Optical coherens tomography angiography findings in adult patients with sickle cell anemia

Introduction: Sickle hemoglobin (HbS) is characterized by a mutation in the beta globin gene, which contains a single nucleotide (GA G à GTG) that replaces glutamine with valine at amino acid position six. These hemoglobins are insoluble at low oxygen concentrations and tend to crystallize. Interactions between sickle red blood cells and vascular endothelium often lead to vaso-occlusion and tissue ischemia. Detecting sickle cell retinopathy in its early stages is important to identify proliferative changes and prevent its long-term consequences, including vitreous hemorrhage, retinal detachment, and vision loss. Optical coherence tomography angiography OCTA is an easy-to-apply imaging method that does not require the use of dyes that accurately show retinal microvascularization. Purpose: It was aimed to measure macular vascular density (VD) and foveal avascular zone (FAZ) in patients with sickle cell anemia by OCTA and to compare with healthy controls. Methods: Eighteen right eyes (group 1) of 18 adult patients with sickle cell anemia followed in the hematology clinic of Dicle University, and 25 right eyes of 25 age- and sex-matched healthy individuals (group 2) were included in the study. Those with systemic diseases other than sickle cell disease, eye diseases such as retinal vascular disease, maculopathy, glaucoma, and those with high refractive errors were excluded from the study. Macular superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density (VD) and FAZ measurements were made with OCTA (RTVue-XR Avanti; Optovue Inc., Fremont, CA, USA). Patients with normal fundus examination and no other systemic disease were included in the study. Vascular density measurements were made in the macula with a 3x3 mm scanning mode. Vascular density in superficial and deep capillary plexus was compared in 8 sectors; as the whole image, parafovea, superior hemi, inferior hemi, temporal, superior, nasal and inferior. Image quality below 8/10 were excluded from the study. Results: The mean age of group 1 was 24.73±6.60, group 2 was 23.70±3.19 (p=0.572). The female/male ratio was 10/8 in group 1 and 12/13 in group 2 (p=0.500). In patients with sickle cell anemia, there was a significant lower VD in DCP in all sectors compared to the control group (p<0.001) (Figure 1). There was a significant lower VD in the superficial capillary plexus only in the temporal region in group 1 compared to group 2 (p=0.015). Superficial FAZ was found to be statistically significantly larger in group 1 than group 2 (p=0.001). Deep FAZ width was found to be similar in both groups (p=0.145) Conclusion: Sickle cell anemia causes a significant decrease in vascular density in the deep capillary plexus. Knowing exactly the status of retinal vascular density and FAZ in sickle cell anemia will guide the pathophysiology of retinopathy and will help prevent retinopathy at an early stage

Comparison of Clear Corneal Incision Morphology Changes in Biaxial Microincision Cataract Surgery by Transverse and Torsional Phacoemulsification: Cohort Study

Objective: To compare the effects of transverse versus torsional phacoemulsification by using the biaxial microincision cata ract surgery technique on corneal structures and clear corneal incision (CCI) morphology. Material and Methods: We evaluated comparative case series of patients with moderate density nuclear cataracts who un derwent biaxial microincision transverse or torsional phacoemulsifica tion. Seventy patients have included in the study and they were divided into 2 groups: transverse and torsional. The main outcome measures included, corrected distance visual acuity, central corneal thickness, central corneal endothelial cell density, endothelial cell loss (ECL), and changes in the CCI morphology. Results: Each group comprised 35 (35 eyes) patients. Epithelial misalignment on the CCI morphology was highly significantly meaningful with the transverse group on the po stoperative first day (p<0.001). Descemet membrane detachment on the first day postoperatively was high in both groups, especially in the transverse group, but the difference was not statistically significant (p=0.073). In the postoperative 3rd month, the mean ECL was 23.6% in the transverse group, and 19.0% in the torsional group, and there was no statistically significant difference between groups (p=0.187). Con clusion: In biaxial microincision cataract surgery, the corneal damage caused by transverse phacoemulsification seems to be higher compared to the torsional mode

Evaluation of Retinopathy Severity According to the Premature Stage in Premature Retinopathy

INTRODUCTION: The aim of this study is to analyze the relationship between the stage of prematurity and retinopathy severity by analyzing the results of premature retinopathy (PR) screening. METHODS: In state Hospital 862 eyes of 431 cases who were admitted between June 2017 and September 2018 were evaluated retrospectively. Cases were classified according to gestational ages and birth weights. The cases were divided into advanced, intermediate and late premature. The relationship between the severity of retinopathy and the degree of premature and multiple births was evaluated RESULTS: Two hundred thirty four (54.3%) of the cases were female and 197 (45.7%) were male. Birth weeks were 23 to 36 weeks (31.9 +- 2.77), and birth weights were 510-3500 gr (1746 +- 476). PR was detected in 137 (31.8%) of the cases at any stage, and no sign of PR was found in 294 (68.2%) cases. Stage 1 PR was detected in 80 cases (58.4%), stage 2 PR in 42 cases (30.7%), stage 3 PR in 13 cases (9.5%), and stage 4 PR in 2 cases (1.5%). The mean birth weight and gestational week were statistically significantly lower in patients with PR at any stage (p &lt;0.05). Stage 3 and Stage 4 PR were detected in 6 (%4,32) cases with a gestational age of &gt;32 weeks. No significant relationship was found between multiple births and PR. (P = 0.908) DISCUSSION AND CONCLUSION: It should always be considered that there may be advanced stage PR in moderate and late premature

