Choroidal structural changes determined by the binarization method after intravitreal aflibercept treatment in neovascular age-related macular degeneration

AIM: To assess the choroidal structural alterations after intravitreal injection of aflibercept in neovascular agerelated macular degeneration (nAMD). METHODS: Fifty eyes with treatment-naïve nAMD were evaluated at baseline, 3rd, and 12th month. Fifty eyes of 50 healthy subjects were also included as controls. Choroidal thickness (CT) was measured in the subfoveal region. Total circumscribed choroidal area (CA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) was calculated using Image J. RESULTS: At baseline, subfoveal CT was increased in nAMD patients compared to controls (P=0.321). Eyes with nAMD had a significantly increased total circumscribed CA and SA (P=0.041, 0.005, respectively). The CVI was decreased (P=0.038). In the 3rd month, the subfoveal CT, LA, and CVI revealed a decrease (P=0.005, P=0.039, 0.043, respectively). In the 12th month, subfoveal CT, LA, and CVI were decreased in comparison to baseline measures (P[removed

Chiari I malformation presenting with ganglion cell complex thinning on routine examination

Chiari I malformation (CMI) is a rare congenital disorder characterized by the caudal displacement of cerebellar tonsils through the foramen magnum into the cervical canal(1). Ophthalmological signs include retro-orbital pain, diplopia, photophobia, impaired visual acuity, nystagmus, strabismus, and papilledema(2-4). The diagnosis is mostly based on magnetic resonance imaging (MRI) findings © This content is licensed under a Creative Commons Attributions 4.0 International License

Electronic Device Screen Time and Meibomian Gland Morphology in Children

Purpose: To investigate changes in meibomian gland morphology and impact of electronic device usage time on meibomian glands in pediatric age group. Methods: In this prospective study, 149 eyes of 149 children were enrolled. The participants also completed the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and provided information regarding weekly hours spent in front of a digital screen. Meibography was performed in all subjects. Grading of images was evaluated using a previously validated 5-point meiboscale (0–4) for meibomian gland atrophy and a 3-point scale for meibomian gland tortuosity (0–2). Results: Of the 149 enrolled children, 83 (55.7%) were female and 66 (44.3%) male. The mean age was 13.0 ± 3.0 (range: 5–18) years. The mean loss of meibomian gland area was 20.80 ± 9.32%. The mean meiboscore was 1.20 ± 0.58 for gland atrophy and the mean tortuosity score was 0.99 ± 0.62. The mean screen time was 29.32 ± 16.18 hr/week. There was a weak and significantly positive correlation between loss of meibomian gland area and screen time (r = 0.210, p = 0.010). There was a weak and significantly positive correlation between meiboscore for gland atrophy and screen time (r = 0.188, p = 0.022). We found a weak but significantly positive correlation between meibomian gland tortuosity and screen time (r = 0.142, p = 0.033). Conclusion: Meibomian gland morphology may show changes in pediatric age group and excessive screen time may be a factor triggering these changes in gland morphology

Short-term effect of angiotensin converting enzyme inhibitor on choroidal vascularity

Purpose: To determine the effect of angiotensin-converting enzyme (ACE) inhibitors on choroidal vascularity using the binarization method in a group of treatment-naïve hypertensive patients. Methods: There were 48 treatment-naive hypertensive patients who were diagnosed according to the "2013 European Society of Hypertension/European Society of Cardiology" guideline and started angiotensin-converting enzyme inhibitor perindopril (Coversyl) in the study. As a control group, 48 healthy volunteers were randomly selected among people who attended the outpatient clinic for routine ophthalmological examination. Enhanced-depth imaging optical coherence tomography (EDI-OCT) images were captured at baseline and at 1 month after treatment. Binarization of the EDI-OCT images was performed by Image-J software. The choroidal thickness (CT), total choroidal area, luminal area, stromal area, and choroidal vascularity index (CVI) were measured. Results: There was a statistically significant increase in CT at all locations (subfoveal, nasal, and temporal) at 1 month after treatment compared with baseline (for all, p˂0.001). Choroidal structural parameters and the mean CVI were statistically significantly increased at 1 month after treatment (for all, p˂0.001). When compared, there was no statistically significant difference for the vascular parameters between the control group and the patient group at 1 month (for all, p>0.05). Conlusion: A statistically significant improvement was demonstrated in the choroidal vascular parameters except for the stromal area after treating with an ACE inhibitor in a group of hypertensive patients. © 2021 Elsevier B.V

