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Purpose: To investigate choroidal vascularity in children with attention-deficit/hyperactivity disorder (ADHD) who were not receiving therapy, children with ADHD who were regularly taking methylphenidate (MPH), and healthy controls. Methods: The study included three groups: patients with newly diagnosed ADHD without treatment, patients diagnosed as having ADHD who were already being treated with oral MPH, and controls. Both choroidal vascularity index (CVI) and choroidal thickness were measured using an enhanced-depth imaging mode of spectral-domain optical coherence tomography (EDIOCT) (Spectralis; Heidelberg Engineering GmbH). Results: There was a significant difference in CVI and stromal area between groups. Post-hoc univariate analysis showed that CVI was significantly lower in patients with ADHD treated with MPH compared with the other groups ( P < .001, for each); however, there was no difference between the treatment-free ADHD group and controls ( P = .305). In contrast, stromal area was significantly higher in patients with ADHD treated with MPH than the other groups ( P < .001, for each group). The correlation of CVI with MPH treatment duration in patients with ADHD treated with MPH showed a significant, moderate negative correlation ( P = .01, r = − 0.66). Conclusions: CVI is reduced in patients with ADHD treated with MPH, and the decrease in CVI becomes significant with increasing duration of MPH treatment. This result reflects an indirect effect of MPH treatment on choroidal vascular structures. [ J Pediatr Ophthalmol Strabismus . 20XX;X(X):XX–XX.]

The aim of the study was to assess retinal microcirculation in patients with coronavirus disease 2019 (COVID-19) through the use of optical coherence tomography angiography (OCT-A) and compare the results with those obtained in healthy controls.The study enrolled 39 patients who had fully recovered from COVID-19 and 40 healthy controls. OCT-A image acquisitions were obtained using AngioVue software (version 2017.1.0.151) and the RTVue XR Avanti imaging system (Optovue Inc., Fremont, CA, USA). Nonflow area in the superficial capillary plexus (SCP), foveal avascular zone (FAZ) area in the whole retinal vasculature, FAZ perimeter, acircularity index of FAZ, and foveal density were automatically obtained with the FAZ assessment tool. Vessel density (VD) at the SCP and deep capillary plexus were also measured.Compared to the control group, the nonflow area and the FAZ area in the whole retina was greater in the COVID-19 group; however no statistically significant difference was observed (p 0.05 respectively). As for vessel densities, all superficial parafoveal VD parameters were considerably higher in the COVID-19 group compared to the control group (p 0.05 respectively). Despite the fact that the vessel densities in the remaining zones were lower in the COVID-19 group, those differences were not statistically significant (p 0.05 respectively).VD at the parafoveal area of the SCP was significantly higher among patients in the late post-recovery period of COVID-19 disease compared to healthy controls. These findings show the impact of COVID-19 on the retinal microvasculature and its possible role as a risk factor for the development of ocular diseases.Ziel dieser Studie war es, die retinale Mikrozirkulation in von der Coronavirus-Krankheit 2019 (COVID-19) betroffenen Patienten mithilfe der optischen Kohärenztomografieangiografie (OCT-A) zu untersuchen und mit den Ergebnissen von gesunden Kontrollpersonen zu vergleichen.In der Studie wurden 39 Patienten, die sich vollständig von der Coronavirus-Krankheit erholt hatten, und 40 gesunde Kontrollpersonen untersucht. Zur OCT-A-Bildakquisition wurde die AngioVue-Software (Version 2017.1.0.151) und das RTVue-XR-Avanti-Bildgebungssystem (Optovue Inc., Fremont, CA, USA) verwendet. Das FAZ-Bewertungstool ermittelt automatisch den Non-Flow-Bereich im oberflächlichen Kapillarplexus (SCP), im Bereich der fovealen avaskulären Zone (FAZ) und im gesamten retinalen Gefäßsystem sowie den FAZ-Perimeter, den FAZ-Azirkularitätsindex und die foveale Dichte. Die Gefäßdichte (VD) im SCP und im tiefen Kapillarplexus wurde auch gemessen.Auch wenn kein statistisch signifikanter Unterschied beobachtet wurde, war der Non-Flow-Bereich und der FAZ-Bereich in der gesamten Netzhaut in der COVID-19-Gruppe größer im Vergleich zur Kontrollgruppe (jeweils p 0,05). Bezüglich der Gefäßdichten waren alle oberflächlichen parafovealen VD-Parameter in der COVID-19-Gruppe erheblich höher im Vergleich zur Kontrollgruppe (jeweils p 0,05). Obwohl die Gefäßdichten in den verbleibenden Zonen in der COVID-19-Gruppe niedriger waren, waren diese Unterschiede statistisch nicht signifikant (jeweils p 0,05).Die VD im parafovealen Bereich des SCP war bei Patienten im späten Rekonvaleszenzstadium der Coronavirus-Erkrankung signifikant höher verglichen mit gesunden Kontrollen. Diese Ergebnisse zeigen die Auswirkungen von COVID-19 auf die retinale Mikrovaskulatur und ihre mögliche Rolle als Risikofaktor für die Entwicklung von Augenerkrankungen auf.

To assess the variability in wavefront aberrations with short-term wear of photochromic senofilcon A contact lenses in both its activated and inactive states.In this cross-sectional study, 20 participants who had previously used soft contact lenses were enrolled. Corneal aberrometry measurements were performed on each subject, without contact lenses, using Sirius Scheimpflug-Placido topography. The photochromic lenses were illuminated using a blue-violet light (The average contact lens sphere power was - 2.33 ± 1.07 D. The mean refractive errors with contact lens wear were 0.07 ± 0.18 D for the sphere and - 0.26 ± 0.15 D for the cylinder. The mean RMS values for all the corneal aberrations showed no statistically significant differences with and without contact lenses (p 0.05). In a bivariate correlation analysis, there was a positive correlation between contact lens sphere power and coma (vertical and horizontal) in the activated state (r = 0.455, p = 0.44 and r = 0.495, p = 0.27, respectively).The photochromic contact lenses did not influence ocular aberration during short-term wear, even when the photochromatic additive was activated. This property may help to provide more comfortable vision with lens wear. This finding needs to be verified by further studies.Untersuchung der Variabilität der Wellenfrontaberrationen beim kurzfristigen Tragen von photochromen Senofilcon-Kontaktlinsen im aktivierten wie auch im inaktiven Zustand.20 Teilnehmer, die zuvor weiche Kontaktlinsen getragen hatten, nahmen an dieser Querschnittsstudie teil. Die aberrometrischen Messungen der Hornhaut wurden bei jedem Probanden ohne Kontaktlinsen mit der Sirius Scheimpflug-Placido-Topografie durchgeführt. Die photochromen Linsen wurden mit blauviolettem Licht (λmax = 420 nm) beleuchtet, um einen aktivierten Zustand zu erzeugen, und die Messungen wurden mit den Linsen in beiden Zuständen durchgeführt. Der RMS (root mean square) der Aberrationen wurde berechnet und die Aberrationen höherer und niedrigerer Ordnung, Astigmatismus, Koma, sphärische Aberration und Trefoil-Messungen wurden mit einem Pupillendurchmesser von 5,0 mm ausgewertet.Die durchschnittliche Stärke der Kontaktlinsen betrug − 2,33 ± 1,07 dpt. Die durchschnittlichen Brechungsfehler beim Tragen von Kontaktlinsen betrugen 0,07 ± 0,18 dpt für die Sphäre und − 0,26 ± 0,15 dpt für den Zylinder. Die mittleren RMS-Werte für alle Hornhautdefekte zeigten keine statistisch signifikanten Unterschiede mit und ohne Kontaktlinsen (p 0,05). Eine bivariate Korrelationsanalyse zeigte eine positive Korrelation zwischen Kontaktlinsenstärke und Koma (vertikal und horizontal) im aktivierten Zustand (r = 0,455; p = 0,44; enr = 0,495; p = 0,27, entsprechend).Die photochromen Kontaktlinsen hatten keinen Einfluss auf die okulare Aberration während des kurzzeitigen Tragens, selbst wenn der photochrome Zusatzstoff aktiviert war. Diese Eigenschaft kann zu einer komfortableren Sicht beim Tragen von Kontaktlinsen beitragen. Dieses Ergebnis muss durch weitere Studien überprüft werden.

