Choroidal Neovascularization Associated with Best Vitelliform Macular Dystrophy.

Objectives: The aim of the study was to evaluate the clinical and optical coherence tomography (OCT) findings of patients with choroidal neovascularization (CNV) due to best vitelliform macular dystrophy (BVMD). Methods: Six eyes that were diagnosed with CNV associated with BVMD were evaluated retrospectively. A standard ophthalmologic examination, a fundus fluorescein angiography (FA), and the OCT findings of the patients were examined. Anatomical and functional changes seen after treatment were evaluated. Results: One (16%) of the cases was female and five (83%) were male. The mean age was calculated as 36.3±24.9 years (range 11-73 years). The mean follow-up period of the cases after detecting CNV was determined as 26 months (range 6-168 months). Best corrected visual acuities were 0.65±0.39 logMAR (1.0-0.2 logMAR) when CNV was detected and 0.42±0.25 logMAR (limits 0.7-0.2 logMAR) at the end of the follow-up. Photodynamic therapy was applied to one (17%) of the cases, and intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment was applied to the others (83%). The mean number of intravitreal injections was found to be 3±1.37 (range 2-4).In all cases, intraretinal fluid (IRF), subretinal fluid (SRF), external limiting membrane, and irregularities in inner retinal layers were observed in the initial OCT examinations. In all cases, it was observed that the IRF regressed with treatment and SRF continued in five eyes. Hypertrophic outer retinal scarring developed in all cases. Conclusion: In cases with CNV due to BVMD, regression in CNV activity was achieved with intravitreal anti-VEGF injection treatment. The IRF is a marker that can be used both in the diagnosis and treatment monitoring of CNV associated with BVMD.

Vitreoretinal interface anomalies in patients with a history of toxoplasmosis retinochoroiditis.

PURPOSE: To evaluate vitreoretinal interface anomalies over time in patients diagnosed with toxoplasmosis retinochoroiditis (TRC) and progression of the chronic disease. STUDY DESIGN: Retrospective clinical study. METHODS: The clinical records of 36 patients with TRC were studied retrospectively. All patients underwent standard ophthalmological examinations and optical coherence tomography (optical coherence tomography: OCT). Vitreoretinal interface changes and retinal layers in the macula and lesion area were evaluated. RESULTS: The fovea was involved in 9 (25%) patients. OCT of the scar region showed retinal layer thinning and disorganization in all cases. Complete posterior vitreous detachment (PVD) was detected in 9 (25%) cases, incomplete PVD in 22 (61%) cases and no PVD in 5 (13.8%) cases. In 23 (63%) of the 36 patients with inactive TRC lesions, an epiretinal membrane (ERM) was detected by follow-up OCT, i.e., in 14 (60%) patients with incomplete PVD, 8 (34.7%) with complete PVD, and 1 (4%) with no PVD. Vitreoschisis was found in 5 of 22 patients with incomplete PVD; an ERM developed in 4 of these 5 patients. No ERM developed only in the macula, i.e., independent of the TRC scar region. CONCLUSIONS: Vitreoretinal interface anomalies are common in patients diagnosed with TRC, including those with incomplete PVD. We observed no progression of vitreoretinal interface anomalies during the follow-up of patients diagnosed with TRC.

Is pseudoexfoliation syndrome associated with vitreoretinal interface abnormalities?

BACKGROUND: To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. METHODS: This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. RESULTS: The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. CONCLUSIONS: We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.

Optical coherence tomography findings in toxoplasma retinochoroiditis.

