Systemic exposure to aflibercept after intravitreal injection in premature neonates with retinopathy of prematurity: results from the FIREFLEYE randomized phase 3 study.

BACKGROUND: There are no data on pharmacokinetics, pharmacodynamics, and immunogenicity of intravitreal aflibercept in preterm infants with retinopathy of prematurity (ROP). FIREFLEYE compared aflibercept 0.4 mg/eye and laser photocoagulation in infants with acute-phase ROP requiring treatment. METHODS: Infants (gestational age ≤32 weeks or birthweight ≤1500 g) with treatment-requiring ROP in ≥1 eye were randomized 2:1 to receive aflibercept 0.4 mg or laser photocoagulation at baseline in this 24-week, randomized, open-label, noninferiority, phase 3 study. Endpoints include concentrations of free and adjusted bound aflibercept in plasma, pharmacokinetic/pharmacodynamic exploration of systemic anti-vascular endothelial growth factor effects, and immunogenicity. RESULTS: Of 113 treated infants, 75 received aflibercept 0.4 mg per eye at baseline (mean chronological age: 10.4 weeks), mostly bilaterally (71 infants), and with 1 injection/eye (120/146 eyes). Concentrations of free aflibercept were highly variable, with maximum concentration at day 1, declining thereafter. Plasma concentrations of adjusted bound (pharmacologically inactive) aflibercept increased from day 1 to week 4, decreasing up to week 24. Six infants experienced treatment-emergent serious adverse events within 30 days of treatment; aflibercept concentrations were within the range observed in other infants. There was no pattern between free and adjusted bound aflibercept concentrations and blood pressure changes up to week 4. A low-titer (1:30), non-neutralizing, treatment-emergent anti-drug antibody response was reported in 1 infant, though was not clinically relevant. CONCLUSIONS: 24-week data suggest intravitreal aflibercept for treatment of acute-phase ROP is not associated with clinically relevant effects on blood pressure, further systemic adverse events, or immunogenicity. GOV IDENTIFIER: NCT04004208.

Changes in retinal and choroidal capillary dynamics in patients with multisystem inflammatory syndrome in children.

PURPOSE: To evaluate patients with multisystemic inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using optical coherence tomography angiography (OCTA) during and after resolution of inflammation to investigate the effect of this entity on the retinal and choroidal circulation. METHODS: The study included 38 eyes of 19 patients diagnosed as having MIS-C between March 2021 and June 2021. OCTA measurements of choroidal thickness and vessel density in the radial peripapillary capillary plexus (RPCP), superficial capillary plexus (SCP), and deep capillary plexus (DCP) obtained at time of diagnosis and 60 days later were compared. Correlations between C-reactive protein (CRP) levels at diagnosis and retinochoroidal involvement were investigated. RESULTS: Compared to post-recovery follow-up examinations, patients with active MIS-C showed foveal avascular zone enlargement (p = 0.031), decreased vessel density in the temporal parafoveal SCP (p = 0.047) and all parafoveal areas of the DCP (p < 0.05 for all), and increased choroidal thickness (p = 0.021). Correlation analysis between CRP levels and OCTA changes during MIS-C revealed significant negative correlations with all parafoveal sectors of the SCP and DCP and a significant positive correlation with CT. CONCLUSION: There were especially marked effects on the DCP and choroid in MIS-C patients. Our findings also correlate with CRP levels. The use of optical coherence tomography angiography in patients with multisystemic inflammatory syndrome may have potential future implications for detecting ocular microvascular changes that occur before permanent damage develops. Clinical Trial Registration Number and Date: 77/1340; March 1, 2021.

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.

Effect of Intravitreal Aflibercept vs Laser Photocoagulation on Treatment Success of Retinopathy of Prematurity: The FIREFLEYE Randomized Clinical Trial.