Hematopoietic stem cell transplantation and high dose chemotherapy in recurrent and/or chemotherapy resistant hodgkin lymphoma cases: A single center experience

Giriş: Standart tedavi alan Hodgkin Lymphoma (HL) hastalarının yaklaşık %20’sinde hastalık dirençli seyredebilir veya tekrar edebilir. Tekrar eden/ dirençli HL’da standart tedavi yüksek doz kemoterapi ve takip eden otolog kök hücre naklidir (OKHN). Otolog KHN sonrası tekrar eden hastalarda ise allojeneik kök hücre nakli (AKHN) önemli bir kurtarma tedavisi olarak görülmektedir. Amaç: Medipol Üniversitesi Tıp Fakültesi çocuk kemik iliği nakil ünitesinde OKHN ve AKHN yapılan hastalarda sonuçları değerlendirmek. Yöntem: Tekrar eden/dirençli HL nedeniyle 2014 Kasım ile Temmuz 2019 tarihleri arasında merkezimizde OKHN yapılan 18 olgu retrospektif olarak değerlendirilmiştir. Otolog KHN sonrası hastalığı tekrar eden ve AKHN yapılan hastalarda ayrıca değerlendirilmiştir. Bulgular: Onaltı hasta halen hayattadır. Onbir hastada OKHN sonrası has talık tekrar etmiştir. Relaps eden hastalardan 10’una AKHN yapılmıştır. Bu hastalardan üçünde tekrar görülmüş olup, sekizi nakil sonrası hayattadır lar.Background: Nearly 20% of patients with Hodgkin Lymphoma (HL) who receive standard treatment will relapse or have a refractory disease. Standard treatment for the Relapsed/Refractory (RR) HL is salvage high dose chemotherapy followed by autologous stem cell transplantation (AuSCT). Management of RR HL after AuSCT with allogeneic stem cell transplantation (ASCT) is also considered as an important salvage therapy. Objective: To describe the outcome in pediatric patients with RR HL who underwent AuHSCT and ASCT in Medipol University hematopoietic stem cell transplantation center. Method: We retrospectively evaluated 18 pediatric patients with RR HL who underwent AHSCT between November 2014 and July 2019. The evaluation of ASCT after RR HL AuSCT is also done. Results: Sixteen patients are still alive. Eleven of them relapsed after AuHSCT. AllogeneicHSCT was performed on 10 patients who relapsed. Relapse was seen in three patients after AHSCT. Eight of them are still alive

Ocular surface epithelial thickness changes with SD-OCT in patients treated with oral isotretinoin

AIM: To use in vivo spectral-domain optical coherence tomography(SD-OCT)to investigate ocular surface epithelial thickness changes in patients treated with oral isotretinoin.METHODS: A total of 64 eyes of 64 acne vulgaris patients were enrolled into two group: thirty-two patients received 0.5 mg/kg isotretinoin daily(Group A), and the other 32 patients received 0.8 mg/kg daily(Group B). The central corneal thickness(CCT), central corneal epithelium thickness(CCET), central corneal epithelium basal membrane thickness(CCEBMT), non-epithelial central corneal thickness(NECCT)and bulbar conjunctival epithelium thickness(BCET)were evaluated using SD-OCT at baseline, at the 45th day, at the fourth month of treatment and at the first month after the end of treatment. RESULTS: There were 44 females(68.75%)and 20 males(31.25%)with a mean age of 21.68±3.75y. In both groups, CCET, CCT and BCET were significantly thinner at the 45th day, at the fourth month of the treatment and at the first month after the end of treatment as compared with baseline. CCEBMT decreased significantly at the 45th day and at the fourth month of treatment, but there was no difference between the baseline and the last visit. There were no significant difference in NECCT during and after treatment as compared with the baseline.CONCLUSION:Ocular surface epithelial thickness decreased in patients treated with oral isotretinoin, whereas NECCT was not affected. The decreasing corneal thickness in patients treated with isotretinon is mainly due to epithelial thinning. After a one-month cessation of isotretinoin treatment, CCEBMT returned to the baseline value, and ocular surface epithelial thickness increased

