Macular Imaging Characteristics in Children with Myelinated Retinal Nerve Fiber and High Myopia Syndrome

Objectives:To investigate the macular imaging features in patients with unilateral myelinated retinal nerve fiber (MRNF) and high myopia syndrome.Materials and Methods:Six patients with unilateral MRNF and high myopia syndrome and 13 myopic controls were enrolled in this study. Spectral domain (SD) optical coherence tomography (OCT), SD enhanced depth imaging OCT, and OCT angiography (OCTA) imaging results of MRNF-affected eyes were compared with the fellow eyes and myopic controls.Results:All patients had abnormal foveal reflex and/or ectopia. No significant difference in retinal thickness parameters were noted between the groups. In OCT scans, posterior vitreous detachment (PVD) was observed in 4 out of the 6 MRNF-affected eyes. Regarding OCTA parameters, only a significant increase in acircularity index was noted in myelinated eyes (p=0.01).Conclusion:All patients demonstrated normal foveal contours, macular structure, and OCTA features except for a higher acircularity index. The incidence of PVD was notably increased in the myelinated eyes

Pharmacological Approach for Treatment of Retinopathy of Prematurity

Current standard of screening examination for retinopathy of prematurity (ROP) is determined in international guidelines. The criteria for classification and therapy are also determined in international guidelines, and currently, retinal laser fotocoagulation of peripheral avascular retinal area is gold standard (ETROP, Early Treatment for Retinopathy of Prematurity Cooperative Group) for proliferative ROP. Vitreoretinal surgery will be used in cases with retinal detachment. In case series after off-label injection of anti-VEGF (vascular endothelial growth factor) agent bevacizumab and in the first report of BEAT-ROP study in proliferative ROP the results are promising. Furthermore, beside the intravitreal anti-VEGF therapy, systemic therapy with mediators like IGF-1 (insulin-like growth factor) and/or ω3-fatty acids outlines pharmacological approach to treatment of ROP. The results of well-designed clinical trials of intravitreal anti-VEGF therapy and pharmacological systemic therapy with the above-mentioned mediators for ROP are needed in order to provide information as to the balance of risk versus benefit, as well as practical guidance regarding optimal treatment parameters and follow-up.(Turk J Ophthalmol 2012; 42: 466-73

Age-Related Macular Degeneration: Classification and Pathogenesis

Age-related macular degeneration (AMD) was first described in 1885 by Otto Haab as a disease in patients above 50 years of age with progressive retinal pigment epithelial and atrophic degenerations of the macula reducing the central visual acuity. AMD is a neurodegenerative disease and is now the most common cause of registrable blindness in the western world. The prevalence of the disease is given as 10% in 65-75-year-old population and as 25% after 75 of age. AMD is a multi-faceted and complex condition. Although different forms of AMD share some common underlying pathological features and causes, there are unique mechanisms for each form. Effective therapies should be derived from in-depth knowledge about each subtype of AMD and should be tailored to address the specific needs in each disease subtype. (Turk J Ophthalmol 2014; 44: 476-80

Pathophysiology of Retinopathy of Prematurity

Retinopathy of prematurity (ROP), an ocular disease characterized by onset of vascular abnormalities in the developing retina, is the major cause of visual impairment and blindness in premature neonates. ROP is a complex multifactorial disease that occurs with microvascular degeneration followed by neovascularization which passing through different stages can progress to retinal detachment. Currently used ablative therapies like cryocoagulation and laser photocoagulation for proliferative ROP have limitations, and patients can still have long-term complications despite a successful treatment. Based on the knowledge regarding ROP pathophysiology, new treatment modalities are being developed. First results of intravitreal anti-VEGF therapy using bevacizumab are promising. Furthermore, besides intravitreal anti-VEGF therapy, systemic therapy with mediators like insulin-like growth factor (IGF-1) and/or ω3-fatty acids outlines the pharmacological approach to treatment of ROP. One of the most destructive manifestations of ROP is preretinal neovascularization. As we continue to decipher the underlying pathophysiological cellular mechanisms governing proliferative retinopathy, fostering normal retinal revascularization will open new therapeutic possibilities. All efforts should be focused on developing preventive strategies for ROP in order to avoid the need for nondestructive therapy modalities. (Turk J Ophthalmol 2012; 42: Supplement 63-7