Purpose: This study aimed to evaluate the optic coherence tomography (OCT) findings in patients with toxoplasmic retinochoroiditis (TRC). Methods: A total of 12 eyes of 12 patients with active TRC were included in the study. At baseline, at the first-month follow-up, at the sixth-month follow-up and at the 1-year follow-up, the TRC lesion OCT and macula OCT were evaluated. Results: Hyperreflectivity of the inner retinal layers and an increase in retinal thickness were observed on the OCT examinations of all the patients with an active TRC lesion. The retinal thickness decreased and the reflectivity of retinal layers was disorganized in the OCT images obtained in the follow-up period. Partial posterior hyaloid detachment (PHD) and no PHD were detected in 11 cases and 1 case, respectively. Epiretinal membrane (ERM) had developed in the adjacent region of the scar in 7 patients. With the regression of the lesion, the disruption of the ellipsoid zone (EZ), retinal pigment epithelium (RPE) and external limiting membrane (ELM) improved in the adjacent areas. In all the eyes, ERM and the PHD configuration did progress during the follow-up period. Vitreoschisis was found in 4 of the 11 patients with partial PHD. It was observed that ERM developed in all the patients with vitreoschisis. Conclusion: ERM and partial PHD were common in the TRC patients, and there was no progression during the follow-up period. Regeneration of the EZ, RPE and ELM was observed in the follow-up period.

Amycolatopsis sulphurea as the first reported agent of endophthalmitis in a patient after penetrating eye trauma with intraocular foreign body: A case report.

We report an Amycolatopsis sulphurea endophthalmitis after the surgical repair of penetrating eye trauma with a metallic intraocular foreign body. A 27-year-old male referred with occupational injury by a nail from his left eye. Endophthalmitis occurred 12 h after the removal of foreign body and repair of the globe. The culture of vitreus samples revealed gram-positive bacillus proliferation, confirming A. sulphurea. Endophthalmitis was eradicated successfully with intravitreal, topical, and systemic antibiotics. To the best of our knowledge, this is the first case, reporting A. sulphurea endophthalmitis.

THICKNESSES OF SCLERA AND LAMINA CRIBROSA IN PATIENTS WITH CENTRAL RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate thicknesses of sclera and lamina cribrosa (LC) in central retinal vein occlusion (CRVO). METHOD: Thirty-two patients with CRVO (mean age 62.2 ± 11.6 years, women/men 18/14) and 35 age- and sex-matched healthy volunteers were included into the study. Scleral thickness was measured at scleral spur and at 1 to 3 mm from scleral spur in four quadrants (temporal, nasal, super, and inferior) using anterior segment optical coherence tomography. Lamina cribrosa was measured using optic disk enhanced depth imaging optical coherence tomography. RESULTS: The sclera was thicker in affected eyes of the CRVO group than healthy subjects at scleral spur in four quadrants (738.7 ± 30.9 µm vs. 702 ± 30.8 µm in temporal, 700.4 ± 19.7 µm vs. 673 ± 13.7 µm in superior, 693 ± 19.3 µm vs. 665.3 ± 24.2 µm in nasal, 810.7 ± 28.9 µm vs. 784.5 ± 23.7 µm in inferior quadrants, respectively; P < 0.05 for all). Lamina cribrosa thickness in affected eyes of the CRVO group was significantly higher than that of healthy subjects (285.2 ± 12.7 µm vs. 266.4 ± 10.7 µm, respectively; P < 0.01). The correlation between scleral thickness and LC thickness was moderate at scleral spur of temporal and superior quadrants of affected eyes (r = 0.510 and r = 0.420, respectively). CONCLUSION: Thicknesses of sclera and LC are increased in the CRVO, which may play a role in the pathogenesis of the disease.

Increased Subfoveal Choroidal Thickness and Retinal Structure Changes on Optical Coherence Tomography in Pediatric Alport Syndrome Patients.

