Safety Profile of Intravitreal Injections in the Injection Cabinet: No Cases of Endophthalmitis Seen After 7238 Injections.

Objectives: The present study evaluates the rate of endophthalmitis in intravitreal injections (IVI) performed in a modular injection cabin that could be easily sited in a closet in an office environment, and the performance tests of the cabin in terms of heating, ventilation, and air conditioning (HVAC). Methods: The injections were given over approximately 18 months in the cabin and the demographics of the patients were screened retrospectively, and the cabin was subjected to HVAC tests. Results: A total of 7,238 injections were performed in the defined period, and no cases of endophthalmitis were encountered (0%). The results of the airflow and flow rate, particle count, pressure difference, decontamination time, light, moisture, and heat tests were all found to be above the standard defined by the International Organization for Standardization (ISO). Conclusion: An injection cabin is a practical modular construction that can be easily sited in any space without the need for special climatization, and provides a sterile and safe environment for IVI.

Effects of COVID-19 infection on retinal vascular density and choroidal thickness measured by optical coherence tomography angiography.

AIM: The present study evaluates the possible effects of COVID-19 on choroid thickness, the Foveal Avascular Zone (FAZ) and retinal vascular indices in the same individuals who had Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) data prior to the COVID-19 pandemic. METHODS: The OCT and OCTA images of the same individuals with no known ophthalmic pathology who developed a COVID-19 infection were obtained were retrieved retrospectively from the database and compared with the repeated images of OCT and OCTA images 1-2 months after COVID-19 infection. RESULTS: Eighty eyes of 40 patients (26 female [65%], 14 male [35%]) who had developed a prior Covid-19 infection were included in the study. When comparing the measurements of the same participants before and after Covid-19 infection, no significant difference was detected in the mean average choroidal thicknesses (p=0.998), average superficial (p=0.425) and deep (p=0.333) retinal vascular densities, and superficial (p=0.991) and deep (p=0.075) FAZ measurements. CONCLUSIONS: No significant effect of COVID-19 on choroid thickness, FAZ or retinal vascular densities was noted in the present study, although there are some studies in literature with equivocal results.

Associations between body mass index and choroidal thickness, superficial and deep retinal vascular indices, and foveal avascular zone measured by OCTA.

AIM: The present study explores the effects of Body Mass Index (BMI) on choroidal thickness, the deep and superficial retinal capillary plexuses, and the foveal avascular zone (FAZ). METHODS: The subjects in this prospective study were divided into five groups based on their calculated BMI. Choroidal thickness, superficial and deep retinal capillary plexuses, and FAZ were measured using enhance depth imaging (EDI) and optical coherence tomography angiography (OCTA). The groups were then compared and correlations with BMI were evaluated. RESULTS: The study included 210 eyes of 105 subjects. The comparison of the BMI groups revealed a significant decrease in the mean choroidal thicknesses in the obese groups (p = 0.001), and a significant negative correlation between BMI and mean choroidal thickness (p = 0.02). The results of the analysis of the mean superficial and deep retinal capillary plexuses did not differ between the groups (p = 0.089, p = 0.808 respectively), while the deep FAZ measurements revealed a significant decrease in the obese groups (p = 0.003). CONCLUSION: Choroidal thickness and deep FAZ are significantly negatively correlated with BMI, suggesting potential choroidal and retinal microvascular effects of obesity.

The Effects of chronic smoking on retinal vascular densities and choroidal thicknesses measured by optical coherence tomography angiography.

PURPOSE: To examine the effects of chronic smoking on vascular density in superficial and deep retinal vascular plexuses and choroidal thicknesses. METHOD: Superficial and deep vessel densities and choroidal thicknesses of smoking volunteers and healthy non-smoking volunteers were measured with the Topcon DRI OCT-1 Tritron® device and compared with each other. RESULTS: This study included 108 eyes of 54 smoking volunteers and 108 eyes of 54 healthy volunteers as a control group. The average superficial vascular density index and deep vascular density indexes of smokers were found to be 39.81 ± 1.5% and 42.53 ± 1.9%, respectively (P = 0.53), while the non-smoking control group was 40.09 ± 1.3% and 41.57 ± 1.6%, respectively (P = 0.006). Average choroidal thicknesses were 284.22 ± 59 in smokers and 270.72 ± 61 in the control group (P = 0.247). Also, smoking quantity per day x years was found to be significantly negatively correlated with average choroidal thicknesses. (P = 0,011). DISCUSSION: In this study, it was determined that chronic smoking increases deep retinal vascular densities on retinal vascular plexus. However, the cumulative effect of smoking was found to be negatively correlated with choroidal thicknesses. Smoking has microvascular effects on vessels such as vasodilatation, vasoconstriction, increased platelet aggregation, endothelial dysfunction. However, studies in the literature are in dispute with the effects of smoking on choroidal and retinal vessels. This study may show that chronic smoking may have different vascular effects on the superficial and deep plexuses and choroidal vessels, as well as different effects from acute use.

