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Purpose To investigate the predictive values of maternal systemic inflammatory markers, such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune-inflammatory index (SII), platelet mass index (PKI), and mean platelet volume (MPV), in treatment-requiring retinopathy of prematurity (TR-ROP). Methods The mothers of the 21 preterm infants who were followed up due to ROP but did not require treatment and the mothers of preterm infants who received ROP treatment (intravitreal injection) (19 patients) were included in the treatment group. The birth weights (BW) and gestational ages (GA) of the infants were recorded. A prenatal maternal complete blood count (CBC) analysis was performed within 3 days before birth. NLR, PLR, LMR, SII, PCI and MPV data were calculated and compared statistically from the complete blood count (CBC) samples of the mothers of the preterm infants who did or did not need ROP treatment. The results were evaluated by adjusting them with logistic regression analysis. Results There was no significant difference between the groups in terms of BW (p = 0.108). The GA was significantly lower in the TR-ROP group compared to the control group (p = 0.04, 26.5 (24–33), 29 (27–32), respectively). Between TR-ROP and control groups, NLR (p = 0.02, 5.9 (3.2–12.9), 4.2 (0.9–11.8)), PLR (p = 0.02, 136.4 ± 27.6, 111.1 ± 37.1), LMR (p = 0.001, 2.06 (1.1–4.2), 3.01 (1.2–5.9)) and SII (p = 0.001) values were significantly different. In the TR-ROP group, when these values were corrected with GA in logistic regression analysis, NLR, PLR, and SII were not statistically significant (p = 0.11, p = 0.83, and p = 0.14), but there was an increase in LMR [p = 0.02, OR = 0.38 95% CI (0.16–0.88)]. Conclusion The prenatal maternal LMR was found to have a statistically significant predictive value for TR-ROP. In the prenatal period, a maternal systemic inflammatory state may be a risk factor for ROP development in the premature baby. Prenatal maternal LMR may be a guide for infants with TR-ROP. Babies who are thought to be at higher risk of TR- ROP may be screened more frequently.

OBJECTIVES To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. METHODS Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). RESULTS Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P

Objectives: To assess the effects of anti-vascular endothelial growth factor (VEGF) drugs on retinal pigment epithelium cell culture. Materials and Methods: Aflibercept (0.5 mg/mL), bevacizumab (0.3125 mg/mL), and ranibizumab (0.125 mg/mL) were applied to retinal pigment epithelium cell cultures isolated from the enucleated eyes of New Zealand white rabbits. Viability, apoptosis, proliferation, and senescence of the cells were evaluated in control and drug-treated cultures at the end of 72 hours. Results: Cells treated with aflibercept showed increased viability and decreased apoptosis compared to the control culture and both the bevacizumab- and ranibizumab-treated groups (p0.05). Conclusion: Anti-VEGF drugs did not affect senescence or proliferation of retinal pigment epithelium cells. Aflibercept was found to decrease apoptosis and increase cell viability, while ranibizumab and bevacizumab increased apoptosis and reduced cell viability in retinal pigment epithelium culture.

PurposeThere have been ongoing clinical trials of therapeutic agents in Huntington's disease (HD) which requires development of reliable biomarkers of disease progression. There have been studies in the literature with conflicting results on the involvement of retina in HD, and up to date there is not a study evaluating the single retinal layers in HD. We aimed to evaluate the specific retinal changes in HD and their usability as potential disease progression markers.MethodsThis cross-sectional study used spectral-domain optical coherence tomography with automatic segmentation to measure peripapillary retinal nerve fiber layer (pRNFL) thickness and the thickness and volume of retinal layers in foveal scans of 15 patients with HD and 15 age- and sex-matched controls. Genetic testing results, disease duration, HD disease burden scores and Unified HD Rating Scales motor scores were acquired for the patients.ResultsTemporal pRNFL, macular RNFL (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer and outer plexiform layer thicknesses and IPL, retinal pigment epithelium and outer macular volume were found lower in HD compared to controls, while outer nuclear layer and outer retinal layer thickness were increased (p