Choroidal vascularity index after a single dose of intravitreal dexamethasone implant in patients with refractory diabetic macular oedema

Purpose: To evaluate choroidal vascularity index (CVI) after a single dose of intravitreal dexamethasone implant in refractory diabetic macular oedema (DME). Methods: Total choroidal area, luminal area, and CVI were measured at baseline, 1st month, and at 3rd month after dexamethasone implant using binarization of enhanced depth imaging optical coherence tomography (EDI-OCT) images. Results: A total of 25 eyes of 25 patients (mean age: 61.4 ± 8.3 years; 12 males, 13 females), were enroled in the study. All eyes had been previously treated with intravitreal aflibercept injections (mean number of injections 4.6 ± 2.5). Mean CVI was 70.3 ± 8.1 prior to intravitreal dexamethasone treatment. It was decreased to 66.1 ± 9.3 at 1 month and 63.5 ± 10.1 at 3 months after treatment. The mean CVI was significantly decreased at 3 months compared with pre-treatment measures (p = 0.033). Conclusion: CVI was found to be decreased in patients who responded to intravitreal dexamethasone implant. © 2022 Elsevier B.V

Topical Ophthalmic Cyclosporine in the Treatment of Toxic Epidermal Necrolysis

Aim. To describe a case of toxic epidermal necrolysis (TEN) with ocular involvement treated with topical ophthalmic cyclosporine. Case Presentation. A 20-year-old woman developed TEN following administration of carbamazepine that was prescribed for epilepsy. Ophthalmic examination revealed bilateral pseudomembranous conjunctivitis. She was hospitalized in the intensive care unit and treated with intravenous corticosteroid and immunoglobulin. Topical cyclosporine was used in combination with topical corticosteroids for ocular surface disease. Following two months of ocular treatment, she recovered without any severe ocular complication. Ocular examination at the four-month followup showed a 2 mm of symblepharon in the lower fornix as the sole pathologic finding. Conclusion. Topical ophthalmic cyclosporine may contribute to decrease the ophthalmic complications of TEN and should be considered in the acute stage of the disease

Structural alterations of the choroid evaluated using enhanced depth imaging optical coherence tomography in patients with coronavirus disease

Purpose: To assess choroidal changes using enhanced depth imaging optical coherence tomography in coronavirus disease (COVID-19). Methods: Thirty-two patients with moderate COVID-19 and 34 healthy subjects were included in the study. Choroidal thickness was measured at 3 points as follows: at the subfovea, 1500 mm nasal to the fovea, and 1500 mm temporal to the fovea. The total choroidal area, luminal area, stromal area, and choroidal vascular index were measured with Image-J. All the measurements were performed during the disease and at 4 months after remission. Results: In the patient group, the subfoveal, nasal, and temporal choroidal thicknesses were decreased as compared with those in the controls, but without statistically significant differences (p=0.534, p=0.437, and p=0.077, respectively). The mean total choroidal, stromal, and luminal areas and choroidal vascular index were statistically significantly decreased in the patient group (p<0.001, p=0.001, p=0.001, and p=0.003; respectively). At 4 months after remission, the choroidal structural parameters and choroidal vascular index revealed statistically significant increases as compared with the baseline measurements in the patients with COVID-19 (all p<0.001 and p=0.047, respectively). Conclusion: The choroidal vascular and stromal parameters showed significant transient decreases during the disease course of COVID-19. © This content is licensed under a Creative Commons Attributions 4.0 International License

Choroidal vascularity index and retinal nerve fiber layer reflectivity in newly diagnosed migraine patients

