Development of ocular hypertension and persistent glaucoma after intravitreal injection of triamcinolone

M Selim Kocabora, Cemil Yilmazli, Muhittin Taskapili, Gokhan Gulkilik, Sahan DurmazVakif Gureba Education and Research Hospital, Istanbul, TurkeyPurpose: This study evaluates intraocular pressure (IOP) elevation secondary to intravitreal injection of triamcinolone acetonide (IVTA) and discusses its management.Methods: The records of 175 patients who underwent IVTA treatment and regular eye examinations in the period 2003–2006 were reviewed. One hundred and twenty-two of these patients were included in the study, of which 147 eyes that received IVTA (4 mg/0.1 ml) were followed for at least 9 months. Mean IOPs observed after IVTA injection as well as IOP elevations defined as moderate (≥5 mm Hg), important (≥10 mm Hg) and severe (>25 mm Hg) during the follow-up period were evaluated and compared statistically.Results: Overall, the mean IOPs following IVTA injection were statistically significantly higher than the preinjection IOP (15.8 ± 2.6), after the first hour (17.7 ± 2.9), the first week (18.7 ± 4.1), the first month (19.6 ± 6.2), the second month (19.1 ± 6.1), the third month (18.0 ± 4.1), the sixth month (17.3 ± 4.0), and the ninth month (17.0 ± 2.7), but not after the first day (16.3 ± 7.6). Important IOP elevations were observed mostly in the first (17.7%) and second months (10.2%). In 40 (27.7%) eyes, topical antiglaucomatous therapy was needed and 7 later required surgical intervention to lower the IOP. Of the remaining 33 eyes, topical treatment was continued in 14 (9.5%) because of IOPs ≥20 mm Hg.Conclusion: The persistence of IOP elevation beyond the IVTA clearance period and the development of intractable secondary glaucoma requiring surgical intervention substantiate the need for careful consideration of IVTA indication and follow-up.Keywords: intravitreal triamcinolone, intraocular pressure, steroid-induced glaucom

The comparison of multimodal imaging findings of central serous chorioretinopathy patients in regard to the early anatomically treatment response to half-fluence photodynamic therapy: a retrospective case–control study

Abstract Background To compare the multimodal imaging findings of chronic central serous chorioretinopathy (CSC) patients who are good or poor responders to low-fluence photodynamic therapy (PDT). Methods Retrospective, interventional comparative study. The CSC patients who were admitted to our clinic for the first time between January 2013 and December 2015 were included in the study. Patients were treated with PDT only if they did not show any sign of resolution after at least 6 months from the initial signs of the disease. The patients who showed full or partial response to PDT after 3 months of treatment were accepted as good responders, those who did not show any sign of resolution were accepted as poor responders. The optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings were compared between the two groups. Results A total of 101 eyes of 101 patients were included: 76 eyes (75.2%) were considered as good responders and 25 eyes (24.8%) as poor responders. In regards to OCT and FA findings there was not a significant difference between the two groups for all of the evaluated findings (p > 0.05 for all). In regards to ICGA findings, there was a statistically difference in the percentage of intense midphase hypercyanescence (p < 0.0001). Conclusions The multimodal imaging findings of CSC patients were compared in regard to their PDT response. The presence of midphase hypercyanescence in ICGA seemed to be positive predictive factor for the PDT response in CSC patients

ASSOCIATION BETWEEN VISUAL ACUITY LOSS AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PATIENTS WITH LATE SOLAR RETINOPATHY

Purpose: To describe optical coherence tomography findings in patients with late solar retinopathy and their association with visual loss

Increased levels of vascular endothelial growth factor in the aqueous humor of patients with diabetic retinopathy