OBJECTIVE: To evaluate optical coherence tomography (OCT) findings of pediatric Alport syndrome (AS) patients with no retinal pathology on fundus examination. MATERIALS AND METHODS: Twenty-one patients being followed up with the diagnosis of AS (Group 1) and 24 age- and sex-matched healthy volunteers (Group 2) were prospectively evaluated. All participants underwent standard ophthalmologic examination, retinal nerve fibre layer (RNFL) analysis, and horizontal and vertical scan macula enhanced depth imaging OCT (EDI-OCT). Statistical analysis of the data obtained in this study was performed with SPSS 15.0. RESULTS: Macula thickness was significantly decreased in the temporal quadrant in Group 1 compared to those of the control group (p=0.013). RNFL measurements revealed statistically significant thinning in the temporal, superior, inferotemporal, and inferonasal quadrants and in average thicknesses in cases with AS compared to the controls (p < 0.001, p < 0.001, p=0.022, p=0.016, p < 0.001, respectively). The mean subfoveal coronial thickness (SCT) was 362.2 ± 77.8 µm in Group 1 and 256,18 ± 71.7 µm in Group 2. There was a statistically significant difference between the two groups in terms of mean CT (p < 0.001). CONCLUSION: OCT provides valuable information in identifying the structural changes and evaluation of ocular findings in patients with AS. Even if no pathological retinal findings were found in the clinical examination, structural changes in the OCT examination begin in early period of AS.

Intravitreal Dexamethasone Implant for Postvitrectomy Macular Edema: A Retrospective Cohort of Patients with Postvitrectomy Macular Edema Treatment.

PURPOSE: To evaluate the clinical findings and the efficacy of dexamethasone intravitreal implant in patients with postvitrectomy macular edema. METHODS: The records of 14 patients diagnosed with postvitrectomy macular edema unresponsive to first-line treatment, treated with intravitreal dexamethazone implant injection and followed at least 6 months between October 2011 and May 2016 were retrospectively reviewed. All patients underwent standard ophtalmological examination, fluorescein angiography, and optical coherence tomography. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressures (IOPs) were recorded at baseline, at first and sixth months after the injection. RESULTS: The mean BCVA, which was 0.2 ± 0.14 logMAR at baseline significantly increased to 0.44 ± 0.2 logMAR at first month (P = 0.05) and to 0.4 ± 0.22 logMAR at sixth month of intravitreal dexamethazone implant injection (P = 0.01). CMT was also significantly decreased to 368.3 ± 90.4 µm at first month and to 323 ± 84.6 µm at sixth month from pre-injection value of 520.7 ± 90.3 µm (P = 0.001 and P = 0.002, respectively). IOP significantly increased from was 15 ± 2.1 mmHg at baseline to 20.6 ± 5.4 mmHg at first month of intravitreal dexamethazone implant injection (P = 0.01). CONCLUSION: Dexamethazone implant treatment may reduce CMT and improve BCVA in cases with postvitrectomy macular edema. IOP should be regularly screened in these cases.

Cilioretinal artery occlusion and anterior ischemic optic neuropathy as the initial presentation in a child female carrier of Fabry disease.

PURPOSE: To report the youngest female carrier of Fabry disease, complicated by cilioretinal artery occlusion and anterior ischemic optic neuropathy (AION). METHODS: Case report. RESULTS: An 11-year-old girl was referred to our clinic with painless, acute loss of vision in her right eye. Posterior segment examination and fluorescein angiography revealed cilioretinal artery occlusion and AION. Systemic evaluations were unremarkable, except for a low blood α-galactosidase A enzyme level of 242.27 pmol/spot*20 h (reference range: 450-2000 pmol/spot*20 h). The patient was diagnosed with female carrier of Fabry disease. CONCLUSION: Retinal vascular occlusions are rare in childhood, and Fabry disease may present with retinal vascular occlusion. Ophthalmological examinations may be contributing for early detection of the disease. To the best of our knowledge, this is the first report of a child female carrier of Fabry disease, complicated by cilioretinal artery occlusion and AION.

MR Imaging of the Anterior Visual Pathway in Primary Open-Angle Glaucoma: Correlation with Octopus 101 Perimetry and Spectralis Optical Coherence Tomography Findings.

