Evaluation of tear film layer and meibomian gland morphology in glaucoma patients

Purpose: This study aims to investigate the changes in meibomian gland (MG) morphology and tear film layer in glaucoma patients. Materials and Methods: The study included 88 eyes of 44 glaucoma patients and 166 eyes of 83 healthy subjects. Noncontact meibography and noninvasive tear break-up time (TBUT) tests were performed with the Sirius Scheimpflug camera. Results: The total meiboscore, first and mean noninvasive TBUT, invasive TBUT, and OSDI scores were 3.57 ± 1.57, 9.24 ± 5.86, 10.76 ± 4.81, 7.62 ± 3.04, and 14.11 ± 10.48, respectively, for the glaucoma group and 2.43 ± 1.42, 11.17 ± 5.72, 12.30 ± 4.65, 9.56 ± 3.39, and 8.17 ± 7.17, respectively, for the control group. Conclusion: Morphological changes in the MG, decreases in TBUT tests and increases in OSDI scores were observed in glaucoma patients. The changes in the MG occurring in glaucoma patients may be associated with long-term use of topical antiglaucoma medication

Optical cohorence tomography analysis of hollenhorst plaque

Retinal arter dal tıkanıklığı (RADT) sıklıkla bir emboliden kaynaklanan ani, ağrısız, görme alanı kaybı ile seyreden klinik tablodur. Hollenhorst Plağı (HP) kolesterol embolisinin neden olduğu, parlak sarı refraktil arteriyolar birikimdir. Bu çalışmada kliniğimizde fundus muayene bulguları ile RADT tanısı konulan 60 yaşında erkek hastanın, RADT ve Hollenhorst Plağı ile uyumlu optik koherens tomografi (OKT) bulguları sunulmaktadır

Intraocular pressure assessment in pediatric cases receiving long-term seasonal allergic conjunctivitis treatment

Amaç: Mevsimsel alerjik konjonktivit (MAK) tanısı ile takip ve tedavi edilen pediatrik yaş grubu hastalarda, dönemsel olarak kullanılan ilaçların uzun dönemde göz içi basıncı (GİB) üzerine olan etkisini araştırmak. Gereç ve Yöntemler: Çalışmaya 16 yaş altında, 5 yıl veya daha fazla süredir MAK tedavisi alan 230 olgu (Grup I) ve kontrol grubuna 16 yaş altında sağlıklı 255 olgu (Grup II) dahil edildi. Hastaların GİB ölçümleri non-kontakt tonometri ile yapıldı. Her iki grubun ortalama GİB değerleri istatistiksel olarak kıyaslandı. Bulgular: Çalışmaya alınan olguların yaş ortalaması grup I'de 9.3±2.0, grup II'de 9.1±2.1 bulundu. Grup I'de hastaların MAK nedeni ile tedavi aldıkları süre ortalama 5.3±0.7 yıldı. Grup I'de ortalama GİB sağ gözde 13.7±3.1 mmHg, sol gözde 13.7±2.8 mmHg bulunurken, grup II'de ortalama GİB sağ gözde 13.8±3.1 mmHg, sol gözde 13.9±3.0 mmHg olarak bulundu. İki grubun ortalama GİB değerleri arasında istatistiksel olarak anlamlı fark olmadığı görüldü (P>0.05). Grup I'de 11 hastada (% 4.8) tedavi esnasında kortikosteroid kullanımına bağlı geçici GİB yükselmesi olduğu gözlendi. Bu hastaların tümünde kortikosteroid kesildikten sonra GİB normale döndü. Sonuç: Pediatrik olgularda MAK tanısıyla dönemsel olarak verilen medikal tedavinin uzun dönemde GİB üzerine kalıcı bir etkisinin olmadığı görüldü. Bu hastalarda olası akut GİB yükselmesini fark etmek için yakın takibin önemli olduğunu düşünmekteyiz.Objective: To investigate the effect of seasonal drugs on intraocular pressure (IOP) in the long term in pediatric age group who are followed up and treated with seasonal allergic conjunctivitis (SAC) diagnosis. Materials and Methods: The study included 230 cases under the age of 16 who received SAC treatment for 5 years or more (Group I), and 255 healthy cases under the age of 16 in the control group (Group II). IOP measurements of the patients were made with non-contact tonometry. Mean IOP values of both groups were statistically compared. Results: The mean age of the patients included in the study was 9.3±2.0 in group I and 9.1±2.1 in group II. The mean duration of treatment in SAC patients was 5.3±0.7 years. In group I, the mean IOP was 13.7±3.1 mmHg in the right eye, 13.7±2.8 mmHg in the left eye, while in group II the mean IOP was 13.8±3.1 mmHg in the right eye and 13.9±3.0 mmHg in the left eye. There was no statistically significant difference between the mean IOP values of two groups (P>0.05). Temporary IOP elevation due to corticosteroid treatment was observed in 11 patients (4.8%) in group I. In all these patients, IOP lowered to normal limits after corticosteroid treatment discontinued. Conclusion: It was observed that medical treatment, which is given periodically with the diagnosis of SAC in pediatric cases, does not have a permanent effect on IOP in the long term. We think that close follow-up is important to realize possible acute IOP elevation in these patients

