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Purpose This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm.Materials and Methods A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated.Results Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose.Conclusion Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit.

Objectives: This study aimed to determine the incidence of poor response to intravitreal (IV) anti-VEGF treatment in neovascular age-related macular degeneration (nvAMD) and to define subgroups of poor responders. Materials and Methods: A total of 235 treatment-naive eyes of 202 patients completed this prospective study. Patients younger than 50 years of age and those with a contraindication for anti-VEGF therapy were excluded. All eyes were treated with IV ranibizumab. Poor response was defined as recurrence, persistence, or worsening despite treatment. Poor responders were classified into subgroups based on progression patterns. Results: of the 235 eyes, 78 (33.2%) showed poor response. Pigment epithelial detachment (PED) and occult choroidal neovascularization (CNV) were more common among poor responders (p

Purpose: To report a case an iris juvenile xanthogranuloma presenting with hypopyon. Case report: A 45-day-old infant was referred to our clinic for unilateral hypopyon. Slit-lamp examination revealed a 2 mm hypopyon in the left eye while visible areas of the iris were normal. Fundus examination was normal. Topical corticosteroids and antibiotics were initiated. The hypopyon regressed to 0.5 mm after 2 weeks of treatment. The now visible peripheral iris revealed an inferotemporal yellow-brown iris mass. Clinical findings were consistent with juvenile xanthogranuloma of the iris. The patient was referred to the pediatrics department which revealed no systemic involvement. Two months after total regression of hypopyon, the baby presented with a 3 mm spontaneous hyphema causing 50 mmHg intraocular pressure. The patient was followed with topical corticosteroids and antiglaucomatous drops until the hyphema was resolved. Conclusion: ocular involvement, which is the most common extracutaneous 15 manifestation of juvenile xanthogranuloma, should be considered in the differential diagnosis of hypopyon and/or hyphema in young children.

Purpose To evaluate the impact of prolonged surgical face mask wearing on dry eye symptoms and tear film break-up time (T-BUT) in health care professionals. Materials and Methods A total of 33 health care professionals were included in this cross sectional, prospective study. T-BUT measurements were performed twice for all participants in the morning (8 am) and in the afternoon (5 pm) in addition to a complete ophthalmological examination. The subjects also filled-in the ocular surface disease index (OSDI) questionnaire twice, before and after wearing the face mask, on the same day. Results Sixty six eyes of 33 participants (17 female and 16 male) were evaluated. The mean age was 33.6 ± 7.55 (24–48) years and mean total duration with mask on between the two evaluations was 514 ± 12.5 (495–526) minutes. The mean T-BUT was 9.3 ± 1.0 (3–16) seconds at 8 am and 8.3 ± 1.5 (3–14) seconds at 5 pm (p = 0.01). The mean OSDI score was 20.1 ± 8.3 (0-68.75) at 8 am and 27.4 ± 10.4 (0-81.25) at 5 pm (p

This review aims to highlight the current knowledge about inflammatory mechanisms of neurodegeneration in glaucoma with emphasis on potential immunomodulation strategies. Glaucomatous retina and optic nerve present multiple evidences of inflammatory responses of astroglia, microglia, and blood-borne immune cells. Although adaptive/protective responses of resident or systemic immune cells can support neurons and promote tissue repair mechanisms after injurious insults, prolonged inflammatory processes can also produce neurotoxic mediators. Treatments targeting these neurodestructive outcomes may restore immune homeostasis and protect neurons from inflammatory injury. Due to widespread and chronic nature of neuroinflammation in glaucoma, immunomodulation offers a treatment strategy to protect different neuronal compartments of RGCs during the chronic and asynchronous course of neurodegeneration. Uncovering of distinct molecular responses and interactions of different immune cells that determine the neuroinflammatory phenotype and participate in neurodegenerative outcomes will be critical to develop effective strategies for immunomodulation in glaucoma. Neuroinflammation has increasingly been recognized to play an important role in glaucomatous neurodegeneration, and its modulation appears to be a promising treatment strategy for neuroprotection.

WOS: 000466509800013, PubMed ID: 31055898, In this case report we aimed to present the outer retinal structural changes secondary to vitreomacular traction (VMT). Outer retinal structural changes occurring secondary to VMT due to incomplete posterior vitreous detachment were described retrospectively with spectral-domain optical coherence tomography in 3 eyes of 3 patients. The patients ranged in age from 58 to 65 years and best corrected visual acuity in the 3 eyes was 4/10, 8/10, and 9/10. All of the patients were symptomatic and exhibited outer retinal microholes at the fovea extending from the retinal pigment epithelium to outer limiting membrane, with an overlying operculum on the detached posterior hyaloid membrane over the macula following spontaneous resolution of VMT. In the mean follow-up period of 32 months, the outer retinal microholes decreased in size but did not completely resolve. As demonstrated in these cases, VMT can cause small outer retinal layer defects without signs of full-thickness macular hole. These lesions can cause symptoms and affect visual function, and may be permanent structural changes.