PURPOSE: To investigate structural changes in the visual pathway measured by magnetic resonance imaging (MRI) and its relationship with the clinical severity of glaucoma in primary open-angle glaucoma (POAG) patients. MATERIALS AND METHODS: The study included 28 patients with POAG and 26 age- and sex-matched healthy volunteers. All the subjects underwent spectral domain optical coherence tomography (OCT) of the peripapillary retina nerve fiber layer (RNFL). The optic nerve diameter (OND), chiasma height (Ch), and lateral geniculate nucleus height (LGNh) were measured bilaterally using a 1.5-Tesla MRI system. RESULTS: The mean values of the OND and LGNh were significantly lower in the POAG group (OND: right p = 0.043 and left p = 0.048; LGNh: right p = 0.008 and left p = 0.025). The OND was not correlated with the clinical stage of glaucoma, but it was correlated with the ipsilateral RNFL thickness. The Ch was correlated with the ipsilateral clinical stage (right r = -0.536, p = 0.004; left r = -0.537, p = 0.004) and average RNFL thickness (RNFLav) (right r = 0.655, p < 0.001; left r = 0.626, p < 0.001). The sum of bilateral clinical stages and left clinical stages showed significant correlations with the right and left LGNh and the sum of both the right and left LGNh. The left RNFLav and the sum of the right-left RNFLav were significantly correlated with all LGNh measurements. CONCLUSIONS: 1.5-Tesla MRI can detect structural changes in the visual pathway early in the course of glaucoma. Thin optic nerve can be a risk factor for glaucoma. The Ch and LGNh seem to be correlated with the clinical stage of glaucoma and RNFL thickness. In particular, LGN can be a target of glaucomatous damage.

Anterior Segment Findings in Women with Polycystic Ovary Syndrome.

OBJECTIVES: This study aimed to investigate the anterior segment in women with polycystic ovary syndrome (PCOS) and to compare them with those of healthy reproductive-age female volunteers. MATERIALS AND METHODS: The study included 50 right eyes of 50 women with PCOS (group 1) and 50 right eyes of 50 healthy women (group 2). Intraocular pressure, Schirmer's test, tear film break-up time and central corneal thickness were evaluated in all subjects. Correlations between serum hormone (estradiol and testosterone) levels and observed findings were also investigated. RESULTS: Mean central corneal thickness values were significantly higher in the PCOS group (p=0.001). The mean intraocular pressures values were similar between the two groups (p=0.560). Schirmer's test results and tear film break-up time values were significantly lower in the PCOS group (p=0.001 and p=0.001 respectively). Serum estradiol levels were moderately positively correlated with mean central corneal thickness (r=0.552), weakly positively correlated with intraocular pressure (r=0.351) and weakly negatively correlated with tear film break-up time (r=-0.393). Serum free testosterone levels were weakly correlated with intraocular pressure (r=0.342) and central corneal thickness (r=0.303), and showed weak negative correlations with Schirmer's test results (r=-0.562) and tear film break-up time (r=-0.502). CONCLUSION: PCOS leads to physiological and structural changes in the eye. Dry eye symptoms were more severe and central corneal thickness measurements were greater in patients with PCOS. Those are correlated serum testosterone and estradiol levels.

Optic nerve and dura mater involvement as the first sign of multiple myeloma.

PURPOSE: To report a case of optic nerve and dura mater involvement as the first sign of multiple myeloma. METHODS: Case report. RESULTS: A 43-year-old woman presented with a headache and decreased vision in both eyes. Ophthalmic examination revealed anterior uveitis and subretinal mass around the optic nerves with accompanying disc edema bilaterally. Magnetic resonance imaging showed dural and optic nerve infiltration with tram-track enhancement in the optic nerve sheath. The diagnosis of multiple myeloma was made as a result of systemic investigations. The patient underwent systemic chemotherapy and cranial radiotherapy. After treatment, the patient's headache disappeared, the papilledema regressed, and the ocular findings improved but complete recovery could not be achieved because of fibrous subretinal tissue and degenerative changes of the optic nerve. CONCLUSIONS: Neurologic and ophthalmic involvement in multiple myeloma may appear as the first manifestation of disease. The correct diagnosis is important because it can be life-saving.