Purpose: To evaluate the choroidal structural parameters, peripapillary retinal nerve fiber layer (RNFL) thickness, and optic density index (ODI) and their correlations in patients with migraine. Methods: Twenty-eight newly diagnosed migraine patients and 28 age-matched healthy controls were included in this prospective cross-sectional study. The enhanced depth-optical coherence tomography images were evaluated. The choroidal area (CA) was binarized to the luminal area (LA) and stromal area (SA) using Image J. The choroidal vascularity index (CVI), the mean peripapillary RNFL thickness, superior-inferior-nasal-temporal quadrant RNFL thicknesses, and the ODI were compared statistically. Results: The difference in the mean CVI between the patient group and controls reached a statistical significance (p=0.035). The mean RNFL thickness was significantly decreased in patients with migraine compared with the controls (p=0.040). The mean RNFL thickness in the superior, temporal, and inferior quadrants was significantly decreased in the patient group in comparison to the control subjects (p=0.030, p=0.001, and p=0.022, respectively). There were no significant differences between the migraine group and the controls for the mean ODI of RNFL (p=0.399). Conclusion: The CVI and the RNFL thickness except for the nasal quadrant were significantly decreased in newly diagnosed migraine patients. © 2021 Elsevier B.V

The Effects of Intravitreal Dexamethasone Implant (Ozurdex®) on Intraocular Pressure and Anterior Chamber Angle

Amaç: İntravitreal deksametazon enjeksiyonunun göz içi basıncı (GİB) ve ön kamara açısı (ÖKA) üzerine etkisini incelemek. Gereç ve Yöntem: Otuz sekiz hastanın 40 gözü incelendi. Hastaların yaş ortalaması 61.39 yıl (aralık: 36-83) olup, %63.2’i kadın, %36.8’i erkekti. %70'i retina ven tıkanıklığı, %20’i diabet, %7.5‘i arka üveit ve %2.5’i psödofakik makula ödemi olgusuydu. GİB Goldmann ap- lanasyon tonometresi ile ölçüldü. GİB ve gonyoskopik muayene enjeksiyondan önce ve enjeksiyondan sonra 1.hafta, 1. 3. ve 6. aylarda ölçüldü. Spektral domain optik koherans tomografi (OKT) enjeksiyon öncesi ve sonrası 1. ay, 3. ay ve 6. ay da üst, nazal, alt, temporal kad- ranlardan alındı. OKT ile ön kamara açı derecesi (ÖKA), trabeküler iris yüzey alanı (TIYA500) ve açı açılma mesafesi (AAM500) ölçüldü. Bulgular: Enjeksiyon yapılan gözlerin GİB'ı enjeksiyon öncesi, enjeksiyon sonrası 1. hafta, 1. ve 3. aylardakine göre anlamlı düşük sap- tandı (sırasıyla p= 0.004, p= 0.002, p= 0.003). Enjeksiyon sonrası 6. ay ile enjeksiyon öncesi arasında ortalama GİB değerleri açısından anlamlı fark izlenmedi. Nazal kadranda enjeksiyon öncesi ve sonrası 1. haftadaki gonyoskopik derece, enjeksiyon sonrası 3. ve 6. aylara göre anlamlı yüksek saptandı (p= 0.007, p= 0,006; p= 0.008, p= 0,008). Gonyoskopide diğer kadranlarda anlamlı fark saptanmadı. Nazal kadranda OKT-ÖKA'nın enjeksiyon sonrası 3. ve 6. aydaki değerleri, enjeksiyon öncesi ve sonrası 1. aya göre anlamlı dar saptandı (p= 0.008, p= 0,008; p= 0.009, p= 0,008). Üst kadranda göz kapağı güvenilir ölçüm alınmasına engel olmuştur. Uygulama yapılan gözlerin alt kadran 3. ve 6. aylardaki OKT-AAM500 ve TİYA500 sonucu enjeksiyon öncesinden anlamlı olarak düşük saptanmıştır (p= 0.002, p= 0.004; p= 0.005, p= 0.001). Sonuç: İntravitreal deksametazon enjeksiyonu sonrası göz içi basıncı artabilir fakat çoğu olguda medikal tedaviyle kontrol altına alınabilir. Enjeksiyon sonrası gonyoskopide ve OKT’de bazı kadranlarda ön kamara açısında daralma olabilir.Purpose: To investigate the effects of intravitreal dexamethasone injection on intraocular pressure (IOP) and anterior chamber angle (ACA). Materials and Methods: Forty eyes of 38 patients were studied. The mean age of the patients was 61.39 years (range: 36-83), 63.2% female and 36.8% male. 70% were retinal vein occlusion, 20% were diabetic, 7.5% were posterior uveitis and 2.5% were pseudophakic macular edema. IOP was measured by Goldman applanation tonometry. IOP and gonioscopic examination were performed before and after injection on the 1st week 1st, 3rd, and 6th months. Spectral domain optic coherence tomography (OCT) was performed on the superior, nasal, inferior, temporal quadrants before and after injection on the 1st, 3rd, and 6th months. Anterior chamber angle (ACA), trabecular iris surface area (TISA500) and angle opening distance (AOD500) were measured by OCT