Retinopathy of prematurity (ROP) is one of the major problems of surviving premature infants with several ophthalmic morbidities such as increased risk of refractive errors, strabismus, and cortical visual impairment. Use of propranolol hydrochloride (PH) for the prevention of ROP is a new promising treatment modality. However, long-term effects are still to be defined. In our study, we aimed to investigate the short-term refractive effects of PH used for ROP prophylaxis in very preterm newborns.This is a prospective, randomized, double-blind, placebo-controlled study. Very preterm newborns with a birthweight less than or equal to 1500 g and/or born prior to 32 gestational weeks were included in the study. The subjects were randomly divided into two groups: control group (CG, n = 37) given placebo and PH group (PHG, n = 34) given PH starting from 4 weeks after birth (27.1 ± 2.1 day). PHG patients received PH therapy for about 1 month (25.7 ± 7.8 day). Anthropometric measurements including weight, length, and head circumference were recorded before PH treatment (at birth) and during eye control (at corrected age). Cycloplegic refraction values were measured by retinoscopy at corrected age (CG: 10.3 ± 4.3 months, PHG: 11.4 ± 4.8 months).Anthropometric measurements including gestational age, weight, length, and head circumference were similar at birth and corrected age in both groups. The mean level of spherical refraction was significantly less hyperopic in the PHG than in the CG (CG: 1.37 ± 1.40 D, PHG: 0.37 ± 1.44 D) (p = 0.005).PH may lead to myopic shift by affecting the beta-adrenergic receptors in the choroid or ciliary body of the developing eye. Long-term refractive follow-up is required in order to elucidate the effects of PH on emmetropization process of these very preterm infants.

AIM: To evaluate the retinal vessel diameters in patients with migraine by optical coherence tomography (OCT). METHODS: In this cross-sectional study, 124 eyes of 62 patients with a diagnosis of unilateral migraine during attack-free period and 42 age- and sex-matched control subjects were included. Migraine patients were divided into the ≤2 migraine attacks per month group and the ≥5 migraine attacks per month group. All subjects underwent complete ophthalmological and neurological examinations before measurements. Retinal vessel diameters and choroidal thickness were examined with the Spectralis OCT. RESULTS: The mean diameters of the arteries in the eyes on the headache side of control group, ≥5 migraine attacks per month and ≤2 migraine attacks per month group at 480 µm from the optic disk (Raster 3) were 119.54±46.69, 136.68±25.93 and 119.34±31.75 µm respectively with a steady decline to 105.57±32.15, 118.18±31.87 and 108.05±38.77 µm at 1440 µm (Raster 7), the last measurement point, respectively. The retinal artery diameter measurements were significantly increased in ≥5 migraine attacks per month patients at four out of five measured points compared to control group (P

A 53-year-old woman with hemiparesis and poor dexterity, underwent cosmetic blepharopigmentation on the both upper eyelids in the dermatology clinic of a private hospital. She was not asked for any information on her medical history and no informed consent was obtained and the procedure was performed without any protective ocular shields. The patient experienced severe lacrimation, discomfort, and increased sensitivity to light during and after the procedure. She also noticed blurred vision after the procedure. Ophthalmologic examination revealed tender and oedematous eyelids and corneal abrasions in both of her eyes. Topical antibiotics and preservative-free lubricants were able to recover her from her signs and symptoms at 1-week follow-up. It is recommended that cosmetic blepharopigmentation should be applied cautiously with patient's informed consent after obtaining a thorough medical history and with protective ocular shields to avoid potential complications.

© 2019 Taylor & Francis Group, LLC.Purpose: To compare the effectiveness of ranibizumab and aflibercept in macular edema (ME) with serous retinal detachment (SRD) following branch retinal vein occlusion (BRVO). Methods: Once every month for 3 months, 33 patients were treated with ranibizumab (Group 1), whereas 30 others were treated with aflibercept (Group 2). In 9 months after that, patients were evaluated every 4 weeks and received additional injections if they met prespecified criteria for retreatment. Corrected visual acuity (BCVA), central foveal thickness (CFT), and height of SRD was measured. Results: During the first 3 months, the improvement of CFT, BCVA, and height of SRD were greater in Group 2 than Group 1. Those differences disappeared in the subsequent 9 months, and changes in CFT, BCVA, and height of SRD were similar between groups at all other visits. Conclusion: Aflibercept was more effective than ranibizumab from baseline to Month 3 in ME with SRD following BRVO.