Purpose: This study aims to investigate the levels of aqueous vascular endothelial growth factor (VEGF) in diabetic patient groups in comparison to normal subjects, and to correlate elevated VEGF with the severity of diabetic retinopathy (DR). Materials and Methods: Aqueous samples were obtained from 78 eyes of 74 patients undergoing intraocular surgery and they were examined by the enzyme-linked immunosorbent assay. Color photographs, optical coherence tomography scans, and fluorescein angiography were used to evaluate patients preoperatively. Results: A strong statistical correlation was found to exist between the level of aqueous VEGF and the severity of DR ( P &lt; 0.001), whereas, the VEGF levels in a control group and a diabetic group without DR were not significantly different ( P = 0.985). Aqueous VEGF levels were significantly elevated in patients with proliferative DR (PDR) as compared to the control group ( P &lt; 0.001), to diabetic patients without retinopathy (NDR) ( P &lt; 0.001), and to diabetic patients with nonproliferative DR (NPDR) ( P &lt; 0.001). The aqueous VEGF levels were significantly higher in patients with active PDR than in those with quiescent PDR ( P = 0.001). On the other hand, a statistically insignificant ( P = 0.065) correlation was found between elevated aqueous VEGF and the presence of macular edema in the NPDR group. Conclusions: VEGF was elevated in the aqueous humor of patients with DR compared to that in normal eyes. The aqueous VEGF level had a strong correlation with the severity of retinopathy along with a statistically insignificant difference in macular edema

Optic Disc Pit with Sectorial Retinitis Pigmentosa

Sectorial retinitis pigmentosa (RP) and optic disc pit (ODP) are rare clinical conditions. We present a 40-year-old woman with a history of mild night blindness and decreased vision in the right eye for about 5 years. Fundus examination revealed retinal pigmentary changes in the superior and inferotemporal sectors covering the macula and reduced arterial calibre and ODP at the temporal edge of the optic disc. In addition, fundus autofluorescence, spectral-domain optical coherence tomography, fluorescein angiography, and multifocal electroretinogram scans confirmed these clinical findings. Visual acuity was decreased due to an atrophic-appearing foveal lesion. No intervention was suggested because of the poor visual potential. To the best of our knowledge, the present study is the first to describe coexistent optic disc pit and sectorial RP in the superior and inferotemporal sectors covering the macula in the same eye with figures

Clinical Performance of Toris K Contact Lens in Patients with Moderate to Advanced Keratoconus: A Real Life Retrospective Analysis

Objectives. To evaluate the visual performance of Toris K soft contact lenses in patients with moderate-to-advanced keratoconus and also to compare the results according to cone types, cone location, and severity of keratoconus. Materials and Methods. Sixty eyes of 40 participants were included in this retrospective study. Uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BCVA), best-contact lens corrected visual acuity (BCLCVA), and comfort rating via visual analogue scales (VAS) were measured. Results. The mean age was 27.3 ± 8.6 years (range: 18 to 54). The mean logMAR UCVA, BCVA, and BCLCVA were 0.85 ± 0.38 (range: 0.30-1.30), 0.47 ± 0.27 (range: 0.10-1.30), and 0.16 ± 0.20 (range: 0-1.00). There were significant increases in visual acuities with contact lenses ( &lt; .05). BCLCVA was significantly better in oval type than globus type ( = .022). UCVA and BCLCVA were significantly better in moderate keratoconus group ( = .015, = .018). The mean line gain in Snellen was 3.6 ± 1.8 lines (range: 0-7 lines). The mean line gain was higher in central cone group than paracentral cone group and oval group than globus group ( = .014, = .045). The mean VAS score was 8.14 ± 1.88 (range: 6-10). Conclusions. Toris K can improve visual acuity of patients with keratoconus. Toris K is successful even in the moderate and advanced form of the disease

Response to: Comment on “The Effects of Hemodialysis on Tear Osmolarity”

WOS: 000382636000001PubMed ID: 27641535We thank Onder Ayyildiz and Gokhan Ozge for their interest and comment on our paper “The Effects of Hemodialysis on Tear Osmolarity” [1, 2]. They thought that detection of TO would be performed at the same time of the day regarding the duration of hemodialysis (HD) which may avoid the bias of the methodology according to the study of Niimi et al. [3]. Niimi et al. have enrolled 38 medically healthy neophytes. Their subjects reported to the CRC an average of 14±2.0 hours (7–17 hours) after awakening for baseline measurements and sleeping at the CRC, thereby allowing for uniform environmental exposure (e.g., humidity and temperature) and timely collection of measurements upon awakening. The physical conditions of our clinic are not suitable for all HD patients to report 7 hours after awakening for baseline measurements and sleeping one day thereby allowing for uniform environmental exposure (e.g., humidity and temperature) and timely collection of measurements upon awakening