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Purpose: To assess the peripapillary choroidal vasculature in paediatric myopic patients with and without peripapillary hyperreflective ovoid mass-like structures (PHOMS)., Methods: This prospective study includes 60 eyes of 60 myopic (spherical equivalent [SE] <-1.00 dioptre [D]) patients with (n = 30) and without (n = 30) PHOMS (PHOMS [+] and PHOMS [-] groups, respectively), and 30 eyes of 30 age- and sex-matched emmetropic children (control group). Peripapillary choroidal parameters, including total choroidal (TCA), luminal (LA), and stromal areas (SA) and choroidal vascularity index (CVI) calculated from vertical and horizontal single-line enhanced depth imaging-optical coherence tomography scans centred on optic nerve head., Results: Peripapillary retinal nerve fibre layer thicknesses were not different between the groups (p > 0.05). In the PHOMS (+) group, TCA, LA and SA were lower, and CVI was higher in all quadrants compared to the control (p < 0.05). However, only the mean TCA and LA in the inferior and nasal quadrants and the mean SA in the nasal quadrant were lower in PHOMS (+) than in PHOMS (-) (p < 0.05). In the PHOMS (-) group, higher CVI was observed in all quadrants except temporal compared to the control group. Although the mean CVI of the PHOMS (+) group was also higher than in the PHOMS (-) group, this difference was not statistically significant., Conclusion: This study indicates that choroidal parameters differ in paediatric myopic patients with PHOMS. Further studies with larger sample sizes are needed to understand the details of choroidal parameters in eyes with PHOMS., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Clinical Relevance: Antimetropia is a rare type of anisometropia in which one eye is myopic and the fellow is hyperopic, This optical condition condition permits the evaluation of both sides of the emmetropisation process failure in the same individual by minimising genetic and environmental factors., Background: This study aimed to evaluate the ocular biometric, retinal, and choroidal characteristics of myopic and hyperopic eyes of antimetropic subjects older than six years., Methods: In this retrospective study, myopic and hyperopic eyes of 29 antimetropic patients with a spherical equivalent (SE) difference of at least 2.00D between the eyes were included. Axial length (AL), mean corneal keratometry, anterior chamber depth, the proportion of anterior chamber depth in AL, crystalline lens power, central macular thicknesses, disc-to-fovea distance, fovea-disc angle, peripapillary retinal nerve fibre layer (RNFL) thicknesses, and subfoveal choroidal features were compared between the eyes. The prevalence of amblyopia was determined. Refractive parameters and total astigmatic profile were evaluated in eyes with and without amblyopia., Results: The median absolute SE and AL differences between the eyes were 3.50D (interquartile range:1.75) and 1.18 mm (interquartile range:0.76), respectively ( p  < 0.001). Myopic eyes had lower crystalline lens power and proportion of anterior chamber depth in AL, and longer disc-to-fovea distance. Macular thicknesses, global RNFL, and temporal RNFL were thicker in myopic eyes, and there was no difference in other RNFL quadrants. Despite the increase in the choroidal vascularity index, other choroidal parameters were decreased in myopic eyes. Amblyopia was found in three of the myopic eyes and seven of the hyperopic eyes ( p  = 0.343). The highest interocular SE and AL difference and the highest frequency of anisoastigmatism were observed in patients with amblyopia in the myopic eye., Conclusion: Each ocular structure may respond differently to, or may be affected differently by, ametropic conditions.

Objective: To investigate the effect of repeated povidone-iodine (PVI) application on the ocular surface parameters of patients who received intravitreal injections., Materials and Methods: In this prospective study, 52 eyes of 52 patients with age-related macular degeneration who underwent unilateral intravitreal injection at least three times in the last 1 year (intravitreal injection [IVI] group), 52 fellow eyes with no previous intravitreal injection (NIVI group), and 51 eyes of 51 healthy subjects (control) were included. Tear break-up time (TBUT), the Schirmer test, the Oxford staining score, the Ocular Surface Disease Index questionnaire, conjunctival impression cytology, and tear inflammatory cytokine levels (interleukin [IL]-1β and IL-6) were analyzed in all participants., Results: The IVI group had lower TBUT and higher Oxford staining score than the NIVI and control groups ( P <0.05). No significant difference was found between the groups in the Schirmer test ( P =0.161). Conjunctival impression cytology analysis revealed that the IVI group had a significantly lower goblet cell count and significantly higher Nelson staging result than the NIVI and control groups ( P <0.05). As a result of tear cytokine analysis, although IVI and NIVI groups had higher IL-1β and IL-6 levels than the control group ( P <0.05), there was no difference between NIVI and IVI groups ( P ≥0.05)., Conclusions: Repeated PVI application caused cytotoxic injury to the ocular surface, resulting in goblet cell loss and squamous metaplasia of epithelial cells. As a result, the stability of the tear film layer was found to be impaired and ocular surface-related symptoms developed in patients., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Contact Lens Association of Ophthalmologists.)