PurposeTo define the alterations in retinal vessel diameter in Parkinson's disease (PD) by optical coherence tomography (OCT).MethodsThis is a case-control study including 41 eyes of 41 patients with diagnosis of PD and 35 eyes of 35 age- and sex-matched control subjects. All subjects underwent complete neurological and ophthalmological examinations before measurements. Retinal vessel diameters and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were evaluated with spectral domain OCT (SD-OCT) with a circular scan centered at the optic disc. The diameters of the superior nasal and temporal arteries and veins, and inferior nasal and temporal arteries and veins were measured and then compared between the groups. Correlations with the duration of the disease, usage of levodopa, and pRNFL thicknesses between retinal vessel diameters were examined with Pearson and Spearman correlation analysis.ResultsAverage pRNFL thickness is significantly decreased in PD compared to age- and sex-matched controls (p

Purpose: The purpose of this study is to evaluate the effects of variation in tunnel length of same-sized clear corneal phacoemulsification incisions on the generation of surgically induced astigmatism and corneal astigmatism. Methods: A total of 126 cataract patients treated in four study groups based on location and tunnel length of the clear corneal incisions (superior long, superior short, temporal long, temporal short) were reviewed. In the short tunnel groups, a 2.8 mm keratome was used with a motion parallel to the iris surface, while in the long tunnel groups, the same keratome was advanced in the corneal stroma until the mark on the keratome was reached. The surgically induced astigmatism and the corneal astigmatism were measured with corneal topography. The tunnel lengths were determined by anterior segment optical coherence tomography. Results: The tunnel lengths of the long tunnel groups were significantly longer than the short tunnel groups. The total and anterior corneal surgically induced astigmatism of the superior long group was significantly higher than the other groups. Posterior corneal surgically induced astigmatism was similar. The postoperative total and anterior corneal astigmatism values of the superior long group was significantly higher than the other groups. No difference was observed for mean change in corneal astigmatism between the groups. Conclusion: The tunnel length of a clear corneal incision is a significant determinant of surgically induced astigmatism for superior placed corneal incisions. Therefore, for superiorly positioned clear corneal incision, the incision should be rectangular with a shorter tunnel to keep the surgically induced astigmatism to a minimum. For squarer-shaped clear corneal incision, limbal-temporal incisions may be performed for astigmatic neutrality.

Purpose We evaluated the retinal effects of systemic metabolic changes clustered under the umbrella of metabolic syndrome (MetS) in comparison with age-matched healthy subjects. Methods Spectral-domain optical coherence tomography (OCT) retinal segmentation analysis of 29 patients with MetS and 36 control subjects was performed. Patients with diabetes mellitus (DM), uncontrolled hypertension, retinopathy, high myopia or hyperopia, and posterior segment surgery, were excluded from analysis. The control group (CG) was selected from age- and sex-matched healthy lean subjects. Mean thickness values of individual retinal layers in nine macular early treatment of diabetic retinopathy study (ETDRS) subfields were determined. Results The MetS group had a significantly thinner ganglion cell layer in two (MetS, 52.4 ± 5.1 μm; CG, 54.8 ± 3.8 μm; P = 0.030), thinner inner plexiform layer in three (MetS, 39.8 ± 4.4 μm; CG, 43.0 ± 3.5 μm; P = 0.003), thinner photoreceptor layer in seven (MetS, 79.4 ± 2.9 μm; CG, 81.1 ± 2.9 μm; P = 0.009) of nine ETDRS subfields. No difference was found in nerve fiber, inner nuclear, outer plexiform, and outer nuclear layers. Conclusions The patients with MetS had thinner inner retinal layers and photoreceptor layer in OCT segmentation analysis, which suggests that inherent factors of MetS, such as insulin resistance and adipose tissue-derived inflammation, might have a neurodegenerative effect independent of the hyperglycemic levels associated with DM. Therefore, beyond glycemic control measures, weight reduction also might be advised to overweight patients with type 2 DM and MetS to prevent the occurrence of retinal neurodegeneration.

To evaluate the effect of fluorescein angiography on retinal vessel diameter with Optical Coherence Tomography (OCT). In this cross-sectional study, a total of 81 eyes of 81 patients who were performed fluorescein angiography (FA) procedure were included. Retinal vessels were examined with the Spectral-domain OCT at baseline and immediately after FA procedure. A cube scan consisting of seven horizontal scans were placed at the inferior border of the disk to include the inferior temporal retinal vessels. Vessels diameters were measured at five measurement points (480–1440 μm inferiorly from the optic disk border). The mean age of the study subjects was 58.02 ± 14.1 years. At baseline, the mean diameter of the retinal artery was 120.16 ± 24.56 µm and of the vein 157.94 ± 32.34 µm at the measurement point of 480 μm, with a gradual decrease to 114.91 ± 25.59 and 152.17 ± 28.17 µm, respectively, at 1440 μm. After FA procedure, the mean diameter of the retinal artery was 122.85 ± 26.35 and of the vein 158.30 ± 32.21 µm at the measurement point of 480 μm, with a gradual decrease to 115.22 ± 22.91 and 151.94 ± 28.93 µm, respectively, at 1440 μm. There were no statistical differences for either of these comparisons at any of the points of both artery and vein measurements. There was not any clinically significant change in retinal artery diameter such as a dilatatory response after FA procedure in patients with hypertension, diabetes, and age-related macular degeneration (AMD).