Incidence of Type-1 Retinopathy of Prematurity in Premature Babies Born Small for Gestational Age

Purpose: To compare the incidence of type retinopathy of prematurity (ROP) in patients small for gestational age (SGA) and in patients appropriate for gestational age (AGA) in a developing country. Material and Method: We included in this study infants (n=162) with gestational age (GA) ≤34 weeks who were screened for ROP in a neonatal intensive care unit between June 2007 and December 2011 and were followed up until the retina was completely vascularized or ROP was regressed. Type 1 ROP was defined according to the ETROP study. To describe the incidence of type 1 ROP, data were analyzed in two main groups: (A) SGA-group and (B) AGA-group. SGA was defined as birth weight below the 10th percentile for gestational age. GA in weeks, birth weight (BW) in grams (g), ROP at any stage, type 1 ROP, and post menstrual age (PMA) at type 1 ROP were evaluated for the two groups. Retrospective review of records was performed. Results: BW (in mean±SD) was 832.45±131.74 g in group A and 962.97±351.47 g in group B; GA (in mean±SD) was 29.27±2.4 weeks in group A and 27.36±2.8 weeks in group B, with significant difference between the groups (p=0.001 vs. p<0.0001). Overall incidence of any-stage ROP was 41.2% in group A and 45.9% in group B, while type 1 ROP was 17.6% in group A and 15.3% in group B. PMA at type 1 ROP detection was 35±3.6 weeks in group A and 33.83±2.7 weeks in group B, without significant difference (p=0.57 vs. 0.44 vs. 0.23). In group A, the earliest diagnosis of type 1 ROP was 31 weeks PMA, the latest diagnosis was 43 weeks PMA. In group B, the earliest diagnosis of type 1 ROP was 32 weeks PMA, the latest diagnosis was 42 weeks PMA. Discussion: In groups A and B, larger infants may develop type 1 ROP and require treatment. Overall incidence of type 1 ROP in groups A and B is without significant difference. (Turk J Ophthalmol 2013; 43: 340-4

Bilateral Asymmetric Rhegmatogenous Retinal Detachment in a Patient with Stickler Syndrome

Here we present the long-term anatomical and visual outcomes of bilateral asymmetric rhegmatogenous retinal detachment repair in a patient with Stickler syndrome. A 17-year-old girl presented with decreased visual acuity in both eyes for more than one year. Her best-corrected visual acuity (BCVA) was 0.1 in the right eye and 0.05 in the left eye. Slit-lamp anterior segment examination revealed subcapsular cataract in both eyes. Fundus examination showed bilateral rhegmatogenous retinal detachment, chronic retinal detachment accompanied by multiple retinal holes, tears and membranous fibrillary vitreous in the peripheral retina. Grade C2 proliferative vitreoretinopathy was observed in the left eye. Scleral buckling surgery was performed initially for both eyes. After the primary surgical procedure, retinal reattachment was achieved in the right eye and the left eye underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy (PPV), and silicone oil injection. After these surgical procedures retinal reattachment was achieved in the left eye. Silicone oil removal was performed six months after PPV surgery. After surgical treatment, BCVA was 0.6 in the right eye at the end of the 3.5-year follow-up period. After silicone oil removal, BCVA reached 0.2 in the left eye after 36 months of follow-up and retinal reattachment was achieved in both eyes. Scleral buckling surgery and PPV are effective and confidential methods for the treatment of chronic retinal detachment cases in Stickler syndrome

Intravitreal Bevacizumab Injection Therapy in a Case with Choroidal Neovascular Membrane Secondary to Toxoplasmosis Retinochoroiditis