Haematologic indices and disease activity index in primary Sjogren's syndrome.

BACKGROUND: The present study was conducted to investigate the association between haematologic indices, neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), platelet/lymphocyte ratio (PLR), disease activation, organ involvement, and inflammatory markers in the SS. METHODS: The study was conducted with newly diagnosed and treatment-naive 41 primary SS patients who met ACR-2012 criteria and 96 healthy volunteers. Blood tests obtained before treatment were evaluated. Lymphocyte, neutrophil and platelet counts, mean corpuscular volume (MCV), platelet distribution width (PDW), plateletcrit (PCT), haematocrit (HCT), MPV, white blood cell count (WBC) values were harvested from CBC of the subjects and NLR, PLR were calculated over these values. The values were compared between groups and correlation with EULAR SS disease activity index (ESSDAI) was evaluated. RESULTS: The study included a total of 41 patients with a mean age of 40.73 ± 12.0 years and 96 healthy subjects with a mean age of 40.0 ± 9.2 years. In inter-group comparisons, lymphocyte, platelet counts, and MPV values were significantly lower in the SS group compared with the control group (P < .01), and NLR was significantly higher in the SS group (P = .026). The mean ESSDAI scores in SS patients were 5.65 ± 0.86 SE. These scores were significantly higher in patients with neurological involvement. There was a positive correlation between ESSDAI and PLR. CONCLUSION: NLR, PLR, and MPV may be used as indicators or with activity index in SS. ESSDAI scores were found to be high in patients with neurological involvement, and it was also found to be correlated with PLR.

The influence of dead spaces and the designs of injectors on the amount of drug dose in intra-vitreal injection.

AIM: To evaluate the dead spaces resulting from different designs of the insulin injectors used for intravitreal injections and the amounts of drug doses. METHODS: In the study, five different brands of sterile insulin injectors of 1 mL were used for the test. The weight of the injectors was determined before and after filling the injectors with 0.05 and 0.1 mL distilled water. The weight of the injectors was measured with and without the needle after the water within the injectors had been taken out and weight differences were measured. The difference between the intended amount of fluid to be thrown out and the weight of the fluid remaining in the injector was calculated as percent error. RESULTS: After throwing out 0.05 mL distilled water from the injector, weights of the Beybi®, Traf®, Becton Dickinson®, Ayset®, and Setojet® brands of injectors with 30 G needle were detected to increase the mean 0.0220 ± 0.006 g, 0.0208 ± 0.008 g, 0.0355 ± 0.016 g, 0.0219 ± 0.017 g, and 0.0150 ± 0.007 g, respectively compared to the weights of the dry injectors. The 0.1 mL injector group was found to be mean 0.0350 ± 0.014 g, 0.0264 ± 0.008 g, 0.0405 ± 0.015 g, 0.0272 ± 0.013 g, and 0.0245 ± 0.014 g, respectively. The maximum increase due to the dead spaces in the injectors was found in the Becton Dickinson® injector, both in the 0.05 mL and the 0.1 mL groups (p < 0.000). CONCLUSION: The injector designs may affect the dose of IVI required to be given. More correct amounts of drugs may be administered via the intra-vitreal route through designs that reduce the dead spaces at the end part of the injector and between the inner wall and the plunger.

The effect of religious fasting and dehydration at Ramadan on choroidal thickness and Retinal vessel densities, measured with optical coherence tomography angiography.

AIM: To investigate the effect of religious fasting and dehydration at Ramadan on choroidal thickness and vessel density in the superficial and deep vascular plexuses with OCTA. METHODS: The choroidal thickness, and superficial and deep vessel density indices of fasting healthy subjects were measured with an OCTA device, and compared with non-fasting measurements. RESULTS: The study included 70 eyes of 35 healthy subjects with a mean age of 42.86 ± 8.3 years. The measured choroidal thickness, superficial vessel density index and deep vessel density index were 288.89 ± 67 µm, 40.56% and 41.43%, respectively when measured in the fasting period, compared to 284.62 ± 65 µm, 40.41% and 41.41%, respectively when measured in the non-fasting period. The choroidal thickness under the fovea center was found to be significantly higher in the fasting period than in the non-fasting period (p = 0.014). The mean total choroidal thickness was found to be reduced in the non-fasting period, although not to a statistically significant degree (p > 0.05). An analysis of the mean total superficial and deep vascular plexuses revealed no statistically significant difference (p = 0.368, p = 0.938 respectively). CONCLUSION: Although a significant increase was noted in central choroidal thickness in the fasting period, no significant change due to fasting was observed in the superficial and deep capillary plexuses. The choroidal layer may vary in thickness due to fasting-related metabolic factors, while retinal vessels are more stable against such effects.