CLINICAL RELEVANCE: The SARS-COV 2 virus, which is responsible for the COVID-19 pandemic, acts on the angiotensin converting enzyme 2 (ACE-2) receptor in the host cell. Ocular effects may occur because of the ACE-2 receptor in the retina. BACKGROUND: To investigate the impact of COVID-19 on the retinal layers and optic disc parameters in previously confirmed COVID-19 patients using spectral domain optical coherence tomography (SD-OCT). METHODS: This study included 60 eyes of 60 subjects; 35 of them were in the COVID-19 group and the remaining 25 were in the control group. Patients with the diagnosis of COVID-19 that had a negative result after treatment were included in the study. Macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements, each retinal layer thickness of all participants were done 14-30 days after COVID-19 symptom onset, following the negative result of real time reverse transcriptase-polymerase chain reaction test using SD-OCT. RESULTS: The mean value of central macular thickness was significantly higher in the COVID-19 group than the control group (p = 0.02). The mean values of the ganglion cell layer and inner nuclear layer thickness in the COVID-19 group were signii¬cantly thinner than control group (p = 0.04 and p = 0.04, respectively). Even though mean RNFL thickness measurements in all sections in the COVID-19 group was thinner than controls, there were no significant differences between groups (p > 0.05 for all). CONCLUSION: In the early recovery phase, changes in the macula, ganglion cell layer and inner nuclear layer could be seen. These patients should be followed up closely for the recognition of new pathologies that could be seen in the late recovery phase.

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To investigate topographic, tomographic, topometric, densitometric, and aberrometric parameters in subclinical keratoconus with the Pentacam HR imaging system. Data of 3128 patients were evaluated, finding in 108 patients clinical keratoconus in one eye and subclinical keratoconus in the other. Corneal topographic, tomographic, topometric, densitometric, and aberrometric values obtained using the Pentacam HR imaging system were compared between clinical keratoconus, subclinical keratoconus, and normal eyes. Comparing eyes with subclinical keratoconus and the control group, while flat K, horizontal coma, horizontal trefoil, and vertical trefoil values were similar (p > 0.05 for each), all other parameters were significantly different (p

To conduct an evaluation of the effects of irregular astigmatism on the retinal nerve fiber layer (RNFL) and the retinal layers observed using spectral-domain optical coherence tomography (SD-OCT) in patients who had keratoconus (KC).A total of 255 eyes from 255 individuals, comprising 72 eyes of KC patients, 70 eyes of patients with astigmia, and 113 eyes of healthy controls were included in the analysis. RNFL scan maps (comprising global, temporal, superotemporal, inferotemporal, nasal, inferonasal, and superonasal maps) and macular thickness (MT) maps of a standard from the Early Treatment Diabetic Retinopathy Study (ETDRS) grid were assessed. The measurements were segmented automatically using Spectralis software, and included the RNFL, inner and outer plexiform layers (IPL, OPL), inner and outer nuclear layers (INL, ONL), ganglion cell layer, retinal pigment epithelium (RPE) in the central 6-mm ETDRS subfield.The RNFL thickness in the KC group was lower when compared with the other two groups; however, statistically significant differences were noted in the global, temporal, superotemporal, and inferotemporal sectors (p 0.05 for all). All of the central MT parameters showed significant variation among the groups, while a statistically significant decrease was noted in the KC group, except in the inferior outer sector (p = 0.741). In the segmentation analysis, the KC group had the significantly lowest IPL, ONL, RPE, and outer retinal layer (ORL) thickness among the groups (p 0.05 for each). The astigmatic group was similar to the control group with regard to these parameters (p 0.05 for each).The eyes in the KC group appeared to have a thinner RNFL and MT when compared to those in the astigmatic and control groups. The ORLs, especially the ONL and RPE, were the most affected component of the macula in the KC group.Es sollte eine Bewertung der Auswirkungen von irregulärem Astigmatismus auf die retinale Nervenfaserschicht (RNFL) und die Netzhautschichten durchgeführt werden, die bei Patienten mit Keratokonus (KC) mittels optischer Kohärenztomografie (SD-OCT) im Spektralbereich beobachtet wurden.Insgesamt 255 Augen von 255 Personen, davon 72 Augen von KC-Patienten, 70 Augen von Patienten mit Astigmatismus und 113 Augen von gesunden Kontrollpersonen, wurden in die Analyse eingeschlossen. RNFL-Scankarten (umfassend globale, temporale, superotemporale, inferotemporale, nasale, inferonasale und superonasale) und Makuladickekarten (MT-Karten) eines Standardrasters der Early Treatment Diabetic Retinopathie Study (ETDRS) wurden bewertet. Die Messungen wurden automatisch mit der Spectralis-Software segmentiert und umfassten die RNFL, innere und äußere plexiforme Schicht (IPL, OPL), innere und äußere Kernschicht (INL, ONL), Ganglienzellschicht, retinales Pigmentepithel (RPE) im zentralen 6-mm-ETDRS-Unterfeld.Die RNFL-Dicke in der KC-Gruppe war im Vergleich zu den anderen beiden Gruppen geringer; jedoch wurden statistisch signifikante Unterschiede in den globalen, temporalen, superotemporalen und inferotemporalen Sektoren festgestellt (p 0,05 für alle). Alle zentralen MT-Parameter zeigten eine signifikante Variation zwischen den Gruppen, während eine statistisch signifikante Abnahme in der KC-Gruppe festgestellt wurde, außer im unteren äußeren Sektor (p = 0,741). In der Segmentierungsanalyse wies die KC-Gruppe die signifikant niedrigste IPL, ONL, RPE-Schicht und die signifikant niedrigste Dicke der äußeren Netzhautschicht (ORL) unter den Gruppen auf (jeweils p 0,05). Die astigmatische Gruppe war hinsichtlich dieser Parameter der Kontrollgruppe ähnlich (jeweils p 0,05).Diejenigen in der KC-Gruppe schienen im Vergleich zu denen in der Astigmatismus- und Kontrollgruppe eine dünnere RNFL und MT zu haben. Die ORLs, insbesondere ONL und RPE, waren die am stärksten beeinflusste Komponente der Makula in der KC-Gruppe.

