Satisfaction and attitude of bipolar patients regarding electroconvulsive therapy: Modified or unmodified

Objective: Ministry of Health of Turkey issued a legislation to use only modified electroconvulsivetherapy (ECT) in 2005, and this study aimed to assess satisfaction and attitude of bipolar patientsregarding modified and unmodified electroconvulsive therapy.Methods: A total of 100 patients (50 treated with modified electroconvulsive therapy (M-ECT) and 50treated with unmodified ECT (UM-ECT) with a diagnosis of Bipolar Disorder (depressive or manic episode)were invited to participate in this study. Patients with euthymic mood were included.Satisfaction and attitude towards ECT were evaluated with a structured attitude questionnaire, and MECTand UM-ECT patients, and their subgroups (depressive vs. manic) were compared.Results: No significant differences were found between M-ECT and UM-ECT groups regarding age, sex,marital status and occupation. The majority of all patients (78%) were satisfied from treatment withECT and with the outcome (88%), without significant differences between modified and unmodifiedgroups. Forgetfulness (70%) and headaches (57%) occurred in all groups, with the only significant differencein forgetfulness being reported by more manic patients treated with UM-ECT. Depressive andmanic patients treated with UM-ECT reported concerns of brain damage and physical harm significantlymore frequently. While 86% of patients treated with M-ECT consented to a future treatment,this was significantly less in patients treated with UM-ECT (50%).Conclusions: Bipolar patients report a high degree of satisfaction treated either with modified orunmodified ECT but there was a significant difference in perception of adverse effects and willingnessfor receiving ECT in future

Vascular and structural alterations of the choroid evaluated by optical coherence tomography angiography and enhanced-depth imaging optical coherence tomography in eyes with reticular pseudodrusen and soft drusen

Background: To assess the vascularity of choriocapillaris and structural choroidal differences in eyes with reticular pseudodrusen (RPD) and soft drusen. Methods: 21 eyes with RPD (group 1), 17 eyes with soft drusen (group 2), and 19 eyes as a control group (group 3) were included in this study. Choriocapillaris vascular density and flow area were measured by optical coherence tomography angiography. Total choroidal area, luminal area, stromal area, and lumen/stroma ratios were measured on optical coherence tomography B-scans converted to binary images. Results: Mean choriocapillaris vascular density was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.003). Mean flow area in choriocapillaris was higher in group 3 than other groups (group 1 vs 3, p = 0.001; group 2 vs 3, p = 0.001). Mean luminal, stromal, and total choroidal areas decreased in group 1 and group 2 compared to controls (p < 0.001, p < 0.001, and p < 0.001, respectively). The stroma ratio decreased in group 1 compared to group 3 (p = 0.013). The lumen ratio and lumen/stroma ratio increased in group 1 compared to group 3 (p = 0.012 and p = 0.008, respectively). Conclusions: The choroid of eyes with RPD and soft drusen was affected in both choriocapillaris and whole choroid layer. © 2021 Elsevier B.V

Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of Chronic Central Serous Chorioretinopathy

Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy. Results. After 12 months, mean BCVA improved from 67.3±14.2 to 71.5±21.4 ETDRS letters in SMYL group and from 60.7±16.3 to 64.4±24.9 ETDRS letters in PDT group (p=0.285 and p=0.440, resp.). Mean CMT decreased from 242.8±80 μm to 156.9±60 μm in the PDT group and from 287.3±126 μm to 138.0±40 μm in the SMYL group (p=0.098 and p=0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from 117.2±58 μm to 31.3±56 μm in the PDT group and from 130.0±104 μm to 12.5±21 μm in the SMYL group (p=0.031 and p=0.014, resp.). Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring

Unilateral Pterjium Olgularında Gözyaşı Sitokin Seviyesinin İncelenmesi

The aim of this study is to determine proinflammatory and antiinflammatory cytokine levels and growth factor concentrations in tear samples of pterygium cases and thus to contribute to the elucidation of the immunological mechanism. Thirty patients with unilateral primary pterygium were included in the study. Age and sex matched 28 healthy participants without any ocular surface disorder constituted the control group. Tear samples were collected from both pterygium eye and healthy fellow eye of the patient group, and randomly selected one eye of the control group. In these tear samples, 30 different cytokine concentrations (GM-CSF, TNF-α, IL-2, IL-1β, IL-4, VEGF, HGF, EGF, IL-8, IL-17, MIP-1α, IL-10, IL-6, IL-5, IL-7, IL-15, IFN-α, IL-2R, IP-10, MIP-1β, Eotaxin, RANTES, MIG, IL-1RA, IL-12 ( p40/70), IL-13, FGF-Basic, IFN-γ, G-CSF, MCP-1) were evaluated with Luminex® technology. Median IL-1β (107.00 pg/ml), IL-17 (554.02 pg/ml) and VEGF (75.11 pg/ml) concentrations were statistically significantly higher in pterygium eyes than healthy fellow eyes (72.44 pg/ml, 427.25 pg/ml, 62.26 pg/ml), and than control group (59.27 pg/ml, 403.80 pg/ml, 37.74 pg/ml) (p <0,05). No statistically significant difference was found in the comparison of healthy fellow eyes and control group. In the pterygium group, the high co-existence of higher IL-1β, IL-17 and VEGF concentrations and being significantly correlated with each other suggested that many inflammatory and angiogenetic steps were involved in the pathogenesis of pterygium. Since IL-17 is also able to induce the VEGF pathway, systemic or topical agent use against IL-17 may be one of the future approaches in pterygium treatment.Bu çalışmada pterjium olgularında gözyaşında proinflamatuar ve antiinflamatuar sitokin seviyeleri ve büyüme faktörleri düzeylerinin saptanması ve bu şekilde immünolojik mekanizmanın aydınlatılmasına katkı sağlanması amaçlanmıştır. Bir gözünde primer pterjium bulunan 30 olgu çalışma grubunu oluşturdu. Kontrol grubunda oküler yüzey bozukluğu bulunmayan yaş ve cinsiyet eşleştirilmiş 28 sağlıklı gönüllü yer aldı. Hasta grubunun hem pterjiumlu gözünden hem de sağlıklı diğer gözünden, kontrol grubunun ise randomize seçilen bir gözünden gözyaşı örneği alındı. Bu gözyaşı örneklerinde Luminex® teknolojisi ile 30 farklı sitokin konsantrasyonu (GM-CSF, TNF-α, IL-2, IL-1β, IL-4, VEGF, HGF, EGF, IL-8, IL-17, MIP-1α, IL-10, IL-6, IL-5, IL-7, IL-15, IFN-α, IL-2R, IP-10, MIP-1β, Eotaxin, RANTES, MIG, IL-1RA, IL-12 (p40⁄p70), IL-13, FGF-b, IFN-γ, G-CSF, MCP-1) ölçüldü. Pterjiumlu gözlerde saptanan ortanca IL-1β (107,00 pg/ml) , IL-17 (554,02 pg/ml) ve VEGF (75,11 pg/ml) değerleri, olguların sağlıklı diğer gözlerine (72,44 pg/ml, 427,25 pg/ml, 62,26 pg/ml) ve kontrol grubuna (59,27 pg/ml, 403,80 pg/ml, 37,74 pg/ml) göre istatistiksel anlamlı derecede yüksekti (p<0,05). Olguların sağlıklı diğer gözlerinin ve kontrol grubunun karşılaştırmasında herhangi bir istatistiksel farklılık saptanmadı. Pterjium grubunda IL-1β, IL-17 ve VEGF konsatrasyonlarının bir arada yüksek bulunması ve her üç mediatörün de birbiriyle istatistiksel anlamlı korelasyon göstermesi pterjium patogenezinde birçok inflamatuar ve anjiyogenik basamağın bir arada yer aldığını düşündürmüştür. IL-17’nin VEGF yolağını da uyarıyor olması nedeniyle IL-17’ye karşı geliştirilecek sistemik ya da topikal ajanlar pterjium tedavisindeki gelecek yaklaşımlar arasında yer alabilir

A Comparative Study of Short-Term Vascular and Stromal Alterations of the Choroid Following Half-Fluence Photodynamic Therapy in Pachychoroid Neovasculopathy and Chronic Central Serous Chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) and pachychoroid neovasculopathy (PNV) are among the pachychoroid spectrum diseases (PSDs). Half-fluence photodynamic therapy (hf-PDT) is one of the effective treatment methods for both diseases. The aim of this study was to compare the effect of hf-PDT on the choroidal structure in CSCR and PNV. Methods: This study included 35 patients with chronic CSCR and 18 patients with PNV. The hf-PDT protocol was applied to all eyes. Before and 3 months after hf-PDT, enhanced-depth optical coherence tomography images were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Results: Compared with baseline values, 3 months after hf-PDT, the mean CA reduced from 1.398 to 1.197 mm2 (p &lt; 0.001) in the CSCR group and the total CA reduced from 1.050 to 1.000 mm2 (p &lt; 0.021) in the PNV group. The mean percentage changes in CA, LA, and SA values were statistically higher in the chronic CSCR group (13.86%, 13.53%, and 14.11%, respectively) than those in the PNV group (4.61%, 4.02%, and 5.74%; p = 0.001, p = 0.002, and p = 0.031, respectively). Conclusion: CSCR and PNV are thought to be PSDs. However, they differ in choroidal morphological response after hf-PDT, which might be a result of the different structural components of the PNV lesions

A Comparative Study of Choroidal Vascular and Structural Characteristics of Typical Polypoidal Choroidal Vasculopathy and Polypoidal Choroidal Neovascularization: OCTA-Based Evaluation of Intervortex Venous Anastomosis