Background: To quantitatively evaluate the effectiveness of the Noise2Noise (N2N) model, a deep learning (DL)-based noise reduction algorithm, on enhanced depth imaging-optical coherence tomography (EDI-OCT) images with different noise levels., Methods: The study included 30 subfoveal EDI-OCT images averaged with 100 frames from 30 healthy participants. Artificial Gaussian noise at 25.00, 50.00, and 75.00 standard deviations were added to the averaged (original) images, and the images were grouped as 25N, 50N, and 75N. Afterward, noise-added images were denoised with the N2N model and grouped as 25dN, 50dN, and 75dN, according to previous noise levels. The choroidal vascularity index (CVI) and deep choroidal contrast-to-noise ratio (CNR) were calculated for all images, and noise-added and denoised images were compared with the original images. The structural similarity of the noise-added and denoised images to the original images was assessed by the Multi-Scale Structural Similarity Index (MS-SSI)., Results: The CVI and CNR parameters of the original images (68.08 ± 2.47 %, and 9.71 ± 2.80) did not differ from the only 25dN images (67.97 ± 2.34 % and 8.50 ± 2.43) (p:1.000, and p:0.062, respectively). Noise reduction improved the MS-SSI at each noise level (p < 0.001). However, the highest MS-SSI was achieved in 25dN images., Conclusions: The DL-based N2N denoising model can be used effectively for images with low noise levels, but at increasing noise levels, this model may be insufficient to provide both the original structural features of the choroid and structural similarity to the original image., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: This study aimed to compare the anatomical and visual outcomes of idiopathic epiretinal membrane peeling surgery, with and without foveal herniation., Methods: This retrospective, comparative, two-center study included age- and sex-matched patients exhibiting an idiopathic epiretinal membrane with and without foveal herniation (epiretinal membrane + foveal herniation group and epiretinal-membrane-only group, respectively). The baseline best-corrected visual acuity and central foveal thickness were compared within the groups through months 1, 3, 6, and 12 of follow-up postoperatively. Then, changes in these two parameters at all follow-up points were compared between the groups., Results: We enrolled 16 patients per study group. The baseline best-corrected visual acuity and central foveal thickness were not significantly different between the two groups (p&gt;0.05). Compared with the baseline, both the best-corrected visual acuity and central foveal thickness improved significantly in both groups in all follow-ups (p&lt;0.05), except for the best-corrected visual acuity of the epiretinal-membrane-only group after month 1 (p&lt;0.05). The mean best-corrected visual acuity improvement after month 1 and the mean central foveal thickness reduction after months 1, 3, and 6 were significantly better in the foveal herniation + epiretinal membrane group than in the epiretinal-membrane-only group (p&lt;0.05). However, the best-corrected visual acuity and central foveal thickness changes were not significantly different between the groups at the final visit (p&gt;0.05)., Conclusions: Although epiretinal membrane + foveal herniation demonstrated prompt anatomical and functional improvement, foveal herniation occurrence did not affect the final surgical outcomes in patients with idiopathic epiretinal membrane.

Purpose: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis., Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded., Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia., Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