Purpose: To quantify the vessel density of the macula and optic disc and foveal avascular zone (FAZ) in healthy children and to evaluate the effects of age, gender, axial length, body mass index (BMI), and refractive errors on vessel density and FAZ. Methods: This study enrolled 92 eyes of 92 participants (42 boys and 50 girls). Optical coherence tomography angiography (OCTA) was performed using AngioVue (Avanti; Optivue). FAZ area, nonflow area, superficial and deep vessel density, FAZ perimeter, acircularity index of FAZ, foveal density, and radial peripapillary capillary vessel density were analyzed by gender. Correlations between the investigated OCTA parameters and age, axial length, and BMI were evaluated. Results: Girls had significantly larger nonflow and FAZ area than boys ( P = .01 and .02). Superficial and deep vessel density at the fovea was significantly higher in boys compared to girls ( P = .01 and .03). Inferior temporal and superior temporal Radial peripapillary capillary vessel densities were significantly higher in girls than boys ( P = .01 and .03). No significant difference was found in the macular and optic disc vessel density measurements within refractive groups ( P > .05, for all). Regarding the correlation of age with FAZ and vessel density parameters, only nonflow area was positively correlated with age ( r = 0.22, P = .03). Conclusions: This study provides normative data for children. Although boys had greater foveal vessel density, girls had greater FAZ area and nonflow area. Refractive status of the eye and BMI did not influence the OCTA parameters. Although nonflow area was positively correlated with age, other parameters were steady within the ages of 7 to 18 years. [ J Pediatr Ophthalmol Strabismus . 2020;57(6):388–398.]

To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients.This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV‑IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire).A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Objectives To investigate the surgical results of the inferior oblique muscle Z-myotomy in patients with inferior oblique muscle overaction (IOOA). Materials and methods The medical records of patients who had undergone inferior oblique muscle Z-myotomy for primary IOOA in a single center between 2017 and 2018 were retrospectively analyzed. All patients had mild IOOA (+1 and between +1 and +2). Preoperative and postoperative IOOA degrees and ocular motility examinations were evaluated. Inferior oblique muscle Z-myotomy is performed at 6 mm along the physiological muscle line after identifying the lower oblique muscle through an inferotemporal fornix incision. Results Forty-seven eyes of 44 patients were included in the study. The patients were divided into those with +1 IOOA (n=37, 78.7%) and those with +1-2 IOOA (n=10, 21.3%). The mean age of the +1 group was 14.18±11.8 years and the mean age of the +1-2 group was 13.40±7.45 years. The mean follow-up time was 10.56±8.7 (6-17) months. Bilateral Z-myotomy was performed in 3 (6.8%) and unilateral in 41 (93.2%) of the patients. IOOA correction was observed in 43 (91.4%) of the 47 eyes after Z-myotomy, while 4 (8.6%) eyes still had preoperative levels of IOOA. There was no statistically significant difference in surgical success rate between the groups (p=0.849). When preoperative and postoperative IOOA values were compared, there was a statistically significant decrease in IOOA values in the postoperative period (p=0.001). No intraoperative or postoperative complications were observed. Conclusion Inferior oblique Z-myotomy is a simple, fast, sutureless surgical procedure in which the original muscle insertion is preserved. Z-myotomy of the inferior oblique muscle can be used as a successful attenuation method in patients with minimal IOOA.

The aim of this study was to image the radial peripapillary capillary vessel densities (RPCvds) of the affected eyes and fellow unaffected eyes of individuals with unilateral pseudoexfoliation syndrome (PES) using optical coherence tomography angiography (OCTA) and to compare the RPCvds with those of normal age-matched individuals. The eyes were divided into three groups: the pseudoexfoliative material (PXM)–positive eyes of patients with clinically unilateral PES (study eyes), the fellow eyes of the PXM-positive patients (fellow eyes), and the eyes of healthy patients (control eyes). Those patients with glaucomatous findings, including peripapillary hemorrhaging, cupping, notching, focal thinning of the neuroretinal rim, or intraocular pressure readings greater than 21 mmHg, were excluded from the study. The RPCvd (%), peripapillary retinal nerve fiber layer (RNFL) thickness (μm), cup/disc area ratio, rim area (mm2), disc area (mm2), and cup volume (mm3) were automatically calculated via OCTA. This cross-sectional comparative prospective study included 128 eyes of 88 patients: 40 PXM-positive eyes, 40 fellow eyes, and 48 control eyes. The RPCvds and RNFL thicknesses in the peripapillary region were significantly lower in the study eyes than in the fellow eyes and the control eyes (p = 0.011 and p = 0.011, p = 0.009 and p = 0.004, respectively). There were no significant differences between the fellow eyes and the control eyes with regard to the RPCvd and RNFL values in any region (p > 0.05 for all). Lower RPCvds could provoke capillary deficiency and deterioration of the perfusion of the optic nerve head in patients with PES.

Purpose: To investigate corneal biomechanical properties in patients with childhood obesity. Methods: The study included 47 patients with childhood obesity (study group) and 39 healthy patients (control group). Corneal hysteresis, corneal resistance factor, corneal compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Ocular Response Analyzer (Reichert, Ophthalmic Instruments, Buffalo, NY) in each eye. Central corneal thickness (CCT), anterior chamber angle (ACA), anterior chamber volume (ACV), and anterior chamber depth (ACD) measurements were obtained by the Pentacam rotating Scheimpflug camera (Oculus Optikgeräte GmBh, Wetzlar, Germany). Results: The mean corneal hysteresis was 10.56 ± 1.52 mm Hg in the study group and 11.16 ± 1.92 mm Hg in the control group ( P = .022). The mean IOP was 14.9 ± 2.0 mm Hg in the study group and 14.1 ± 1.3 mm Hg in the control group ( P = .003). Corneal hysteresis showed a significant, positive correlation with corneal resistance factor ( P < .001, r = 0.851), IOPg ( P = .044, r = 0.213), CCT ( P < .001, r = 0.477), and IOP ( P = .005, r = 0.295). Corneal hysteresis showed a significant, negative correlation with IOPcc ( P = .001, r = −0.355), ACA ( P = .005, r = −0.294), ACV ( P = .019, r = −0.246), and ACD ( P = .046, r = −0.211). Conclusions: Patients with childhood obesity have lower corneal hysteresis and higher IOPcc measurements when compared with healthy patients. Corneal tissue changes may occur in early life in childhood obesity, which could lead to ocular disease in the future. [ J Pediatr Ophthalmol Strabismus . 2020;57(2):103–107.]

Purpose: To determine the influence of phenylephrine and cyclopentolate on foveal avascular zone (FAZ) and vessel density of macular capillary plexus measurements via optical coherence tomography angiography (OCTA). Materials and Methods: The participants were separated into 2 groups according to the administration of drops. One drop of phenylephrine 2.5% was administered on one eye of each subject in the phenylephrine group (n=30) and one drop of cyclopentolate 1% in the cyclopentolate group (n=30). FAZ parameters and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were calculated via OCTA priorly and at 45 min following the drop administration in both eyes. Vessel density, acircularity index of FAZ, FAZ area, perimeter of FAZ and foveal density-300 were evaluated via OCTA. Results: The vessel density values of fovea in SCP and DCP was 18.51±7.14% and 36.05±8.76% and significantly decreased to 16.16±6.26% and 33.29±9.47% respectively after drop instillation in dilated eyes in phenylephrine group (p=0.041 and p=0.032). Likewise, the vessel density values in SCP and DCP were 21.56±7.74% and 39.27±8.76% and significantly decreased to 18.89±7.32% and 35.36±5.75% respectively, after drop instillation in dilated eyes in cyclopentolate group (p=0.035 and p=0.028). However, there was no significant difference between before and after instillation of drops in terms of foveal density-300 value via FAZ assessment tool in both dilated and nondilated contralateral eyes in both groups (p>0.05 for all). Conclusions: Mydriasis with phenylephrine and/ or cyclopentolate did not affect the foveal density-300 values while analyzing the perfusion of macula. Vessel density in foveal region should be evaluated via FAZ evaluation software of the OCTA.