Sialidosis is a rare lysosomal storage disease caused by neuraminidase gene (NEU1) mutation and a deficiency of the enzyme neuraminidase. The aim of this study was to examine the sialidosis type 1 brain using volumetric magnetic resonance imaging (MRI), diffusion tensor imaging and functional MRI in comparison to 3 controls. The patient’s gene analysis identified compound heterozygous mutation in the NEU1 that is shown to be associated with the sialidosis type 1. In this very rarely seen case, we found volume changes in different brain structures. We found that subthalamic nucleus volumes were found to be smaller in the patient compared to the controls. Also, sialidosis type 1 had significantly smaller cerebellar volume compared with the control group. The case had higher mean diffusivity and lower fractional anisotropy values in the cerebellum and displayed abnormal functional connectivity.

Differentiating Parkinson disease (PD) from progressive supranuclear palsy (PSP) can be challenging early in the clinical course. The aim of our study was to see if specific retinal changes could serve as a distinguishing feature.We used spectral domain optical coherence tomography (SD-OCT) with automatic segmentation to measure peripapillary nerve fiber layer thickness and the thickness and volume of retinal layers at the macula.Thicknesses of superior peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer, inner plexiform layer, inner nuclear layer, and macular volume were more affected in PSP compared with PD (P0.05). Thicker inferotemporal pRNFL and lower macular volume were detected in levodopa users compared with nonusers in patients with PD.PD and PSP are associated with distinct changes in retinal morphology, which can be assessed with SD-OCT.

To assess the correlation between functional and anatomical evaluations with multifocal electroretinography (mfERG) and spectral-domain optical coherence tomography (SD-OCT) in patients with Parkinson's disease (PD). This cross-sectional study involved 116 eyes of 58 patients with PD and 30 age- and sex-matched control subjects. All study participants underwent a comprehensive neuro-ophthalmic examination, retinal single-layer thicknesses and volumes, and peripapillary retinal nerve fiber layer (pRNFL) measurements with SD-OCT, and the patients' mfERG recordings were evaluated. The macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), and photoreceptor layer (PR) thicknesses, and mRNFL, RPE, and PR volumes were found lower in PD compared to those of controls, while outer plexiform layer (OPL) volumes were increased (p < 0.05). We found delayed implicit times and decreased amplitudes in the mfERG of PD patients versus those in control subjects (p < 0.05). We found significant correlations between outer macular volumes, PR thicknesses, and N1 amplitudes of rings 2 and 3and P1 amplitudes of rings 3, 4, and 5. Our study revealed thinning of both inner and outer retinal single layers, increased OPL volume, and delayed implicit times and decreased amplitudes in the mfERG of PD patients versus control subjects and correlation between structural and functional parameters. Our findings point out that SD-OCT and mfERG could both serve as non-invasive tools for evaluating ophthalmic manifestations of Parkinson's disease.

PURPOSE To compare corneal wetting performances of different dispersive ophthalmic viscosurgical devices. METHODS Three different types of dispersive ophthalmic viscosurgical devices, hydroxypropyl methylcellulose %2 (HPMC), sodium hyaluronate %3-sodium chondroitin sulphate %4 (HACS), and sodium hyaluronate %3 (HA), were applied on corneal surfaces of 10 healthy volunteer subjects repeatedly at 3 different time points. Corneal wetting properties of the ophthalmic viscosurgical devices were compared qualitatively and quantitatively by anterior segment optical coherence tomography for 30 minutes. RESULTS Sodium hyaluronate 3% and HACS applications had a higher mean precorneal ophthalmic viscosurgical device thickness than HPMC application at all time points (seventh minute HPMC: 105.2 ± 25.3 μm, HA: 561.4 ± 115.8 μm, HACS: 481.2 ± 55 μm, P < 0.001). All HPMC applications were terminated by the 12th minute because of insufficient corneal wetting. Mean survival estimate time was significantly shortest for HPMC (11.5 ± 0.5 minutes, P < 0.001) and longest for HA (29.7 ± 0.28 minutes). It was slightly shorter for HACS (26.9 ± 0.87 minutes, P = 0.007) than the HA application. CONCLUSION Sodium hyaluronate 3% and HACS provide superior corneal covering compared with HPMC with an effect that can be maintained up to 30 minutes. They may be an effective option for corneal wetting during long vitreoretinal surgeries with longer duration of effect and fever number of applications.

