Retinal ultrastructural, electrophysiological and microvascular morphological outcomes in diabetic macular edema treated with intravitreal Bevacizumab

Purpose: To investigate retinal ultrastructural, electrophysiological, and microvascular morphological changes, as well as correlations between these changes and visual outcome in naïve diabetic macular edema (DME) patients after intravitreal bevacizumab therapy Design: A prospective interventional study Methods: A total of 31 DME patients’ eyes had monthly intravitreal bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and fundus fluorescein angiography, optical coherence tomography (OCT), microperimetry (MP), as well as optical coherence tomography angiography (OCTA) were performed before and after therapy. Patients were then grouped based on BCVA improvement after three consecutive intravitreal injections: group 1- >10 letters, group 2- ≤5 letters, and group 3- between 6 and 10 letters. Results: Mean BCVA increased significantly after therapy, rising from 34.2 to 39.9 letters (p<0.001). The central macular thickness (CMT) decreased significantly from baseline 335.1 μm to 276.4 μm (p<0.001). Fixation stability, mean retinal sensitivity, and mean local deficit all improved significantly after therapy (p<0.001 for all). There was no statistically significant change in IOP before and after therapy (p=0.665). While OCTA parameters did not change significantly, patients with lower foveal avascular zone area, higher FD-300 and deep plexus vascular density showed better improvements in mean BCVA, retinal sensitivity, and local defect. Also, there were no significant intergroup differences in gender, age, baseline BCVA, HbA1c, IOP, phakic/pseudophakic lens ratio, presence of concomitant hypertension, and superficial capillary plexus vascular density. Conclusions: Intravitreal bevacizumab therapy was associated with significantly improved BCVA, retinal ultrastructural integrity, and electrophysiological patterns in naive DME patients. Improvements in retinal electrophysiology correlated with ultrastructural improvements, which could be predicted using OCTA

Retinal ultrastructural, electrophysiological and microvascular morphological outcomes in diabetic macular edema treated with intravitreal Bevacizumab

Purpose: To investigate retinal ultrastructural, electrophysiological, and microvascular morphological changes, as well as correlations between these changes and visual outcome in naïve diabetic macular edema (DME) patients after intravitreal bevacizumab therapy Design: A prospective interventional study Methods: A total of 31 DME patients’ eyes had monthly intravitreal bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and fundus fluorescein angiography, optical coherence tomography (OCT), microperimetry (MP), as well as optical coherence tomography angiography (OCTA) were performed before and after therapy. Patients were then grouped based on BCVA improvement after three consecutive intravitreal injections: group 1- >10 letters, group 2- ≤5 letters, and group 3- between 6 and 10 letters. Results: Mean BCVA increased significantly after therapy, rising from 34.2 to 39.9 letters (p<0.001). The central macular thickness (CMT) decreased significantly from baseline 335.1 μm to 276.4 μm (p<0.001). Fixation stability, mean retinal sensitivity, and mean local deficit all improved significantly after therapy (p<0.001 for all). There was no statistically significant change in IOP before and after therapy (p=0.665). While OCTA parameters did not change significantly, patients with lower foveal avascular zone area, higher FD-300 and deep plexus vascular density showed better improvements in mean BCVA, retinal sensitivity, and local defect. Also, there were no significant intergroup differences in gender, age, baseline BCVA, HbA1c, IOP, phakic/pseudophakic lens ratio, presence of concomitant hypertension, and superficial capillary plexus vascular density. Conclusions: Intravitreal bevacizumab therapy was associated with significantly improved BCVA, retinal ultrastructural integrity, and electrophysiological patterns in naive DME patients. Improvements in retinal electrophysiology correlated with ultrastructural improvements, which could be predicted using OCTA

Audiometric Evaluation of the Relationship between Sensorineural Hearing Loss and Chronic Glaucoma