In-vitro dewetting properties of planned replacement and daily disposable silicone hydrogel contact lenses.

AIM: To compare the in-vitro videokeratoscopic surface dewetting properties of new-generation silicone hydrogel (SiH) planned replacement contact lenses (CL) with those of daily disposable CLs. METHOD: A chrome coated cornea model was used for the in-vitro evaluation of surface dewetting. Pre-lens and post-lens film layers were formed by instilling a normal preservative-free normal saline solution (PFNs) (0.9 %) before and after the placement of the CL on the model cornea. The tests were carried out on fanfilcon A, lotrafilcon B, samfilcon A, and senofilcon A lenses, as well as such daily disposable lenses as delefilcon, nesofilcon A and senofilcon one day. Using videokeratoscopic methods, images were obtained at 30-second intervals up to 180 s in the lens and control groups and were analyzed by the ImajeJ® program. RESULTS: The mean measured area of the keratoscopic rings was largest in the fanfilcon group (67.56 mm2), followed by 61.53 mm2 in the lotrafilcon A group and 64.60 mm2 in the samfilcon group, while the smallest area was measured in the senofilcon A group, at 56.90 mm2. The area was measured as 64.33, 63.09 and 68.39 mm2 for the delefilcon, nesofilcon and Senofilcon one day CLs, respectively. The dewetting patterns and properties differed in the CL groups (p < 0.05), while no significant differences were found between the measured areas of the planned replacement and daily disposable CL groups (p > 0.05). DISCUSSION: Videokeratoscopy using in-vitro cornea models has been identified as a reproducible and reliable method for the analysis of the surface dewetting of CLs. The dewetting characteristics of CL groups have been found to differ from each other, despite all being produced from SiH materials. The surface wetting coating has been shown to affect CL dewetting performance.

The effects of vital dyes on mechanical properties of the human anterior lens capsule.

Purpose: The purpose of this study was to evaluate the mechanical effects of vital dyes on the anterior lens capsule via the nanoindentation method. Methods: Twenty anterior lens capsules of 20 different patients were dissected into four equal fragments. Each fragment was stained separately with dyes for intraocular surgeries, such as trypan blue 0.06% (TB), brilliant blue 0.025% (BB), and indocyanine green 0.05% (ICG), for 1 min. The remaining fragment was assessed as an untreated control group. The alterations on the mechanical characteristics of the anterior lens capsule were evaluated using a nanoindentation testing device with Oliver-Pharr and Martens hardness methods. Results: The mean values of elasticity were 7.842 ± 0.55 GPa for capsules fragments stained with TB (P < 0.05), 8.407 ± 0.82 GPa for capsules fragments stained with BB (P < 0.05), 8.557 ± 0.60 GPa for ICG (P < 0.05), and 6.09 ± 0.57 GPa for the untreated control group. The mean values of stiffness were 299.7 ± 47 MPa for TB (P < 0.05), 317.9 ± 34 MPa for BB (P < 0.05), 331.8 ± 48 MPa for ICG (P < 0.05), and 229.85 ± 44 MPa for the untreated control group. The elasticity of the capsules statistically decreased in comparison to the control group, and the capsule stiffness showed a statistically significant increase in comparison to the untreated controls. Conclusion: The mechanical characteristics of the human anterior lens capsule were affected in association with the alterations in the elasticity and stiffness properties of the capsule as a result of exposure to three different dyes.

Evaluation of Neutrophil-Lymphocyte Ratios, Mean Platelet Volumes, and Platelet-Lymphocyte Ratios in Pterygium.

OBJECTIVES: To assess the neutrophil-to-lymphocyte ratio (NLR), mean platelet volumes (MPV), platelet-lymphocyte ratios (PLR) and other complete blood count parameters (CBC) as indicators of inflammation in patients with pterygium. METHODS: This study was carried out retrospectively in 111 consecutive pterygium patients and 106 control subjects. Laboratory and clinical parameters were obtained from the patient data management system. NLR and PLR were calculated by dividing neutrophil and platelet count by lymphocyte count. RESULTS: A significant difference was found in NLR and lymphocyte values between the pterygium and control groups (p<0.05). However, there was no significant difference found in MPV, PLR and other parameters between groups (p>0.05). CONCLUSION: NLR may have an association with pterygium, which should be investigated at larger subgroups in further studies.