Background: We aimed to evaluate the optical coherence tomography(OCT) findings and oxidative stress parameters in patients with bipolar disorder(BD) and their unaffected first-degree relatives(FDRs) and to explore OCT findings and oxidative stress parameters as potential endophenotype candidates., Methods: Fifty patients with BD, 40 FDRs of BD, and 50 healthy controls(HCs) were included. OCT was performed to measure peripapillary retinal nerve fiber layer(RNFL), ganglion cell layer(GCL), inner plexiform layer(IPL), central macular, and minimum foveal thicknesses(CMT and MFT), choroidal thickness(ChT). 4-hydroxy-2-nonenal(HNE), total thiol(TT), native thiol(NT), total oxidant status(TOS), total antioxidant status(TAS), disulfide(DIS) and oxidative stress index(OSI) were measured from serum samples., Results: TOS was higher patients with BD and FDRs than HCs (p < .001 and p = .012, respectively). OSI, DIS, HNE levels were higher patients with BD and FDRs than HCs (p < .001). TAS, TT, NT levels were lower patients and FDRs than HCs (p < .001). MFT of patients was thinner than HCs (p = .001). CMT of patients was thinner than HCs (p = .006); the same trend was observed in FDRs but did not reach the statistical significance level (p = .07). The groups did not differ on RNFL and choroidal thickness or GCL and IPL volume., Limitations: Evaluation of only a few retinal layers., Conclusions: TOS, TAS, OSI, TT, NT, DIS, HNE can be useful endophenotype biomarkers in BD. Among the OCT findings, CMT was determined as the closest parameter to being an endophenotype biomarker. Our study corroborates that oxidative stress parameters are more effective than OCT findings in endophenotype studies., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: To compare intraretinal layers between the eyes in patients with myopic anisometropia, and evaluate the relationship between the layers with spherical equivalent (SE) and axial length (AL)., Methods: In this retrospective study, the more myopic (MM) and fellow (F) eyes of 41 patients with myopic anisometropia, and 38 emmetropic (± 0.50 diopter) control (C) eyes were inclueded. Intraretinal layer segmentation was performed by optical coherence tomography. Global volumes of retinal layers and their thicknesses in nine macular regions were compared. Correlation analysis was used to determine the relationship with SE and AL in each layer., Results: Total retinal, ganglion cell (GCL), inner nuclear (INL), and outer plexiform (OPL) layer volumes in MM eyes were less than in C eyes, while INL and OPL were less than in F eyes. There was no difference in the fovea, except for the retinal pigment epithelium. In MM eyes, only INL and OPL were thin in at least one perifoveal and parafoveal quadrant compared to F eyes. Only INL and OPL thicknesses were significantly correlated with both SE and AL in all perifoveal quadrants. In contrast to the thinning found in MM eyes, the only layer in which thickening was detected to compare to C eye was nerve fiber layer (NFL), which correlated positively with SE and negatively with AL., Conclusion: While the fovea is less affected by myopia, thinning becomes remarkable in the perifoveal quadrants. Despite thinning in many layers, especially INL and OPL, NFL thickening may be seen due to myopia., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the effects of 1,25 dihydroxyvitamin D 3 (vitamin D 3 ) either alone or under oxidative damage on human retinal pigment epithelium cell lines., Methods: The human retinal pigment epithelial cell lines were pretreated with hydrogen peroxide with different concentrations (100-1000 μM) and durations (4, 12 and 24 h) to determine the appropriate dose. A group of cells were treated with vitamin D 3 alone, and another group of cells were co-treated with different concentrations of (10-100 nM) vitamin D 3 and hydrogen peroxide. Anti-cytotoxic, anti-apoptotic and anti-genotoxic effects of vitamin D 3 on the hydrogen peroxide treated cell line were evaluated. In addition, mitochondrial membrane potentials of treated cell lines were measured., Results: Vitamin D 3 showed statistically significant anti-cytotoxic effects and increased cell viability in all concentrations (p < 0.001). It has also significantly decreased the intracellular ROS generation at concentrations between 10-60 nM and increased intracellular reactive oxygen species in high doses over 90 nM (p < 0.01). When apoptosis was evaluated, vitamin D 3 caused statistically significant decrease in a dose-dependent manner (p < 0.001). In terms of DNA damage which was caused by oxidative stress, it was observed that vitamin D 3 significantly reduced the damage in a dose-dependent manner (p < 0.001). At the doses of 10-50 nM, vitamin D 3 significantly decreased the mitochondrial membrane potential (p < 0.01)., Conclusion: Our study suggests that 1,25 (OH) 2 D3 is capable for alleviating the oxidative damage in ARPE cell lines. With these results, vitamin D is thought to be a therapeutic alternative for the prevention of age-related macular degeneration. This warrants further investigations., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the effect of intravitreal dexamethasone (Ozurdex ® ) implant in eyes with serous macular detachment (SMD) secondary to diabetic retinopathy (DRP) with diabetic macular edema (DME). Methods: Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP were included in this study. Twenty-four eyes of 24 patients (12 men and 12 women) with clinically significant macular edema and SMD due to DRP, which was documented by optical coherence tomography, were included in this study. Intravitreal dexamethasone implantation was performed for treatment to all eyes. Main outcome measures included changes in best corrected visual acuity (BCVA), central neuroretinal thickness (CRT), and height of SMD. After intravitreal dexamethasone implantation, functional and anatomic responses were observed. Results: From the data at 3 months follow-up, we found that the Ozurdex implant was effective in treating SMD with DME, no eyes had lost vision from baseline, 22 eyes (92%) had improved visual acuity, and 22 eyes (92%) had presented SMD regression. Only two eyes had needed dexamethasone implant retreatment. Data at 6-months follow-up, no eyes had lost vision from baseline, 20 eyes (83%) had improved visual acuity, and all eyes had presented SMD regression. Also, after injections and at the end of the follow-up, mean CRT and BCVA were statistically different from the baseline. Conclusions: Intravitreal Ozurdex implantation increases BCVA and reduces SMD and CRT, in patients with SMD. In this context, intravitreal dexamethasone implantation is an effective treatment for SMD in patients with DME.

Purpose: To compare the safety and efficacy of two Nd: YAG laser capsulotomy techniques., Methods: In this prospective comparative interventional case series, 60 eyes of 57 patients with posterior capsular opacification were enrolled. Thirty eyes were selected to undergo a cruciate capsulotomy (Cross group) and the other 30 eyes were selected to undergo a circular capsulotomy (Circular group). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), amount of energy used, mean macular thickness (MMT), and floater symptoms., Results: The amount of energy used was significantly higher in the Circular group than in the Cross group (p < 0.001). BCVA and IOP were not significantly different between the two groups at baseline or follow-up. MMT was significantly higher in the Circular group than in the Cross group at one day after the laser procedure (p = 0.032). MMT was not significantly different between groups at one week, one month, and three months (p > 0.05). The number of patients with floater symptoms was significantly higher in the Circular group than in the Cross group at one week and one month (p < 0.05)., Conclusion: Both the cross-like and circular Nd:YAG laser capsulotomy techniques induce similar visual and IOP changes. The circular technique is associated with a higher amount of energy used, more floater symptoms, and has a greater effect on macular thickness at one day after laser capsulotomy.