Importance: Laser photocoagulation, which is the standard treatment for retinopathy of prematurity (ROP), can have adverse events. Studies of anti-vascular endothelial growth factor injections have suggested efficacy in the treatment of ROP, but few studies have directly compared them with laser treatments. Objective: To compare intravitreal aflibercept vs laser photocoagulation in infants with ROP requiring treatment. Design, Setting, and Participants: This noninferiority, phase 3, 24-week, randomized clinical trial was conducted in 27 countries (64 hospital sites) throughout Asia, Europe, and South America. Overall, 118 infants (gestational age ≤32 weeks at birth or birth weight ≤1500 g) with ROP severity (zone I stage 1+ [stage 1 plus increased disease activity], zone I stage 2+, zone I stage 3, zone I stage 3+, zone II stage 2+, or zone II stage 3+) requiring treatment or with aggressive posterior ROP in at least 1 eye were enrolled between September 25, 2019, and August 28, 2020 (the last visit occurred on February 12, 2021). Interventions: Infants were randomized 2:1 to receive a 0.4-mg dose of intravitreal aflibercept (n = 75) or laser photocoagulation (n = 43) at baseline. Additional treatment was allowed as prespecified. Main Outcomes and Measures: The primary outcome was the proportion of infants without active ROP and unfavorable structural outcomes 24 weeks after starting treatment (assessed by investigators). The requirement for rescue treatment was considered treatment failure. Intravitreal aflibercept was deemed noninferior if the lower limit of the 1-sided 95% bayesian credible interval for the treatment difference was greater than -5%. Results: Among 118 infants randomized, 113 were treated (mean gestational age, 26.3 [SD, 1.9] weeks; 53 [46.9%] were female; 16.8% had aggressive posterior ROP, 19.5% had zone I ROP, and 63.7% had zone II ROP) and 104 completed the study. Treatment (intravitreal aflibercept: n = 75; laser photocoagulation: n = 38) was mostly bilateral (92.9%), and 82.2% of eyes in the intravitreal aflibercept group received 1 injection per eye. Treatment success was 85.5% with intravitreal aflibercept vs 82.1% with laser photocoagulation (between-group difference, 3.4% [1-sided 95% credible interval, -8.0% to ∞]). Rescue treatment was required in 4.8% (95% CI, 1.9% to 9.6%) of eyes in the intravitreal aflibercept group vs 11.1% (95% CI, 4.9% to 20.7%) of eyes in the laser photocoagulation group. The serious adverse event rates were 13.3% (ocular) and 24.0% (systemic) in the intravitreal aflibercept group compared with 7.9% and 36.8%, respectively, in the laser photocoagulation group. Three deaths, which occurred 4 to 9 weeks after intravitreal aflibercept treatment, were considered unrelated to aflibercept by the investigators. Conclusions and Relevance: Among infants with ROP, intravitreal aflibercept compared with laser photocoagulation did not meet criteria for noninferiority with respect to the primary outcome of the proportion of infants achieving treatment success at week 24. Further data would be required for more definitive conclusions regarding the comparative effects of intravitreal aflibercept and laser photocoagulation in this population. Trial Registration: ClinicalTrials.gov Identifier: NCT04004208.

Optical coherence tomography angiography in healthy children: normative data and age-related changes in microvascular structure of the optic disk and macula.

PURPOSE: To determine normative data and reference ranges according to age groups by measuring the foveal avascular zone (FAZ), superficial capillary plexus vascular density (SCP-VD), deep capillary plexus vascular density (DVP-VD), radial peripapillary capillary plexus vessel density (RPC-VD), and peripapillary retinal nerve fiber layer (ppRNFL) in healthy children and to determine the age and sex-related changes of these values. METHODS: This prospective study included data from 370 eyes of 370 healthy children (202 girls, 168 boys) aged 7-18 years. Participants were divided into four groups according to their age. Optical coherence tomography angiography (OCTA) measurements were taken using AngioVue (Avanti; Optivue). RESULTS: No statistically significant difference was observed in terms of FAZ, SCP-VD, DCP-VD, RPC-VD, and ppRNFL thickness values according to the age groups (except the RPC-VD superior) (p > 0.05 for all). VDs in all deep parafoveal regions in groups 1 and 2 were higher in girls. While FAZ values were higher in girls in all age groups (statistically significant in groups 1, 3, and 4), ad SPD and DPD values were higher in boys in all age groups (statistically significant in group 1 and 2 for SPD, and group 1 and 3 for DPD). CONCLUSIONS: We report normal reference ranges for macula and disk vessel density and ppRNFL parameters in healthy children aged 7-18 years using OCTA. These normative values could be useful in diagnosing retina and optic disk disease early in childhood.

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.

Intraocular pressure in subjects with beta-thalassemia minor / Pressão intraocular em indivíduos com talassemia beta minor

ABSTRACT Purpose: Beta-thalassemia minor, a common hereditary blood disorder in Mediterranean countries such as Turkey, is associated with insulin resistance. Insulin resistance, in turn, can be associated with excessively high intraocular pressure and, therefore, intraocular pressure-induced blindness. This study aimed to investigate the intraocular pressure in subjects with beta-thalassemia minor. Methods: We conducted a cross-sectional study comprising of 203 subjects divided into two groups: beta-thalassemia minor (103) and healthy (100).Hemoglobin electrophoresis was performed and complete blood count, blood pressures, serum fasting glucose and insulin levels were measured. All subjects underwent ophthalmological examinations including intraocular pressure measurements. Results: Intraocular pressure in the subjects with beta-thalassemia minor was significantly lower than that in healthy subjects (p=0.007). Additionally, intraocular pressure was inversely correlated with hemoglobin A2 levels (p=0.001, r=-0.320). Serum insulin and systolic blood pressure were significantly higher in subjects with beta-thalassemia minor (p=0.03, p=0.009, respectively). Conclusion: Subjects with beta-thalassemia minor had lower intraocular pressure than healthy controls, suggesting beta-thalassemia minor may actually protect against high intraocular pressure.