The severe acute respiratory syndrome coronavirus 2 virus, which causes the coronavirus disease 2019 (COVID-19) pandemic, can bind to epithelial cells in the human cornea and conjunctiva, which may result in changes of corneal and lenticular densitometry.We aimed to report the corneal and lenticular clarity of patients who had been diagnosed previously with confirmed infection of COVID-19.This was a prospective, cross-sectional study. Fifty-three patients who had recovered from COVID-19 and 51 healthy individuals who had not had COVID-19 (control) were included in this study. Measurement of the corneal (at a corneal diameter of 12 mm) and lens densitometry of participants was performed using a Pentacam HR Scheimpflug imaging system. Three different optimal depths as anterior, central, and posterior layers and four concentric zones, consisting of diameters of 0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm, were chosen to perform the corneal densitometric measurements. The mean lenticular densitometric values were calculated in zone 1 at 2.0 mm, zone 2 at 4.0 mm, and zone 3 at 6.0 mm by taking the central part of the pupil as reference point.When compared with the individuals in the control group, the corneal densitometry measurements in the patients in the COVID-19 group were considerably higher in anterior 0 to 2 mm, 2 to 6 mm, 6 to 10 mm zones and total diameter; center 0 to 2 and 2 to 6 mm zones and total diameter; posterior 0 to 2 mm zone; and total corneal 0 to 2 and 2 to 6 mm zones and total diameter (P.05, for each). When compared with the individuals in the control group, all of the lens densitometry measurements, except for those located in zone 1, were determined to be significantly higher among the patients in the COVID-19 group (P.05, for each).Significant alterations were found in corneal and lenticular densitometric values in patients who had had COVID-19. The virus could adversely affect cornea and lens transparency.

To investigate whether abnormal glucose metabolism in diabetes mellitus (DM) affects the retinal microcirculation of children with well-controlled type 1 DM and to compare these results with those obtained from healthy children.Cross-sectional prospective study.This study enrolled 60 patients with DM without clinically detectable diabetic retinopathy (DR) and 57 age-matched control subjects. Optical coherence tomography angiography (OCT-A) was performed using AngioVue (Avanti, Optivue). Foveal avascular zone (FAZ) area, nonflow area, superficial and deep vessel densities, FAZ perimeter, acircularity index of FAZ (AI; the ratio of the perimeter of FAZ and the perimeter of a circle with equal area), and foveal density (FD-300; vessel density in 300 μm around FAZ) were analyzed. Correlations between the investigated OCT-A parameters with DM duration and glycated hemoglobin (HbA1c) levels were evaluated among patients with type 1 DM.Differences in the mean values for FAZ perimeter, AI, and FD-300 were statistically significant between DM group and control group (P.001, P = .001, and P = .009, respectively). There were also statistically significant differences between the groups for vessel densities of deep superior hemi-parafovea, deep temporal parafovea, and deep superior parafoveal zones (P = .008, P = .015, and P = .005, respectively). There were no significant correlations between DM duration and HbA1c levels with the investigated OCT-A parameters.Diabetic eyes without clinically detectable DR exhibited alterations in FD-300, AI, perimeter, and vessel density of parafoveal capillaries in deep capillary plexus preceding the enlargement of FAZ; therefore, these new parameters might be sensitive imaging biomarkers to define early DR.

PURPOSE To evaluate the ocular surface characteristics based on Schirmer's test, tear break-up time (TBUT), and conjunctival impression cytology (CIC) in children with Hashimoto's thyroiditis (HT). METHODS This study included 51 children with HT and 53 control subjects. The ocular surface characteristics of participants were assessed via Schirmer's test, TBUT, and CIC. Conjunctival samples were examined cytologically according to the Nelson grading system. RESULTS Schirmer's and TBUT results were significantly lower in HT group (p < .05). All samples in both the study and control groups were evaluated as grade 0 according to the Nelson classification (p = .841), however, goblet cell density (GCD) was significantly lower in HT group (p = .001). Schirmer test results were significantly associated with the duration of HT (p = .025, r = -0.311). CONCLUSION Hashimoto's thyroiditis without any ocular complaints may cause ocular surface changes with TBUT and Schirmer's. Although CIC analysis showed similar grading results, GCD was significantly decreased in HT group.

Aim To evaluate the tomographic indices changes in keratoconic eyes which were classified as unilateral and bilateral non-progressive keratoconus according to the definition of Global Consensus on keratoconus and ectatic disease. Methods Fifty non-progressive fellow eyes of 50 keratoconus patients who underwent corneal cross-linking treatment for the other progressive eyes (group 1), 50 eyes of 50 keratoconus patients who were followed up as bilateral non-progressive keratoconus (group 2), and 50 eyes of 50 control subjects (group 3) were included in this retrospective study. Topographic, topometric, and Belin–Ambrosio Enhanced Ectasia Display-III indices were recorded at baseline and after six months. Results Groups were similar in terms of age and gender. The changes in topographic parameters and topometric indices were similar among the three groups (p > 0.05 for all values). The maximum pachymetric progression index (PPImax), maximum Ambrosio relational thickness (ARTmax), and final D significantly increased at sixth-months in group 1 (p 0.05 for all values). ARTmax, PPImax, and final D value changes indicated a statistically significant difference among the groups using the one-way ANOVA test (p = 0.03, p = 0.007, and p = 0.03 respectively). The Bonferroni posttest revealed that these values increased at a higher rate in group 1 than in group 2 (p = 0.03, p = 0.01, and p = 0.04 respectively) and group 3 (p = 0.04, p = 0.03, and p = 0.04, respectively). Conclusions Fellow eyes of keratoconus patients who have underwent CXL for their progressive eyes may be more prone to progress than the patients who have no progression in both eyes. Screening unilateral non-progressive patients more closely than those with bilateral non-progressive patients and evaluating the changes in final D, ARTmax, and PPImax values may be helpful in the follow up of non-progressive keratoconus.

PURPOSE To investigate the possibility of detecting presumed corneal blood staining after traumatic hyphema with corneal densitometry and to evaluate corneal transparency after hyphema resolution. METHODS Twenty-eight patients with uniocular nonpenetrating ocular trauma with hyphema were included in the study. Corneal densitometry measurements were performed at the first week and the first month after full resolution of blood in the anterior chamber and discontinuation of medication. The uninjured eyes were accepted as the control group. RESULTS The corneal densitometry values at all zones of the posterior layer in the study eyes were significantly higher at the first week compared with the first month (P < 0.05 for all). Comparison of the corneal densitometry values of the study eyes at the first week with the fellow eyes showed significantly higher values at all zones of the posterior corneal layer (P < 0.05 for all). Comparison of the study eyes at the first month with the fellow eyes was significantly higher at the posterior 0- to 2-, 2- to 6-, and 6- to 10-mm zones (P = 0.030, P = 0.044, and P = 0.035, respectively). Although corneal densitometry values at the posterior 10- to 12-mm and posterior total zones were higher at the first month compared with those of the fellow eyes, these differences were not statistically significant (P = 0.197 and P = 0.085, respectively). CONCLUSIONS Corneal densitometry at all zones of the posterior corneal layer significantly changed after traumatic hyphema. Corneal densitometry analysis could be used in clinically normal cases for possible early corneal blood staining detection.