Intravitreal Ranibizumab Therapy in Wet Type Macular Degeneration

Objectives: To evaluate the efficacy and safety of intravitreal ranibizumab treatment in all types of choroidal neovascularization that developed secondary to age-related macular degeneration. Materials and Methods: We enrolled ninety-four eyes of 92 patients with previously untreated neovascular age-related macular degeneration who underwent intravitreal ranibizumab injection and were followed for at least 12 months. All of the patients underwent a complete examination, including best-corrected visual acuity (BCVA) (Snellen), biomicroscopy, and dilated fundus examination at preoperatively and postoperative follow-up visits. Number of injections and frequency of follow-up visits per year were evaluated. Size, location, and type of the lesions were evaluated by fluorescein angiography (FA). Pre- and postoperative changes in lesion size, central macular and foveal thickness measured by OCT were compared. Results: A total of 92 patients (36 women and 56 men) with a mean age of 69.1±11.0 years were evaluated. Mean follow-up time was 14.6±3.44 (12-25) months, and mean number of injections was 4.9±1.81 (3-12). The average annual number of follow-up visits was 9.2±1.02 (8-12). Patients’ mean best-corrected visual acuity increased by 12.1 letters. The lesion size was 3.27±0.95 µm at pre-treatment period and improved to 2.72±1.15 µm in post-treatment period measured by FA (p=0.006). Leakage was still detected in ten patients at final follow-up visit. Statistically significant decrease in macular and foveal thickness was recorded in all post-treatment measurements compared to pre-treatment ones. Conclusion: Intravitreal ranibizumab treatment is efficient and safe in all types of choroidal neovascularization that develops secondary to age-related macular degeneration. Flexible dosing interval increases the patient compliance and anatomical and functional success rate. (Turk J Ophthalmol 2014; 44: 356-60

Evaluation of parafoveal and peripapillary vascular densities using optical coherence tomography angiography in children with thalassemia major

Background: Thalassemia major (TM) is an inherited anaemia caused by faulty haemoglobin synthesis. Reducing serum iron levels using iron chelating agents is an important step in the treatment of TM, and the effects on the eye of both the disease and these agents can be determined by regular eye examination. Objectives: We evaluated macular and optic nerve vascular densities in children with TM and compared the results with healthy controls using optical coherence tomography angiography (OCTA). Design: This is a prospective study. Methods: A total of 30 children with TM and 30 healthy controls were included in the study. The area of the foveal avascular zone (FAZ) and the vascular densities (VD) of the optic nerve head (ONH), radial peripapillary capillary (RPC) and deep and superficial retinal vascular networks were measured using OCTA. Results: A statistically significant decrease in VD was observed in the whole image and the parafovea, superior hemi, superior and inferior parts of the superficial capillary plexus and in the whole image and the superior regions of the deep capillary plexus in the TM patient group compared with the control group ( p  < 0.05). A significant decrease in VD was also observed in the whole image and the inside disc, peripapillary, nasal, inferonasal and temporal regions of the ONH and in the whole image and the inside disc, peripapillary and inferonasal regions of the RPC network in patients with TM ( p  < 0.05). A significant positive correlation was observed between both serum ferritin levels and deferasirox dosage, on one hand, and both the superficial ( p  = 0.023 and p  = 0.002, respectively) and deep FAZs ( p  = 0.015 and p  = 0.045, respectively), on the other hand. A negative correlation was also found between the deferasirox dosage and the VDs of the superficial ( p  = 0.010) and deep ( p  = 0.001) foveal plexuses. Conclusion: Retinal VD and FAZ are affected in patients with TM. OCTA, which can noninvasively measure retinal VD in patients with TM, may be a useful tool for the early detection of retinal microvascular changes that may occur during the course of the disease

Apelin-13: A Promising Biomarker for Age-Related Macular Degeneration?

Purpose: To investigate the value of serum apelin-13 levels in patients with age-related macular degeneration (AMD). Methods: Patients with dry-type AMD, patients with treatment-naive neovascular-type AMD, and healthy controls were included in this study. Diagnoses were confirmed on detailed fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Central foveal thickness and subfoveal choroidal thickness were evaluated. Both serum apelin-13 and vascular endothelial growth factor (VEGF) levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) principle. Results: A total of 84 subjects, i.e., 24 in the dry-type AMD group (group 1), 27 in the neovascular-type AMD group (group 2), and 33 in the control group (group 3) were included in the study. Mean best-corrected visual acuity (BCVA) was 76 +/- 4.5, 48.4 +/- 16.3, and 83.4 +/- 3.09 ETDRS letters in group 1, 2, and 3, respectively. The level of serum VEGF was 44.11 +/- 26.14, 56.53 +/- 53.77, and 61.47 +/- 41.62 pg/mL in groups 1, 2, and 3, respectively (p = 0.553, p = 0.286, and p = 0.896, respectively). The level of serum apelin-13 was 586.47 +/- 167.56, 622.18 +/- 324.52, and 379.31 +/- 171.96 pg/mL in groups 1, 2, and 3, respectively (p = 0.847, p = 0.04, and p <= 0.001, respectively). There was a negative correlation between the level of serum apelin and visual acuity (VA) and choroidal thickness. Conclusion: Serum apelin-13 levels were higher in both dry-type and neovascular-type AMD patients than in controls. Further studies demonstrating the relationship of the level of serum apelin-13 and AMD are needed

Quality of life assessment after pediatric hematopoietic stem cell transplantation

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