RESUMO Objetivo: Beta-talassemia menor é uma doença hereditária comum no sangue em países mediterrâneos como a Turquia e está associada à resistência à insulina. A resistência à insulina por sua vez, pode estar associada à pressão intraocular excessivamente alta e, portanto à cegueira induzida pela pressão intraocular. Este estudo teve como objetivo investigar a pressão intraocular em indivíduos com beta-talassemia menor. Métodos: Foi realizado um estudo transversal compreendendo 203 indivíduos divididos em 2 grupos: beta-talassemia menor (103) e saudável (100). Eletroforese de hemoglobina foi realizada e hemograma completo, pressão arterial, glicemia em jejum e níveis de insulina medidos. Todos os indivíduos foram submetidos foram submetidos a exames oftalmológicos, incluindo medidas de pressão intraocular. Resultados: A pressão intraocular nos indivíduos com beta-talassemia menor foi significativamente menor do que em indivíduos saudáveis (p=0,007). Além disso, a pressão intraocular foi inversamente correlacionada com os níveis de hemoglobina A2 (p=0,001, r=-0,320). Insulina sérica e pressão arterial sistólica foram significativamente maiores em indivíduos com beta-talassemia menor (p=0,03, p=0,009, respectivamente). Conclusão: Os indivíduos com beta-talassemia menor tiveram pressão intraocular menor do que os controles saudáveis, sugerindo que a beta-talassemia menor pode, na verdade, proteger contra a alta pressão intraocular.

Intraocular pressure in subjects with beta-thalassemia minor.

PURPOSE: Beta-thalassemia minor, a common hereditary blood disorder in Mediterranean countries such as Turkey, is associated with insulin resistance. Insulin resistance, in turn, can be associated with excessively high intraocular pressure and, therefore, intraocular pressure-induced blindness. This study aimed to investigate the intraocular pressure in subjects with beta-thalassemia minor. METHODS: We conducted a cross-sectional study comprising of 203 subjects divided into two groups: beta-thalassemia minor (103) and healthy (100).Hemoglobin electrophoresis was performed and complete blood count, blood pressures, serum fasting glucose and insulin levels were measured. All subjects underwent ophthalmological examinations including intraocular pressure measurements. RESULTS: Intraocular pressure in the subjects with beta-thalassemia minor was significantly lower than that in healthy subjects (p=0.007). Additionally, intraocular pressure was inversely correlated with hemoglobin A2 levels (p=0.001, r=-0.320). Serum insulin and systolic blood pressure were significantly higher in subjects with beta-thalassemia minor (p=0.03, p=0.009, respectively). CONCLUSION: Subjects with beta-thalassemia minor had lower intraocular pressure than healthy controls, suggesting beta-thalassemia minor may actually protect against high intraocular pressure.

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.

A practical and easy surgical technique for recovery of an incarcerated haptic.

PURPOSE: To present a surgical intervention for a posterior haptic trapped between the cartridge and plunger during intraocular lens (IOL) implantation. MATERIALS AND METHODS: Posterior haptic incarceration was detected in 36 cases during implantation of a one-piece foldable IOL during cataract surgery with phacoemulsification. In 11 of the patients (Group 1), recovery was achieved by forcibly pulling out the incarcerated posterior haptic. In 25 cases (Group 2), the haptic was recovered by using an MVR knife to cut the cartridge tip from the bottom up parallel to the trapped haptic. RESULTS: In Group 1, tears were seen on the incarcerated haptic in all cases (100%). In Group 2, the procedure was successful in all 25 cases and there was no accidental cutting of the haptic. In all cases, the surgeries were completed with the recovered IOL in Group 2. CONCLUSIONS: Posterior haptic incarceration in cataract surgery can be solved by the simple and easy method of cutting the cartridge tip from the bottom upwards and releasing the haptic.

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.

Does Fluid Temperature Affect Corneal Endothelium-Descemet Membrane Scroll Formation? An In Vitro Study.

OBJECTIVES: To investigate whether unfolding time of Descemet membrane (DM) graft rolls changes at various fluid temperatures. MATERIALS AND METHODS: The study was prospective, ex vivo, and experimental. The study was conducted at the tertiary center for corneal disease in Adana Numune Training and Research Hospital between June 2014 and June 2015. DMs were divided into 4 categories according to baseline roll tightness and these were distributed among 4 different groups using 4 different balanced salt solution (BSS) temperatures (8, 16, 23, and 36 °C). Sixteen donor corneas were obtained from the hospital eye bank. RESULTS: DM roll formations may vary according to the donor cornea received. Some form tighter rolls while others can form a more open roll. No differences in roll tightness were observed in any of the DM rolls after 5 or 10 minutes in the different BBS temperatures. In all groups, neither tightening nor opening was observed in DM roll formations. CONCLUSION: Different BSS temperatures were found to have no effects on DM unfolding time in this study.

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.