Objectives To evaluate the additive effect of topical nepafenac on pupil diameter (PD) in patients with diabetes mellitus (DM) and cataract. Methods This prospective comparative study included the patients having cataract surgery with and without DM. Two consecutive PD measurements were taken using an automatic quantitative pupillometry system (MonPack One, Metrovision). A baseline measurement was taken, then one drop of nepafenac % 0.1 (Nevanac; Alcon, Fort Worth, TX) was instilled only to the eye that will be operated on (study eye). Cyclopentolate 1.0% (Sikloplejin; Abdi Ibrahim, Istanbul, Turkey) was instilled to both eyes (study eye/fellow eye) 5 minutes later. The second measurement was taken at 1 hour after this application. Results The DM group consisted of 43 patients, and the control group consisted of 39 participants. The baseline PDs of both eyes were similar in the DM group (P=0.070) and the control group (P=0.345). The change in pupil size from baseline to mydriasis was statistically significantly greater in the study eyes (2.69±0.53) than fellow eyes (2.54±0.61) in the DM group (P=0.009), but there was no statistically significant difference in the control group (2.94±0.63 vs. 2.86±0.58). When the groups were compared, the PD changes were similar in the study eyes between groups (P=0.065), while the PD changes in the fellow eyes were lower in the DM group (P=0.017). Conclusions Nepafenac has been shown additive effect on pupil dilation in diabetic patients before cataract surgery.

Purpose: To evaluate the morphological, clinical, and tomographic characteristics of focal choroidal excavation in the context of concomitant retinal pathologies. Methods: This case series included 13 eyes of 13 patients with focal choroidal excavation diagnosed by spectral-domain optical coherence tomography. Morphologic characteristics of excavation and quantitative thicknesses of retinal layers and choroid were analyzed in excavation area, area adjacent to excavation, and fellow eye without focal choroidal excavation by spectral-domain optical coherence tomography. Results: At the initial examinations, one eye had a history of blunt trauma, three eyes were diagnosed with choroidal neovascularization, one with choroidal osteoma, one with angioid streaks, one with retinal detachment, one with diabetic macular edema, one with optic pit, one with torpedo maculopathy, and the rest three with idiopathic focal choroidal excavation. The mean choroidal thickness in the area of focal choroidal excavation was statistically significantly thinner compared to in the area adjacent to focal choroidal excavation and fellow eye ( p Conclusion: This study confirmed the presence of focal choroidal excavation in various ocular diseases and the evaluation of focal choroidal excavation using the spectral-domain optical coherence tomography demonstrated choroidal thinning and outer nuclear layer thickening in the area of the excavation.

To investigate the effects of iron deficiency anemia (IDA) on radial peripapillary capillary vessel density (RPCvd) and retinal nerve fiber layer (RNFL) thickness.Forty patients with IDA, and 46 healthy participants, were enrolled in this study. Optical coherence tomography angiography was used to determine RNFL thickness and RPCvd measurements. In addition, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ferritin laboratory values were evaluated.Analysis of retinal regions (whole images, peripapillary, superior-hemi, inferior-hemi, inferior-nasal, inferior-temporal, temporal-inferior, temporal-superior, superior-nasal) showed that RPCvd values were significantly lower in patients with IDA compared to the control group values (p 0.05 for all). However, there were no significant differences in RNFL thickness values between the IDA patient group and the control group (p 0.05 for all). In addition, there were significant positive correlations between RPCvd values and hematological values for Hb, HCT, MCV, MCH, MCHC, and ferritin.It is important to identify changes in retinal vascularity to prevent possible ocular problems in patients with IDA. Specifically, the significant positive correlations between RPCvd values and hematological values suggest that anemia treatment is important for optic nerve perfusion.

Purpose: To investigate the corneal topometric and tomographic findings that can be used in the diagnosis of subclinical keratoconus. Methods: A retrospective cohort study. The study group was selected from patients with clinically evident keratoconus in one eye and subclinical keratoconus without evident topographic findings in fellow eye. The age-matched control group was selected from patients who were candidates for laser in situ keratomileusis (LASIK) and did not develop ectasia after LASIK surgery at least 1-year follow-up. All subjects underwent topographic, topometric and tomographic (Belin-Ambrósio Enhanced Ectasia Display III) analyses via a Pentacam HR rotating Scheimpflug camera (Oculus, Germany, version 1.20r.98) before LASIK surgery. Results: The study group consisted of 151 patients (69 male and 82 female, mean age of 24.8 ± 7.2 years) and the control group also consisted of 150 patients (70 male and 80 female, mean age of 26.0 ± 6.3 years). There were statistically significant differences in all measured topometric (p?.05) and tomographic (p?.001) parameters between the eyes with subclinical keratoconus and those of the control group. In discriminating eyes with subclinical keratoconus from normal eyes, final D showed the highest area under curve value (0.858, sensitivity 85.2%, specificity 66.7%), followed by maximum pachymetric progression index (0.809, sensitivity 81.9%, specificity 69.4%) and average pachymetric progression index (0.796, sensitivity 81.9%, specificity 68.1%) in receiver operating characteristic analysis. Conclusion: Topometric and tomographic parameters might be useful for early detection of keratoconus, but the sensitivity and specificity of any parameter are not high enough to be used alone.

Purpose: To determine the correlation between the extent of disorganization of the retinal inner layers (a parameter of spectral domain optical coherence tomography) and optical coherence tomography angiography parameters in eyes with center-involved macular edema associated with retinal vein occlusion. Methods: This retrospective observational study included 34 eyes of 34 patients with newly diagnosed macular edema associated with retinal vein occlusion and evidence of center-involved macular edema. Optical coherence tomography angiography and spectral domain optical coherence tomography were evaluated after resolution of the macular edema. Disorganization of the retinal inner layers was determined via spectral domain optical coherence tomography and optical coherence tomography angiography parameters, including foveal avascular zone area in the superficial capillary plexus and capillary nonperfusion areas, foveal avascular zone area in full retinal vasculature, foveal avascular zone perimeter, acircularity index of the foveal avascular zone, and foveal density. Results: The mean disorganization of the retinal inner layers extent was 512.72 ± 238.47 microns, and the mean capillary nonperfusion area was 4.98 ± 2.85 mm2. There was a positive correlation between the extent of disorganization of the retinal inner layers and capillary nonperfusion area (p

Uzel, Mehmet Murat (Balikesir Author), Purpose: To investigate the usefulness of systemic inflammatory markers [i.e., white blood cell and platelet counts, mean platelet volume, and their ratios] as diagnostic markers of the pathogenesis of diabetic macular edema. Methods: The study cohort included 80 diabetic macular edema patients (40 with diabetic retinopathy and 40 without) and 40 healthy age- and sex-matched controls. Neutrophil, lymphocyte, monocyte, and platelet counts, and the mean platelet volume were determined from peripheral blood samples, and the monocyte/lymphocyte, platelet/lymphocyte, and mean platelet volume/lymphocyte, and neutrophil/lymphocyte ratios were calculated and compared among groups. Results: The mean neutrophil/lymphocyte ratio of the diabetic macular edema and non-diabetic macular edema groups was higher than that of the control group, and the value of the diabetic macular edema group was higher than that of the non-diabetic macular edema group (p= 2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with a sensitivity of 85% and specificity of 74%. The mean platelet volume of the diabetic macular edema group was higher than those of the non-diabetic macular edema and control groups, while those of the non-diabetic macular edema and control groups were similar (diabetic macular edema vs. non-diabetic macular edema, p=0.08; diabetic macular edema vs. control, p=0.02; and non-diabetic macular edema vs. control, p=0.78). All other parameters were similar between groups (all p>0.05). Conclusion: The neutrophil/lymphocyte ratio and mean platelet volume of the diabetic macular edema group were higher than those of the non-diabetic macular edema and control groups. A neutrophil/lymphocyte ratio cutoff value of >= 2.26 was identified as an indicator of the pathogenesis of diabetic macular edema with high sensitivity and specificity. Moreover, the neutrophil/ lymphocyte ratio of the non-diabetic macular edema group was higher than that of the control group.