Histopathologic Distribution of Eyelid and Periocular Region Tumors

Amaç: Kırıkkale ili ve çevresinde biyopsi alınarak histopatolojik değerlendirmesi yapılan göz kapağı ve perioküler bölge tümörlerinin epidemiyolojisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: 2008-2016 yılları arasında 217 hastaya ait 239 lezyonun histopatolojik tanısı, yerleşim yeri ve lateralizasyonu geriye dönük olarak taranmış ve sınıflandırılmıştır. Hastalara ait demografik bilgiler derlenmiştir. Bulgular: 217 hastanın 104' ü erkek (%47.9), 113'ü kadın (%52.1) idi. Hastaların Yaş ortalaması 46.0±2.04 olarak bulundu.Lezyonların 117'si sağ (%48.9) 122'si (%51.1) sol tarafta yerleşmiş idi. Olguların 99'u alt kapaktan (%41.4), 120'si üst kapaktan (%50.2), 17'si (%7.1) medial kantus 3'ü (%1.3) ise dış kantusta idi. 239 olgunun %36.8'i epitelyal tümör (n=88), %5.8'i adneksiyal (n=14), % 3.8'i vasküler (n=9), %5'i ksantomatöz (n=12), %15.8 pigmente - melanositik (n=38), %21.3 inflamatuvar veya enfeksiyöz (n=51) , %11.2 u ise malign (n=27) olarak dağılım göstermekteydi. Sonuç: Yaklaşık olarak yapılan her 10 biyopsiden birinin malignite tanısı aldığı görülmektedir. Bir kısım literatür ile uyumlu olan sonuçlarımızın bazıları ile ise farklılık göstermesinin çevresel faktörlerden kaynaklanabileceği düşünülmüştürAim: The aim of the study was to explore the distribution of eyelid and periocular mass lesions in kırıkkale , Middle Anatolia, Turkey, from a histopathological point of view.Methods: Two hundred and thirty nine lesions in 217 patients were classified according to their diagnosis, location and lateralization who admitted between 2008-2016. Demographic data were also reviewed.Results: One hundred and four (47.9%) were female and 113 (52.1%) were female patients. Mean age was 46.0 ±2.04 years. One hundred seventeen (%48.9) of the lesions were on the right side and 122 (%51.1) were on the left. Ninety nine lesions were located at lower eyelid (%41.4) 120 at upper eyelid, 17 (%7.1) at medial canthus (%5.6), 3 (%1.3) at lateral canthus. Two hundred twelve (%88.70) of the lesions were benign. Of these, %36.8 were epithelial (n=88), % 5.85 adnexial (n=14), % 3.7 vascular (n=9), %5 xanthomatous (n=12), %15.9 pigmentary (n=38), and %21.3 inflammatory (n=51) in nature. The rest 27 (%11.29) lesions were malign. Conclusions: Approximately one of every 10 biopsies is diagnosed as malignancy. Some of our results were consistent with literature. We think that inconsistencies were based on as a results of regional difference