Kronik blefaritli geriatrik hastalarda meibomian bez morfolojisi ve göz yaşı film tabakasının değerlendirilmesi

Introduction: To investigate the changes in meibomian gland morphology and their effects on tear parameters in geriatric patients with chronic blepharitis. Materials and Method: The study included 70 eyes of 35 healthy subjects in the control group and 60 eyes of 30 patients with chronic blepharitis. The patients were requested to complete a symptom questionnaire [Ocular surface disease index] before clinical examination. Non-contact meibography and non-invasive tear break-up time tests were performed with the Sirius Scheimpflug camera. Meibography scoring (Meiboscore) of the upper and lower lids was performed in all patients. Invasive tear break up time was performed 1 min after putting a single drop of fluorescein in all patients. Results: The mean age of the patients was 74.6±7.1 and 73.9±6.3 years in the blepharitis and control groups, respectively (p = 0.669). The total meiboscore, non-invasive first and mean tear break up time, invasive tear break up time, and ocular surface disease index score were 3.6±1.7, 8.0±4.8, 9.7±4.0, 7.1±3.0, and 27.4±11.7, respectively, for the blepharitis group and 3.0±1.4, 10.4±5.7, 11.4±5.0, 8.6±3.1, and 18.0±6.4, respectively for the control group (respectively p = 0.03, 0.01, 0.03, 0.00, 0.00). Conclusion: Chronic blepharitis in patients aged ≥65 years was associated with morphological changes in meibomian gland, decreased tear break up time, and increased ocular surface disease index scores. In these patients, meibomian gland atrophy score is considered as a valuable method consistent with clinical findings.Giriş: Bu çalışmada kronik blefariti olan geriatrik hastalarda meibomian bez morfolojisini ve bunun gözyaşı parametrelerine olan etkisini değerlendirmek amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya 30 kronik blefaritli hastanın 60 gözü ve kontrol grubuna 35 sağlıklı bireyin 70 gözü dahil edildi. Klinik muayene öncesinde tüm hastalardan semptom anketini tamamlaması istendi [Oküler yüzey hastalık indeksi]. Non-kontakt meibografi ve noninvaziv göz yaşı kırılma zamanı ölçümleri Sirius Scheimpflug Camera ile yapıldı. Tüm olgularda her iki gözde alt ve üst kapaklarda meibografi skorlaması (Meiboskor) yapıldı. Tüm olgularda invaziv gözyaşı kırılma zamanı bir damla floresein damlatıldıktan 1 dakika sonra ölçüldü. Bulgular: Çalışmaya alınan olgularda yaş ortalaması blefarit grubunda 74.6±7.1, kontrol grubunda 73.9±6.3 yıldı (p = 0.669). Sırasıyla toplam meiboskor, non-invaziv ilk ve ortalama gözyaşı kırıma zamanı, invaziv gözyaşı kırılma zamanı, oküler yüzey hastalık indeksi skoru blefarit grubunda 3.6±1.7, 8.0±4.8, 9.7±4.0, 7.1±3.0, 27.4±11.7 iken kontrol grubunda 3.0±1.4, 10.4±5.7, 11.4±5.0, 8.6±3.1, 18.0±6.4 bulundu (sırasıyla p = 0.03, 0.01, 0.03, 0.00, 0.00). Sonuç: Altmışbeş yaş ve üzerindeki kronik blefaritli hastalarda meibomian bezlerde morfolojik değişiklikler, azalmış gözyaşı kırılma zamanı ve artmış oküler yüzey hastalık indeksi skorları olduğu görülmektedir. Bu hastalarda, meibomian bez atrofi skorunun klinik bulgularla uyumlu değerli bir yöntem olduğu düşünüldü

Relation between visual acuity, macular retinal thickness, visual field and multifocal electroretinography in patients with retinitis pigmentosa

Purpose: To investigate the correlation between corrected visual acuity (CVA), macular retinal thickness, visual fi eld and multifocal electroretinography (mfERG) responses in patients with retinitis pigmentosa (RP). Materials and Methods: The study included RP patients who were admitted to our clinic between January 2014 and December 2018 and had CVA at least ≥0.05. All patients underwent thorough ophthalmologic examination. Spectral domain (SD) optical coherence tomography (OCT) was performed to assess macular retinal thickness and standard central 30-2 threshold test was used as visual fi eld test. The visual fi eld responses, matching to mfERG, were estimated by calculating average value for 5 concentric rings. Correlation analysis was performed among CVA, macular retinal thickness, visual fi eld and mfERG responses. Results: Forty-four eyes of 22 patients were included in the study. The mean age was 30.6±13.0 (range 17 to 52) years in the study population. The CVA ranged from 0.05 to 1. In our study, there was a positive correlation between CVA, macular retinal thickness (r=0.668, p<0.01), visual fi eld (r=0.578, p<0.01) and mfERG responses for ring 1 (r=0.511, p<0.01). Conclusion: In addition to ophthalmologic examination, visual fi eld, SD-OCT and mfERG are important tests in the follow-up of patients with RP. We think that ophthalmologic examination together with anatomical and functional tests will be useful in the clinical follow-up of these patients