PURPOSE To assess the decentration and angle of tilt of the intraocular lens (IOL) according to the intravitreal tamponade types used in combined phacoemulsification and vitreoretinal surgery. METHODS This prospective and randomized clinical study involved 73 eyes of 69 patients who underwent combined vitreoretinal surgery. Eyes with intravitreal tamponades formed the study group and eyes without intravitreal tamponades formed the control group. The study group was further divided into silicone oil and gas tamponade subgroups. Cross-sectional IOL images were captured using a Pentacam HR (Oculus, Germany) and tilt and decentration were calculated with Adobe Photoshop software (Adobe, San Jose, CA). RESULTS The mean angle of tilt and decentration at the vertical meridian were significantly higher in both tamponade groups than in the control group (P 0.05). When comparing the silicone oil and gas tamponade subgroups, no significant differences were noted on the position of IOL at both meridians (P > 0.05 for all). CONCLUSION Intravitreal tamponades have an important effect on the position of IOL in combined vitreoretinal surgery. Silicone oil and gas tamponades may induce postoperative tilt and decentration of one-piece acrylic IOLs.

To quantitatively measure the flow, nonflow, density, and foveal avascular zone (FAZ) assessment tool parameters of optical coherence tomography angiography (OCTA) in patients with nonocular Behcet's Disease (BD), and to compare the results with those obtained in healthy controls.FAZ parameters, flow area of choriocapillaris, and vessel density values of both superficial (SCP) and deep capillary plexuses (DCP) were measured using OCTA.The FAZ area in SCP, FAZ area in full retinal vasculature, and FAZ perimeter were significantly higher and foveal density-300 was significantly lower in the BD group than in the control group (p = 0.008, p = 0.015, p = 0.011, and p = 0.045, respectively). Vessel density of the foveal region in SCP and DCP were significantly lower in the BD group than in the control group (p = 0.039 and p = 0.010).Lower capillary vessel densities, particularly in the foveal region, could be considered a subclinical form of ocular involvement in nonocular BD.

Background To investigate whether abnormal glucose metabolism and duration of diabetes mellitus (DM) caused the thinning in retinal layers in children with type 1 DM without retinopathy by using spectral domain optical coherence tomography (SD-OCT) and to compare the results obtained with those in healthy children. Methods This cross-sectional prospective study included 73 patients with type 1 DM (DM group) and 62 age-matched control subjects (control group). The duration of DM and the glycosylated haemoglobin (HbA1c) levels of the diabetic children were recorded. Macular and peripapillary retinal nerve fibre layer (RNFL) thickness measurements obtained by SD-OCT were compared. Results There were significant differences in the mean values of the temporal inner, temporal outer and inferior outer macular thickness measurements between the groups (p = 0.031, p = 0.028 and p = 0.039, respectively). Moreover, the children with type 1 DM showed significantly thinner global, temporal superior and nasal inferior RNFL thickness measurements compared to the controls (p = 0.035, p = 0.022 and p = 0.034, respectively). Additionally, both the mean duration of DM and the mean HbA1c values were inversely and statistically significantly correlated with the mean temporal outer macular thickness and global RNFL thickness measurements in the DM group. Conclusions Retinal neural changes, which can be shown by SD-OCT, may be present in diabetic eyes even before clinically detectable retinal vasculopathy. Macular and RNFL thickness measurements might be useful indicators for early detection of diabetic retinopathy in the future.

To investigate the effect of Helicobacter pylori (H. pylori) infection on choroidal thickness (CT) and retinal nerve fiber layer thickness (RNFLT). The study included 25 patients with H. pylori infection and 25 healthy individuals as the control group. Helicobacter pylori patients were classified as the pre-treatment (Group 1; n: 25) and the post-treatment (Group 2; n: 25). RNFLT and CT were measured before and after treatment of H. pylori infection, using enhanced depth imaging (EDI) spectral-domain optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany). The axial length and intraocular pressure were also measured. The mean subfoveal CT was 320.96 ± 29.15 μm in Group 1 and 287.48 ± 49.17 in the control group (p = 0.007), while the mean subfoveal CT did not show any difference between Group 2 and the control group (p > 0.05). No statistically significant difference was determined between the H. pylori patients and the control group in respect of RNFLT values (p > 0.05). CT increases during H. pylori infection and returns to the normal range within 6 weeks of treatment. RNFLT does not show any change during H. pylori infection. The data related to the subfoveal CT may be useful in understanding the pathogenesis of central serous chorioretinopathy developing in H. pylori patients.

To quantitatively analyze the microcirculation in the peripapillary sectors in the affected eyes and fellow unaffected eyes of individuals with unilateral Fuchs uveitis syndrome (FUS) using optical coherence tomography angiography (OCTA), and to compare the radial peripapillary capillary vessel density (RPCvd) with normal and age-matched individuals. Eyes were divided into three groups based on the involvement of the FUS: FUS-positive eye of patients (study eye), fellow eye of FUS-positive patients (fellow eye), and the control eye for the control group (control eye). RPCvd (%) and peripapillary retinal nerve fiber layer (RNFL) thickness (μm) at eight equal sectors and two equal hemispheres were automatically calculated in peripapillary region via OCTA. This study included 105 eyes of 71 patients: 34 FUS-positive eyes of 34 patients, 34 fellow eyes of FUS-positive patients, and 37 control eyes of 37 patients. RPCvd was significantly lower in study eyes than in fellow and control eyes in the peripapillary region (p = 0.044 and p = 0.005, respectively). There was no significant difference between fellow eyes and control eyes regarding RPCvd in any region (p > 0.05 for all). There were no significant differences between the three groups regarding peripapillary RNFL values (p > 0.05 for all). OCTA is a novel technology for imaging of the RPC network in patients with FUS. Lower radial peripapillary capillary vessel density in FUS could induce capillary insufficiency and impairment of ocular blood flow to optic nerve head.

To assess the incidence, clinical characteristics, and outcome of postoperative eccentric macular hole (ECMH) after epiretinal membrane (ERM), macular hole (MH), and idiopathic vitreomacular traction (VMT) surgery and discuss the underlying possible mechanisms. A retrospective study was carried out for 711 eyes of 711 consecutive patients who underwent 25-gauge pars plana vitrectomy (PPV) with ERM (396 eyes), MH (268 eyes), and VMT (47 eyes) surgery between 2010 and 2016. Mean follow-up time was 19 months. Eight patients developed ECMH (1.12%). Four of the patients were ERM, three patients were idiopathic full thickness MH, and one patient was ERM and lamellar pseudohole. There was no ECMH in patients with VMT. The average time of hole formation after vitrectomy was 7.25 weeks with a range from 2 to 15 weeks. Three patients developed 2 ECMH, and others had 1 ECMH. The location of the ECMH was mostly in the temporal of fovea. All patients were asymptomatic. No retinal detachment or choroidal neovascularization occurred in any patient and no additional intervention was attempted in the postoperative period in any case. Postoperative ECMH may be seen after vitreomacular interface surgery. They are mostly asymptomatic, usually do not require additional intervention and often located in the parafoveal area. ILM peeling-induced muller cell damage, residual ILM contraction, and iatrogenic trauma may play a role as the underlying cause in our case series.