Objectives:To assess hearing function in chronic glaucoma patients in comparison to healthy individuals.Materials and Methods:This cross-sectional study included 24 primary open-angle glaucoma (POAG) patients (24 ears) and 22 pseudoexfoliative glaucoma (PEG) patients (22 ears) who were followed for at least 5 years in the Afyonkarahisar Health Sciences University Ophthalmology Department, as well as 21 age- and gender-matched healthy individuals (21 ears, control group). Following a thorough ophthalmological examination that included visual acuity and intraocular pressure measurements, as well as anterior and posterior slit-lamp biomicroscopy, audiometry was performed in all participants to determine hearing function.Results:Mean ages in the POAG, PEG, and control groups were 64.50±7, 66.90±4.51, and 64.38±4.36 years, respectively. The mean deviation in standard automated perimetry was -14.47±2.89 in the POAG group and -15.02±2.87 in the PEG group (p=0.306). When compared with the control group, the POAG group had significantly higher hearing thresholds at 500 (p=0.011) and 1,000 Hz (p=0.003), while the PEG group had significantly higher hearing thresholds at 250 (p=0.009), 500 (p=0.009), 1,000 (p=0.001), 2,000 (p=0.005), 4,000 (p=0.001), 8000 (p=0.010), and 10,000 Hz (p=0.009).Conclusion:Both glaucoma and hearing loss are common chronic diseases that have an impact on the well-being of older people. Potential hearing problems in chronic glaucoma patients make routine ocular and otolaryngology examinations in older patients critical for prompt diagnosis and treatment

Effect of Proparacaine 0.375%-Sodium Fluorescein 0.25% Eye Drop Mixture and Fluorescein Strip on Anterior Segment Parameters

Purpose. To determine the effect of proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture and fluorescein strip on anterior segment parameters commonly used in routine ophthalmology practice. Methods. 115 healthy volunteers without any systemic or ocular disease were divided into two groups. 57 volunteers were in the proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture group, and 58 volunteers were in the fluorescein strip group. Measurements (CCT (central corneal thickness), topographic pupil diameter, AD (aqueous depth), ACV (anterior chamber volume), ICA (iridocorneal angle), LLD (limbus-limbus distance), and CV (corneal volume)) were taken before and at 1, 5, 15, and 30 minutes after application. Results. 59 (51.3%) participants were female, and 56 (48.7%) were male. The mean age of the drop application group was 26.88 ± 8.03, and the mean age of the strip application group was 26.33 ± 7.28. The mean CCT was 556 ± 32 μm before drop application and 569 ± 30 μm in the 1st minute, 560 ± 32 μm in the 5th minute, and 559 ± 31 μm in the 15th minute. The change was statistically significant (p<0.001, p=0.005, and p=0.013, resp.). Before the strip application, mean CCT was 552 ± 36 μm, while it increased to 556 ± 36 μm at the 1st minute, and this change was statistically significant (p=0.002). The mean CV before dropping was 59.29 ± 3.53 mm3 and 60.62 ± 3.53 mm3 at the 1st minute and 59.66 ± 3.70 mm3 at the 5th minute, which was statistically significant (p<0.001 and p=0.034). Mean topographic pupil diameters at the 1st, 5th, 15th, and 30th minute after application of drops and strips were not significantly changed compared to the preapplication values in the AD, ACV, ICA, and LLD measurements. Conclusions. Proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture and fluorescein strip application lead to a temporary change in CCT and CV of the anterior segment parameters. Anterior segment measurements with the Scheimpflug camera have to be done before topical fluorescein application

Quality assessment and comparison of two- and three-dimensional YouTube videos as additional educational tools for cataract surgery: “METAVERSE”