A 57-year-old male patient presenting with visual loss in the left eye was diagnosed as choroidal neovascular membrane secondary to inactive toxoplasmosis retinochoroiditis scar. He underwent intravitreal bevacizumab injection as primary therapy. The choroidal neovascular membrane regressed partially and the initial visual acuity improved from 1/10 to 3/10. Intravitreal bevacizumab injection appears to be effective in the treatment of choroidal neovascular membrane secondary to toxoplasma retinochoroiditis. (Turk J Ophthalmol 2014; 44: 237-9

Comparison of intravitreal bevacizumab and triamcinolone acetonide theraphies for diffuse diabetic macular edema

AIM: To compare therapeutic effects of intravitreal triamcinolone acetonide (IVTA) versus intravitreal bevacizumab (IVB) injections for bilateral diffuse diabetic macular edema (DDME). METHODS: Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 mL IVTA was injected to one eye and 2.5 mg/0.1 mL IVB was injected to the other eye. The effects of injection for diabetic macular edema (DME) were evaluated using best -corrected visual acuity (BCVA), central macular thickness (CMT) by optical coherence tomography (OCT) and intraocular pressure (IOP) by applanation tonometer. Patients underwent eye examinations, including BCVA, CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24wk after injection. During the follow -up, second injections were performed to eyes which have CMT greater than 400 pm at 12wk for salvage therapy. RESULTS: BCVA (logarithm of the minimum angle of resolution) at pre -injection, 1, 4, 8, 12 and 24wk after injection was 0.71 +/- 0.19, 0.62 +/- 0.23, 0.63 +/- 0.12, 0.63 +/- 0.13, 0.63 +/- 0.14 and 0.61 +/- 0.24 in the IVTA group and 0.68 +/- 0.25, 0.61 +/- 0.22, 0.60 +/- 0.24, 0.62 +/- 0.25, 0.65 +/- 0.26 and 0.59 +/- 0.25 in the IVB group, respectively. CMT (mu m) at pre-injection, 1, 4, 8, 12 and 24wk after injection was 544 +/- 125, 383 +/- 96, 335 +/- 87, 323 +/- 87, 333 +/- 92, 335 +/- 61 in the IVTA group and 514 +/- 100, 431 +/- 86, 428 +/- 107, 442 +/- 106, 478 +/- 112, 430 +/- 88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at 12wk, and 38% at 24wk in the IVTA group. Second IVTA injections were performed to the 6 eyes (30%) at 12wk. Reduction ratios of mean CMT were 16% at 1wk, 17% at 4wk, 14% at 8wk, 7% at 12wk, and 16% at 24wk in the IVB group. Second IVB injections were performed to the 15 eyes (75%) at 12wk. CONCLUSION: This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab

The relationship between the degree of cognitive impairment and retinal nerve fiber layer thickness

WOS: 000357043900008PubMed ID: 25575807The goal of the present study is to investigate the relationship between the degree of cognitive impairment and retinal nerve fiber layer (RNFL) thickness which is measured by the optical coherence tomography (OCT). Thirty-five patients with Alzheimer's disease (AD), 35 patients with mild cognitive impairment (MCI), and 35 healthy volunteers, between the ages of 60-87, who were examined in the neurology outpatient clinic among 2012-2013 were prospectively involved in our study. Mini mental state examination (MMSE) test, montreal cognitive assessment (MOCA), and also neuropsychological test batteries were used for the neurocognitive evaluation. RNFL thickness was measured by the OCT technique and the differences among groups were studied. The relationship between RNFL thickness and MMSE scores with demographic characteristics was investigated. RNFL thickness was significantly lower in AD and MCI groups compared with the control group (p 0.05). Significant correlation was found between MMSE scores and the RNFL values (p < 0.05). Significant thinning in RNFL along with age was detected (p < 0.05). In our study, it is thought that retinal nerve fiber degeneration and central nervous system degeneration may be concurrent according to the thinning of RNFL measured by OCT in AD and MCI groups. RNFL measurement may also be useful for early diagnosis and evaluation of the disease progression. Further studies are needed to optimize the utility of this method as an ocular biomarker in AD.Baskent University Research FundBaskent University [KA11/115]This study was funded by Baskent University Research Fund with a project code of KA11/115