To compare the static and dynamic pupillometry measurements in patients with pseudoexfoliation syndrome (PES), patients with pseudoexfoliation glaucoma (PEG) and age-matched healthy subjects using an automatic quantitative pupillometry system.This prospective, cross-sectional study consisted of 40 patients with PES, 30 patients with PEG and 43 control subjects. Static pupillometry measurements including scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter were undertaken. Subsequently, dynamic pupillometry measurements including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation were undertaken. These measurements were compared between the groups.The scotopic, mesopic, and low photopic pupil diameter values were statistically significantly lower in patients with PES and PEG compared with controls (p 0.001). However, these parameters were similar between the patients with PES and PEG (p 0.05). The mean values of high photopic pupil diameter were similar within all groups (p = 0.54). The amplitude of pupil contraction values of the patients with PEG was statistically significantly lower than the patients with PES and the controls (p 0.05). Patients with PES also had significantly lower amplitude of pupil contraction values compared with controls (p 0.001). Additionally, the velocity of pupil contraction values was statistically significantly higher in control subjects when compared to the patients with PES and PEG (p 0.05).This study demonstrated that accumulation of pseudoexfoliative material can cause alterations in static and dynamic pupillary characteristics and the progression from PES to PEG may be associated with reduced amplitude of pupil contraction values.

Purpose: To investigate whether diabetes mellitus (DM) affects ocular surface of children with well-controlled type 1 DM. Methods: Sixty-five diabetic patients and 55 age-matched controls enrolled to study. Detailed ocular surface assessment including, ocular surface disease index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test, and conjunctival impression cytologic analysis were performed. Results: Schirmer test and TBUT results were significantly lower in DM group than controls (p = 0.001, for all). OSDI scores of all participants were within normal range. Impression cytology analysis showed grade 0 changes in all participants and there was no difference between groups for goblet cell density (p > 0.05). The TBUT results were significantly associated with duration of DM (r = ?0.309, p = 0.036). Conclusion: Diabetic children without symptoms, signs, and definite diagnosis of dry eye still had lower TBUT and Schirmer test results than controls; however, impression cytology analysis was similar in both groups. © 2019, © 2019 Taylor & Francis Group, LLC.

Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.

To evaluate the longitudinal tomographic changes and to compare the discriminatory potential of a novel progression display between progressive and nonprogressive keratoconic eyes.Retrospective evaluation was made of 81 eyes of 81 patients with keratoconus who had undergone Scheimpflug measurements at least twice with an interval of 12 months or longer between each measurement. The progressive group was defined as 36 eyes, which showed progression according to the definition of the global consensus on keratoconus and ectatic diseases when 2 of the 3 criteria were met, and the other 45 eyes were considered the nonprogressive group. The main outcome measures from progression display were "A" for anterior radius of curvature, "B" for posterior radius of curvature, "C" for thinnest pachymetry, "D" for distance visual acuity; Kmax; Q-value front and back; index of surface variance (ISV), vertical asymmetry, height asymmetry, and height decentration; overall deviation of normality (final D); average pachymetric progression index; and maximum Ambrósio relational thickness.The rate of change per year of A, B, C, thinnest pachymetry, Kmax, final D, and ISV was significantly different between groups (P≤0.01 for all values). It was determined that yearly change rates greater than 0.12 for A, 0.14 for B, 10.04 μm for thinnest pachymetry, 0.68 D for Kmax, 0.15 for final D, and 2.11 for ISV might indicate progression in keratoconus management.Belin progression display parameters may be useful in discriminating progressive from nonprogressive keratoconic eyes.

Purpose:The aim of this study is to perform a comparison of static and dynamic pupillometry measurements in patients with hyperopic anisometropic amblyopia and age-matched controls.Methods:This prospective cross-sectional study consisted of 38 patients with hyperopic anisometropic amblyopia and 80 control subjects. A quantitative pupillometry system was used to evaluate the pupil characteristics of higher hyperopic eyes (Group 1), the fellow eyes (Group 2), and healthy eyes (Group 3). Static pupillometry measurements were taken including scotopic pupil diameter, mesopic pupil diameter, low-photopic pupil diameter, and high-photopic pupil diameter. Subsequently, dynamic pupillometry measurements were taken including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation.Results:Groups 1 and 2 had statistically significantly lower scotopic and high-photopic pupil diameter values compared with Group 3 (p 0.05, for all).Conclusion:Static and dynamic pupil characteristics of higher hyperopic eyes and their fellow eyes are similar. This may support that amblyopia is not a monocular disorder, but can affect both eyes.

PURPOSE: To investigate the corneal biomechanical responses of subclinical keratoconus with normal topographic, topometric, and tomographic findings. METHODS: In this prospective observational study, the study group was selected from patients with clinically evident keratoconus in one eye and subclinical keratoconus with normal topographic, topometric, and tomographic findings in the fellow eye. The control group was selected from candidates for contact lens use. The biomechanical analyses were performed using the Corvis ST (Oculus Optikgeräte, Wetzlar, Germany). The following parameters were analyzed: A1 velocity, A2 velocity, A1 length, A2 length, deformation amplitude ratio, stiffness parameter at the first applanation, Corvis Biomechanical Index, and Tomographic and Biomechanical Index (TBI). RESULTS: The study group consisted of 21 patients (10 men and 11 women; mean age: 27.7 ± 6.9 years), and the control group consisted of 35 patients (17 men and 18 women; mean age: 26.1 ± 5.8 years). No significant differences were found between the eyes with subclinical keratoconus and normal eyes in corrected distance visual acuity and the topographic, topometric, and tomographic parameters ( P > .05). Significant differences were found in the values of A2 length, A1 velocity, A2 velocity, and TBI between the subclinical keratoconus group and the control group ( P < .05). In distinguishing eyes with subclinical keratoconus from normal eyes, the TBI showed the highest area under the curve (0.790; cut-off: 0.29; sensitivity: 67%; specificity: 86%) in the receiver operating characteristic analysis. CONCLUSIONS: Biomechanical analysis with the Corvis ST may be used as a complementary diagnostic method in detecting subclinical keratoconus. [ J Refract Surg . 2019;35(4):247–252.]

PURPOSE The purpose of this study was to perform a comparison of static and dynamic pupillometry measurements in patients with clinically unilateral pseudoexfoliation syndrome (PES) and age-matched controls. METHODS This prospective cross-sectional study consisted of 38 patients with unilateral PES and 40 control participants. A quantitative pupillometry system was used to evaluate the pupil characteristics of eyes with PES (group 1), clinically unaffected fellow eyes (group 2), and healthy eyes (group 3). Static pupillometry measurements including scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD were undertaken. Subsequently, dynamic pupillometry measurements including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation were undertaken. RESULTS There were statistically significant differences between the groups with regard to scotopic PD, mesopic PD, and low photopic PD (P

To evaluate the correlations between corneal endothelial cell properties and corneal densitometry values and to investigate whether corneal densitometry may be used as an indicator of the health of corneal endothelium.Two hundred fifty-three eyes were analyzed in this prospective cross-sectional study. Corneal densitometry was measured with densitometry software of Pentacam HR-Scheimpflug corneal topography over a 12-mm diameter of the cornea. Furthermore, corneal endothelial cell properties including cell density (CD), average cell area, SD of the cell area, coefficient of variation (CV) of the cell area, maximum cell area, minimum cell area, and percentage of hexagonal cells (HEX) were measured by a specular microscope. The correlations were calculated using Pearson correlation tests.The average cell area, SD, maximum cell area, and minimum cell area values were not statistically significantly correlated with the corneal densitometry values in any layer or concentric annulus. CD, CV, and HEX were statistically significantly correlated with the corneal densitometry values in all layers and concentric annuli (P0.05 for each one). Moreover, CD and HEX were inversely and moderately correlated with total corneal densitometry (r = -0.403, P0.001, and r = -0.327, P0.001, respectively), whereas the CV was positively and moderately correlated with total corneal densitometry (r = 0.349, P0.001).Corneal densitometry might have potential to be used as an indicator of the health of corneal endothelium in the future.