Background: The aim of this study was to compare the choroidal characteristics of typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV) cases, and to investigate the presence of intervortex venous anastomoses in these PCV subtypes by using en face optical coherence tomography angiography (OCTA). Methods: A total of 35 eyes of 33 PCV cases were included. The PCV cases were divided into T-PCV and P-CNV groups. The choroidal vascularity index (CVI) was calculated. En face OCTA images were evaluated for the presence of intervortex venous anastomoses. The diameter of the largest anastomotic Haller vessel was measured. Results: T-PCV cases had significantly higher mean CVI values (73.9 &plusmn; 3.7 vs. 70.8 &plusmn; 4.5%) than P-CNV cases (p = 0.039). Intervortex venous anastomoses were observed in 85.7% of T-PCV eyes and in 91.7% of P-CNV eyes on en face OCTA (p = 1.000). In the cases with intervortex venous anastomosis, the mean diameter of the largest anastomotic vessel on en face OCTA was 341.2 &plusmn; 109.1 &micro;m in the T-PCV and 280.4 &plusmn; 68.4 &micro;m in the P-CNV group (p = 0.048). Conclusions: The higher CVI value in T-PCV may be an important feature concerning the pathogenesis and classification of PCV. Although there was no difference between the two subtypes in terms of intervortex anastomosis, more dilated anastomotic vessels were observed in the T-PCV

The Diagnostic Role of Multimodal Imaging Techniques in Isolated Foveal Hypoplasia

To report a case of bilateral isolated foveal hypoplasia in which multimodal imaging was used to confirm the diagnosis. Fundus autofluorescence imaging, optical coherence tomography (OCT), and fundus fluorescein angiography were used to describe the typical findings of a patient with isolated foveal hypoplasia. Spectral domain OCT showed absence of foveal depression and persistent inner retinal layers in the fovea. Fundus autofluorescence did not reveal foveal hypoautofluorescence in the presumed foveal area. Clinical diagnosis of foveal hypoplasia may be difficult due to the subtle nature of fundus findings. Fundus autofluorescence imaging may help to diagnose these patients. Foveal hypoplasia should be considered in the differential diagnosis of absence of foveal hypoautofluorescence

Chemotherapy in Retinoblastoma: Current Approaches

Retinoblastoma (RB) is the most common childhood malignant intraocular tumor. Although enucleation and external beam radiotherapy have been historically used, today the most commonly used eye-sparing approach is chemotherapy. Chemotherapy can be used in both intraocular and extraocular RB cases. Chemotherapeutic agents may be applied in different ways, including systemic, subconjunctival, intra-arterial and intravitreal routes. The main purposes of application of systemic therapy are to reduce the tumor size for local treatment (chemoreduction), or to reduce the risk of metastasis after enucleation surgery (adjuvant therapy). Intra-arterial chemotherapy with the current name “super-selective intra-arterial infusion therapy” could be applied as primary therapy in tumors confined to the retina or as a secondary method in tumor recurrence. The most important advantage of intra-arterial therapy is the prevention of systemic chemotherapy complications. Intravitreal chemotherapy is administered in the presence of persistent or recurrent vitreous seeding. The term “extraocular RB” includes orbital invasion and metastatic disease. Current treatment for orbital invasion is neoadjuvant chemotherapy followed by surgical enucleation and adjuvant chemotherapy and radiotherapy after surgery. In metastatic disease, regional lymph node involvement, distant metastases, and/or central nervous system (CNS) involvement may occur. Among them, CNS involvement has the worst prognosis, remaining at almost 100% mortality. In metastatic disease, high-dose salvage chemotherapy and autologous hematopoietic stem cell rescue therapy are the possible treatment options; radiotherapy could also be added to the protocol according to the side of involvement

A Comparative Study of Choroidal Vascular and Structural Characteristics of Typical Polypoidal Choroidal Vasculopathy and Polypoidal Choroidal Neovascularization: OCTA-Based Evaluation of Intervortex Venous Anastomosis

Background: The aim of this study was to compare the choroidal characteristics of typical polypoidal choroidal vasculopathy (T-PCV) and polypoidal choroidal neovascularization (P-CNV) cases, and to investigate the presence of intervortex venous anastomoses in these PCV subtypes by using en face optical coherence tomography angiography (OCTA). Methods: A total of 35 eyes of 33 PCV cases were included. The PCV cases were divided into T-PCV and P-CNV groups. The choroidal vascularity index (CVI) was calculated. En face OCTA images were evaluated for the presence of intervortex venous anastomoses. The diameter of the largest anastomotic Haller vessel was measured. Results: T-PCV cases had significantly higher mean CVI values (73.9 ± 3.7 vs. 70.8 ± 4.5%) than P-CNV cases (p = 0.039). Intervortex venous anastomoses were observed in 85.7% of T-PCV eyes and in 91.7% of P-CNV eyes on en face OCTA (p = 1.000). In the cases with intervortex venous anastomosis, the mean diameter of the largest anastomotic vessel on en face OCTA was 341.2 ± 109.1 µm in the T-PCV and 280.4 ± 68.4 µm in the P-CNV group (p = 0.048). Conclusions: The higher CVI value in T-PCV may be an important feature concerning the pathogenesis and classification of PCV. Although there was no difference between the two subtypes in terms of intervortex anastomosis, more dilated anastomotic vessels were observed in the T-PCV