eyes (22%). At two years of age, no significant difference was found in terms of spherical or cylindrical refractive errors compared to the control group. In control group, 2/13 patients' and in study group, 3/13 patients' neurological examinations were abnormal. No significant difference was found in the mean cognitive, language or motor BSID-III test scores of the groups. CONCLUSIONS: IVB appears to be useful for advanced ROP when laser treatment is precluded or not sufficient for preventing the progression of ROP. This pilot study indicates that IVB seems to contribute no further complications to the complications already present due to prematurity.

Epidemiological analysis of retinopathy of prematurity in a referral centre in Turkey.

PURPOSE: To collect data towards the establishment of a guideline to predict the population under risk for the development of retinopathy of prematurity (ROP) in Turkey. METHODS: Medical reports of 2950 preterm infants who underwent screening examinations for ROP between 1996 and 2010 at Istanbul Faculty of Medicine, Department of Ophthalmology were reviewed. The study population was classified as inpatient infants and referred infants. A risk factor analysis was performed limited to the 788 inpatient infants. The demographical variables regarding birth weight (BW), gestational age (GA) and postnatal age at the time of treatment were compared independently between 403 referred and 64 inpatient infants who were treated for severe ROP. RESULTS: The mean GA of the infants with severe ROP was 31.2±2.7 weeks, mean BW was 1543.4±508.3 g. The risk factor analysis of inpatient infants revealed BW<1500 g, GA<32 weeks; intraventricular haemorrhage, respiratory distress syndrome, sepsis, apnoea and phototherapy were associated with a higher incidence of ROP. In addition, sepsis, male gender, multiple gestations, BW<1500 g were associated with a higher incidence of progression to severe ROP, whereas maternal pre-eclampsia was associated with a lower incidence. On the other hand, comparison of demographic features revealed that the referred infants with ROP were born at a significantly higher BW and needed significantly earlier treatment than inpatient infants with ROP. CONCLUSIONS: The high BW and GA of infants with severe ROP indicate wider screening criteria should be used in our country. BW might be a more important criterion than GA for ROP screening.