To quantify normative corneal optical density (COD) values of healthy individuals and to investigate alterations in the COD in relation to their ocular and demographic characteristics.Prospective, cross-sectional, and observational.In total, 588 eyes from 588 healthy participants with clear corneas were consecutively enrolled. Corneal densitometry values expressed in standardized grayscale units (GSU) from different corneal layers and zones obtained using the rotating Pentacam Scheimpflug system were analyzed.The mean (SD) COD over the 12-mm diameter area was 14.4 ± 2.74 GSU. A significant positive correlation was found between the participants' age and the total COD (r = 0.756, P .001). No significant differences were found between males and females with respect to COD (P = .51). No significant correlation was found between the COD measurements and refractive error, pachymetry, and keratometry (P .05 for all comparisons). On the other hand, COD was negatively correlated with white-to-white (WTW) corneal diameter (r = - 0.415, P .001). Moreover, the WTW corneal diameter was correlated with the COD in any zone and layer of the cornea (P .05 for all comparisons).Wide variations in COD can be detected even in corneas deemed clinically clear. Age and corneal diameter that seem to influence corneal transparency should be taken into account when evaluating corneal backscatter.

To report a case of choroidal neovascularization (CNV) associated with rubella retinopathy (RR) treated with intravitreal aflibercept. A 15-year-old girl presented a complaint of visual decrease in her left eye. She had a history of hearing decrease since she was 1 year old in addition to patent ductus arteriosus. On ocular examination, the best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left eye. Dilated fundus examinations revealed a classic salt-and-pepper appearance in both eyes and a whitish subretinal lesion with retinal hemorrhages in the left macula. Fundus fluorescein angiography (FFA) of the left eye illustrated a pattern of diffuse spotty fluorescence with an active subfoveal CNV lesion, that hyperfluoresces in the early phases of the FFA, maintains well-demarcated borders, and leaks. Spectral domain optical coherence tomography (SD-OCT) revealed thickened and elevated retinal layers at the macula due to the subretinal and intraretinal fluid with foveal and extrafoveal protruding hyper-reflective lesion in the left eye. Single dose of intravitreal aflibercept was performed to the left eye and at the first month after the injection, the BCVA improved to 20/100 and the OCT revealed scar formation. At the follow-up visits, the macula was similar to those at the first month post-injection, and the BCVA was preserved. No additional injections were needed. Intravitreal aflibercept may be a treatment alternative, which provides satisfactory anatomical and functional results and leads to a better visual acuity in cases with RR complicated by CNV.

Purpose To evaluate the repeatability and reliability of Belin-Ambrosio Enhanced Ectasia Display-III indices and topometric indices with a Scheimpflug system (Pentacam HR) in normal eyes and keratoconic eyes. Setting Ulucanlar Eye Research and Training Hospital, Ankara, Turkey. Design Prospective case series. Methods The same operator performed 3 consecutive successive measurements with the Scheimpflug device in the eyes of patients with keratoconus (keratoconus group) and healthy volunteers (normal group). The keratoconus group was further classified into the following 3 subgroups according to the topographic keratoconus classification: early, moderate, and severe. One eye of each volunteer was assigned randomly to a repeatability test. The maximum keratometry (K), 6-parameter topometric indices, and 9 parameter ectasia display indices were recorded. The within-subject standard deviation, precision, repeatability indices, coefficient of variation, and intraclass correlation coefficient (ICC) values were calculated for repeatability and reliability assessments. Results There were 100 patients in the keratoconus group and 100 healthy volunteers in the normal group. The maximum K, topometric indices except for index of height asymmetry, ectasia display indices except for deviation of normality of the front elevation, and deviation of normality of the back elevation were repeatable in normal eyes and keratoconic eyes. The repeatability indices of all parameters increased as the severity of keratoconus increased. The maximum K value and all indices showed good to excellent reliability in both groups (ICC values between 0.750 and 1.0 for all values). Conclusion The maximum K value, most topometric indices, and ectasia display indices were repeatable and reliable in normal eyes and keratoconic eyes.

This study sought to determine normative static and dynamic pupillometry data in different age groups in a healthy population, and to investigate the effects of age on pupillometric characteristics.Pupillometry measurements were undertaken on 155 healthy participants using an automatic quantitative pupillometry system. Static pupillometry measurements were undertaken; these included scotopic pupil diameter (PD), mesopic PD, low photopic PD and high photopic PD values. Dynamic pupillometry measurements were undertaken, including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation and velocity of pupil dilation.Overall, 69 (44.5 per cent) participants were male and 86 (55.5 per cent) were female, with a mean age of 29.7 ± 17.8 years. Neither static nor dynamic pupillometry measurements varied significantly between males and females. Age was inversely and moderately correlated with each of the static pupillometric characteristics (p 0.05). Resting diameter, velocity of pupil contraction, and velocity of pupil dilation values were inversely and moderately correlated with age (p 0.001, r = -0.63; p 0.001, r = -0.47; and p 0.001, r = -0.34, respectively). Latency of pupil contraction was positively and moderately correlated with age (p = 0.002, r = 0.29).The current study presents population-specific normative data on static and dynamic pupillometry values in different age groups and the effect of age on pupillary characteristics.

To evaluate optical coherence tomographic angiography (OCTA) findings on retinal microcirculation in hyperopic anisometropic amblyopia compared with fellow eyes and nonamblyopic control eyes.A total of 40 pediatric patients with hyperopic anisometropic amblyopia and 57 control subjects were recruited, and 137 eyes (40 amblyopic, 40 fellow, and 57 control eyes) were evaluated. Data on best-corrected visual acuity (logMAR), axial length (mm), refractive error, and OCTA findings (foveal avascular zone parameters, macular vascular density in superficial and deep retinal capillary plexus, central macular thickness) were recorded in amblyopic, fellow, and control eyes.Compared with fellow and control eyes, amblyopic eyes were associated with significantly lower foveal vessel density values within 300 μm around the foveal avascular zone (P 0.01) and lower vascular density in certain areas of superficial and deep retinal capillary plexus in axial length- and refraction-adjusted analysis (P 0.05 for all), along with significantly higher full thickness of the central macula (P = 0.04). In amblyopic eyes, best-corrected visual acuity values were negatively correlated with foveal density (r = -0.57; P = 0.02) and deep capillary retinal plexus vascular density in foveal (r = -0.51; P = 0.03) parafovea temporal (r = -0.52; P = 0.03), and parafovea superior (r = -0.51; P = 0.04) areas.Our findings indicate a possible association between retinal microcirculation and amblyopia.