Contrast Sensitivity in Microtropic and Anisometropic Eyes of Successfully Treated Amblyopes.

OBJECTIVES: To assess and compare contrast sensitivity function in the previously amblyopic and non-amblyopic "normal" eyes of patients with microtropia and anisometropia who achieved 20/20 visual acuity after occlusion therapy. MATERIALS AND METHODS: Contrast sensitivity was tested monocularly on both eyes of 34 successfully treated microtropic and 15 anisometropic subjects (visual acuity 20/20 in both eyes). Contrast sensitivity function was evaluated by CSV-1000E and age-matched nomograms were used (spatial frequencies of 3, 6, 12, and 18 cycles per degree [cpd]) for comparison. RESULTS: The mean age of subjects was 11.2±1.3 years in the microtropic group, 9.8±1.7 years in the anisometropic group (7-12 years); the mean follow-up time was 16.4±3.2 months (12 to 92) in the microtropic group and 27.7±1.8 months (12-84) in the anisometropic group. Statistical comparison of the microtropic amblyopic eyes versus non-microtropic eyes showed significant differences at spatial frequencies of 3, 12 and 18 cpd (3 cpd, t=2.8, p=0.007; 6 cpd, t=1.1 p=0.261; 12 cpd, t=2.2, p=0.033; 18 cpd, t=2.2, p=0.030). When anisometropic eyes were compared with non-anisometropic eyes, there was a significant difference only at 12 cpd (t=2.1 p=0.049). The comparison of non-amblyopic eyes versus age-matched nomograms revealed no differences at any of the spatial frequencies (p>0.05 for all). CONCLUSION: Contrast sensitivity was decreased in patients with amblyopia, especially in the microtropic group. The assessment of contrast sensitivity function may serve as a new parameter for termination of occlusion therapy.

Corneal, Scleral, Choroidal, and Foveal Thickness in Patients with Rheumatoid Arthritis.

OBJECTIVES: To investigate corneal, scleral, choroidal, and foveal thicknesses in female patients with rheumatoid arthritis (RA) and compare them with healthy subjects. MATERIALS AND METHODS: This prospective study included consecutive female patients diagnosed with RA and healthy subjects. Corneal, scleral, choroidal, and retinal (foveal) thicknesses were obtained by using optical coherence tomography and a comparison was performed between groups for all outcome measures. RESULTS: Thirty-six eyes of 36 female patients diagnosed with RA (group 1) and 36 eyes of 36 healthy female volunteers (group 2) were included. Mean corneal, scleral, choroidal thicknesses and retinal thickness at the fovea of group 1 were 543.3±33.7 µm, 343.7±42.2 µm, 214.6±50, and 213.5±18.9 µm, respectively; in group 2, these values were 549.9±29.6 µm, 420.9±42.4 µm, 206.4±41.9 µm, and 222±15.5 µm, respectively. The comparison between group 1 and 2 with respect to corneal, choroidal, and foveal thicknesses did not reveal statistical significant differences (p>0.05). On the contrary, there was a statistically significant difference with respect to scleral thickness between the groups, with the RA patients demonstrating a thinner scleral layer (p<0.001). CONCLUSION: Female patients with RA seem to demonstrate statistically significant scleral thinning when compared with healthy subjects, while there was no difference concerning corneal, choroidal, and foveal thickness.

Herpetic Keratouveitis and Trabeculectomy Failure during Infliximab Therapy in a Patient with Behçet's Disease.

A 51-year-old man was diagnosed with Behçet's disease in 2001. The patient was resistant to all immunosuppressive therapies. After 6 months of infliximab therapy, he presented to our clinic with pain and blurred vision in his right eye. The visual acuity was 20/200 and the intraocular pressure was 35 mmHg in the right eye. Biomicroscopic examination revealed corneal dendritic ulcers and 2+ cells in the anterior chamber in the right eye. The herpetic keratouveitis attack was controlled with antiviral therapy but the patient needed another glaucoma surgery. Trabeculectomy with mitomycin C was performed about halfway through an eight-week interval between two doses of infliximab.

Unusual presentation of an intraocular foreign body retained for sixty years.

Intraocular foreign bodies may remain quiescent for many years particularly if they are not metallic. We report a case of a missed intraocular stone foreign body that had remained asymptomatic underneath the iris for 60 years and appeared during cataract surgery.