Retina dış kat delikleri

An outer retinal hole is a clinical entity characterized by loss of photoreceptor cells and stretches from the retina pigment epithelium band to the external limiting membrane. It is not a pathognomonic finding and it can be seen with a large group of disordes. The differential diagnosis will play an important role for planning follow-up and treatment. Based on a review of the recent literature, similar optical coherence tomography findings can be seen with many ophthalmological disorders such as solar maculopathy, juxtafoveal macular telangiectasia, tamoxifen retinopathy, Stargardt disease, achromatopsia, foveolar vitreomacular traction and acute retinal pigment epithelitis. In this study we present the clinical findings of our 17 patients with outer retinal holes to introduce these findings and discuss the differential diagnosis

Incomplete treatment response, treatment resistance, pharmaceutical changes and combined treatments in branch retinal vein occlusion and macular edema

Retinal ven dal tıkanıklığı (RVDT) diyabetik retinopatiden sonra en sık görülen retina damar hastalığıdır. Görme kaybı etkilenen venin bulunduğu bölgeye göre değişkendir. RVDT’nda görme kaybının başlıca nedenleri maküla ödemi ve maküler iskemidir. Anti-VEGF ajanlar, RVDT’na bağlı makula ödeminde görme keskinliğinde artış sağlaması nedeniyle tedavide öncelikli tercih edilmektedir. Anti-VEGF tedavi ile erken yanıt alınsa da bazı olgularda maküla ödemi tedaviye dirençlidir. Bu derlemede RVDT ve maküla ödeminde tedaviye yanıtsızlık, tedaviye direnç, ilaç değişimleri ve kombine tedaviler gözden geçirilecektir.Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease after diabetic retinopathy. Vision loss varies depending on the affected area. The main causes of vision loss in BRVO are macular edema and macular ischemia. Anti- VEGF agents are preferred in the treatment of macular edema due to BRVO because of the increase in visual acuity. Although anti-VEGF therapy provides early response, in some cases macular edema is resistant to the treatment. In this review, incomplete treatment response, treatment resistance, pharmaceutical changes and combined treatment are mentioned in cases with BRVO and macular edema

Corticosteroid Treatment in Diabetic Macular Edema

Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature

Longitudinal assessment of meibomian glands and tear film layer in systemic isotretinoin treatment

Purpose: This study aimed to analyze the changes in meibomian glands (MGs) and tear film layer over time in patients taking systemic isotretinoin treatment. Methods: Patients who received systemic isotretinoin treatment between 4 and 8 months were prospectively followed up. In addition to full ophthalmologic examination, MG dysfunction (MGD), noncontact meibography, noninvasive and invasive tear break-up time (TBUT), ocular surface disease index (OSDI), corneal staining, and eyelid margin abnormality scores were recorded before, during, and after treatment. Results: A total of 88 eyes of 88 patients were included in the study. The right eyes of all the patients were included. The mean age of the patients was 21 +/- 2.9 years. Of the 88 patients, 70 (79.6%) were females and 18 (20.4%) were males. Before the treatment, MGD, noncontact meibography, first noninvasive TBUT, mean noninvasive TBUT, invasive TBUT, OSDI, corneal staining, and eyelid margin abnormality scores were 0.29 +/- 0.45, 4.93 +/- 3.50, 13.78 +/- 3.89 s, 14.47 +/- 3.09 s, 12.96 +/- 3.61 s, 0.54 +/- 1.00, 0.04 +/- 0.20, and 0.09 +/- 0.28, respectively. Twelve months after the end of treatment, the scores were 0.97 +/- 0.87 (p < 0.001), 9.62 +/- 3.89 (p < 0.001), 11.24 +/- 3.52 s (p < 0.001), 12.34 +/- 3.02 s (p < 0.001), 11.31 +/- 2.90 s (p < 0.001), 1.90 +/- 2.44 (p < 0.001), 0.20 +/- 0.40 (p < 0.001), and 0.56 +/- 0.49 (p < 0.001), respectively. Conclusion: Systemic isotretinoin treatment causes morphological changes in the MGs. However, this treatment may negatively affect the tear film layer of patients. Some of these changes may persist for a long time even if the treatment is discontinued

Central areolar choroidal dystrophy case

Central areolar choroidal dystrophy is a rarely seen, hereditary retinal disease which primarily affects macula. Here, we aimed to review clinical findings, ophthalmological imaging results and electrodiagnostic test results in a 43-years old man presented with visual impairment to our clinic and diagnosed as central areolar choroidal dystrophy