© 2022, The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.Background: To compare the content and quality of 3D YouTube videos with 2Ds as additional educational tools for phacoemulsification surgery. Methods: This cross-sectional study included 2D and side-by-side 3D phacoemulsification videos found on YouTube by searching for “phacoemulsification,” “phaco,” and “cataract.” Data was collected on video length (min), time since upload (days), number of views, likes, dislikes, cataract type, chop technique, and visualization system. Video popularity and interaction were calculated by video power index, interaction index, and viewing rate. Two senior ophthalmologists (SOs) and two ophthalmology residents (ORs) evaluated videos using the DISCERN, global quality score (GQS), and usefulness scoring systems. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC). Results: A total of 457 videos were screened, with 85 in 2D and 85 in 3D deemed appropriate for analysis. 2D videos received significantly more views, likes, dislikes, days since upload, video power index, and viewing rate than 3Ds (p < 0.001). Video length and interaction index in 3D videos were significantly greater than in 2Ds (p < 0.001). All video scoring systems revealed that 3D videos outperformed 2Ds in ORs (p < 0.05). ICC confirmed good inter-rater reliability agreement even at the lowest value (SOs: 0.924, 95% CI, 0.910–0.937; ORs: 0.892, 95% CI, 0.878–0.908). Conclusions: 3D YouTube videos as additional educational tools could help not only SOs but also ORs fully comprehend the breadth and depth of ocular surgeries, particularly phacoemulsification, by improving depth perception. They can also be used to review previously learned procedures, observe new ones, and recall old ones

Comparison of anterior segment measurements using Sirius Topographer® and Nidek Axial Length-Scan® with assessing repeatability in patients with cataracts

Purpose: The purpose of this study is to evaluate anterior segment measurements obtained using CSO Sirius Topographer® (CSO, Firenze, Italy) and Nidek Axial Length (AL)-Scan® (Nidek CO., Gamagori, Japan). Methods: A total of 43 eyes of 43 patients were included in this prospective study. The central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white distance (WTW), flat keratometry (K1), steep keratometry (K2), and mean keratometry (K) values were randomly measured three times with each device by the same examiner. The intraclass correlation coefficient of repeatability was analyzed. The compatibility of both devices was evaluated using the 95% limits of the agreement proposed by Bland and Altman. Results: Examiner achieved high repeatability for all parameters on each device except the WTW measured by Sirius. All measurements except WTW and K1 taken with the Sirius were higher than that taken with the Nidek AL-Scan®. The difference in CCT, ACD, and WTW values was statistically significant. Conclusion: High repeatability of the measurements was achieved on both devices. Although Km, K1, and K2 measurements of the Sirius and the AL-Scan® showed good agreement, WTW, CCT, and ACD measurements significantly differed between two devices. Thus, anterior segment measurements except for Km, K1, and K2 cannot be used interchangeably between Sirius and Nidek AL-Scan® devices

Repeatability and reproducibility of automatic segmentation of retinal layers in healthy subjects using Spectralis optical coherence tomography

<div><p>ABSTRACT Purpose: To evaluate the repeatability and reproducibility of automatic segmentation in healthy subjects using a Spectralis optical coherence tomography (OCT) system. Methods: A total of 60 eyes from 60 patients were included in this prospective study. Spectral-domain optical coherence tomography images were generated using the Spectralis OCT system. An automated algorithm was used to segment the macular retina into nine layers and evaluate the thickness of each layer in the foveal, inner, and outer Early Treatment Diabetic Retinopathy Study (ETDRS) subfield rings. The eyes were imaged three times by an examiner to assess intraobserver repeatability and imaged once by a second examiner to assess interobserver reproducibility. The first scan was used for reference, whereas the second and third scans were collected using the device’s follow-up mode. Intraclass correlation coefficients (ICCs) of repeatability and reproducibility were analyzed. Results: The examiners achieved high repeatability and reproducibility for all parameters. Good agreement was found for all parameters in all ETDRS subdivisions with an ICC of >0.96 for all measurements. Conclusion: It is possible to obtain cross-sections from the same location using the device’s follow-up mode, making it virtually impossible to distinguish between repeated measurements taken with the device by different examiners.</p></div