Background: Retinopathy of prematurity (ROP) is a proliferative vitreoretinopathy resulting from vascular defect of the retina. The present study evaluates platelets, which are involved in VEGF storage, transport and release, and their functions with regard to the prognosis of the disease. The objective was to suggest a simple minimal invasive method that will facilitate the management of the disease and help clinicians in predicting the prognosis. Methods: In this single center, retrospective, case–control study, we included a control group consisting of very preterm newborns (n = 83) at risk of ROP and a laser photocoagulation group including infants (n = 63) who received laser therapy during their follow-up examinations. The employed assessments included platelet counts and platelet mass index (PMI) which provide guidance in understanding platelet activity. In doing so, consideration was given to the first and second phases of ROP. The accuracy of prognostication was assessed with receiver operating characteristic analyses. Results: The study groups did not differ statistically significantly by platelet count during the first and second phases of ROP (p > 0.05) nor were the PMI measurements statistically significantly different between the study groups during the first phase of the disease (p > 0.05). PMI values of the study groups, however, differed significantly in the second phase of ROP (p

PURPOSE To evaluate choroidal thickness (CT) in patients with Cushing syndrome (CS) with enhanced depth imaging optical coherence tomography. METHODS Twenty-eight patients with CS and 38 healthy volunteers were enrolled in this observational cross-sectional study. Patients with newly diagnosed CS who have been admitted to Erciyes University Department of Endocrinology in 3 years time interval were compared with age- and sex-matched healthy volunteers. Choroidal thickness was measured at the fovea and 2 points nasal and 2 points temporal to the fovea with 500-μm intervals each. RESULTS Choroidal thickness measurements were higher in patients with CS than in the control group at all examination points; however, the difference was found to be significant at the center of the fovea (367.8 ± 94.4 μm vs. 329 ± 90.5 μm) and 1,000 μm temporal to the fovea. Choroidal thickness measurements were significantly higher in adrenocorticotrophic hormone (ACTH)-dependent CS group than in the control group at all measurement points (CT at fovea 388.2 ± 92.4 μm vs. 329.1 ± 90.5 μm). All CT measurements were found to be correlated with ACTH levels. CONCLUSION Cushing syndrome is associated with increased CT. The ACTH-dependent CS may increase CT more than ACTH-independent CS. This effect may be directly related to ACTH itself or increased plasma cortisol levels or both.

Purpose: Retinopathy of Prematurity (ROP) is a proliferative vitreoretinopathy which is one of the most frequent causes of blindness in children. In an attempt to find a solution to this important problem in preterm children, the search for new, effective treatment modalities with fewer side effects is underway. In our study, which was planned for this reason, we aimed to investigate the effects of propranolol treatment applied to cases of ROP in various stages during the second phase (known as the neovascularization-hypoxia phase) and to determine the correlation of these effects with the platelet mass index (PMI).Method: A total of 171 preterm infants at risk of ROP were selected randomly for inclusion in the study. All of the patients were classified according to their stage of ROP and were divided into control and treatment groups. While the cases in the control group were administered physiological saline solution, those in the treatment group were administered propranolol in the period that corresponded to the second stage of the disease. The thrombocyte and PMI values in the first and second stages of each study group were recorded.Results: A significant difference was found between the control and treatment groups of the stage 2 ROP study subjects. In the stage 2 ROP study group, no significant difference was detected between the control and treatment cases in terms of platelet counts in phase 1 or in the PMI values and the thrombolytic counts in phase 2. On the other hand, in phase 2 of the stage 2 ROP study subjects significant differences were detected between the control and treatment group in terms of PMI values.Conclusion: In the study, it was found in the stage 2 ROP study group that propranolol reduced the need for laser photocoagulation significantly. Also, in parallel to the efficacy of propranolol in this study group, a decrease was observed in PMI values.