Objectives: To evaluate functional and anatomical responses to intravitreal aflibercept (IVA) treatment in newly diagnosed and untreated neovascular age-related macular degeneration (nvAMD) cases and to investigate the effect of baseline lesion characteristics on anatomical responses. Materials and Methods: This prospective, cross-sectional study included a series of 139 eyes of 133 patients that were diagnosed with active nvAMD and had not been treated. All eyes were subjected to complete ophthalmological examination, spectral-domain optical coherence tomography and fluorescein angiography, and 42 eyes also underwent indocyanine green angiography. IVA treatment was performed using a “treat and extend” regimen after 3 injections at 4-6 weeks intervals. Anatomical and functional responses at 4 weeks after the last injection were evaluated in eyes that completed 3 injections and the subgroup of eyes that completed 6 IVA injections. The effect of baseline lesion characteristics on IVA treatment results was also investigated. Results: All 139 eyes included in the study received 3 IVA injections (group 1) and 62 received 6 IVA injections. Both groups showed statistically significant improvement in best-corrected visual acuity (p

INTRODUCTION: To compare the surgical outcomes of anterior chamber (AC) and posterior chamber (PC) implantation of iris claw lens (ICL) combined with penetrating corneal transplantation (P-CT), in eyes with no capsular support. METHODS: The records of 20 P-CT cases who underwent ICL implantation were retrospectively evaluated. The eyes were grouped according to the location of implantation; AC ICL and PC ICL. Pre- and post-surgical best-corrected visual acuity (BCVA), post-operative complications and graft rejection rates were compared between the two groups. Mean follow-up time was 28 (range, 12 and 76) months. RESULTS: ICLs were implanted during P-CT surgery in 14 (70%) eyes, and as a secondary procedure after P-CT in 6 (30%) eyes. ICLs were implanted in PC in 12 (60%) and in AC in 8 (40%) eyes. Mean preoperative BCVA was 0.064 (range, 0.001-0.02) in PC group and 0.02 (range, 0.001-0.1) in AC group (p=0.86). Mean postoperative BCVA was 0.17 (range, 0.0001-1.0) in PC group and 0.14 (range, 0.0001-0.4) in AC group (p=0.81). Glaucoma developed in 5 (41.6%) eyes with PC ICL. No eye with AC ICL developed glaucoma over time. DISCUSSION AND CONCLUSION: Both AC and PC ICL implantation provide favorable visual outcomes and complication rates in CT patients. However, PC implantation of ICL seems to increase glaucoma incidence.

Background Glia-driven neuroinflammation promotes neuron injury in glaucoma that is a chronic neurodegenerative disease of the optic nerve and a leading cause of irreversible blindness. Although therapeutic modulation of neuroinflammation is increasingly viewed as a logical strategy to avoid inflammatory neurotoxicity in glaucoma, current understanding of the molecular regulation of neuroinflammation is incomplete, and the molecular targets for immunomodulation remains unknown. Growing datasets pointed to nuclear factor-kappaB (NF-κB), a key transcriptional activator of inflammation, which was identified to be most affected in glaucomatous astroglia. Using a cell type-specific experimental approach, this study aimed to determine the value of astroglial NF-κB as a potential treatment target for immunomodulation in experimental mouse glaucoma. Methods Neuroinflammatory and neurodegenerative outcomes of experimental glaucoma were comparatively analyzed in mice with or without cre/lox-based conditional deletion of astroglial IκKβ, which is the main activating kinase involved in IκB degradation through the canonical pathway of NF-κB activation. Glial responses and the inflammatory status of the retina and optic nerve were analyzed by cell morphology and cytokine profiling, and neuron structure and function were analyzed by counting retinal ganglion cell (RGC) axons and somas and recording pattern electroretinography (PERG) responses. Results Analysis of glial inflammatory responses showed immunomodulatory outcomes of the conditional transgenic deletion of IκKβ in astroglia. Various pro-inflammatory cytokines known to be transcriptional targets for NF-κB exhibited decreased production in IκKβ-deleted astroglia, which included TNF-α that can induce RGC apoptosis and axon degeneration during glaucomatous neurodegeneration. Indeed, transgenic modulation of inflammatory responses by astroglial IκKβ deletion reduced neurodegeneration at different neuronal compartments, including both RGC axons and somas, and protected PERG responses. Conclusions The findings of this study support a key role for astroglial NF-κB in neuroinflammatory and neurodegenerative outcomes of experimental glaucoma and the potential of this transcriptional regulator pathway as a glial treatment target to provide neuroprotection through immunomodulation. By pointing to a potential treatment strategy targeting the astroglia, these experimental findings are promising for future clinical translation through transgenic applications to improve the treatment of this blinding disease.

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Glaucoma is a chronic neurodegenerative disease of the optic nerve and a leading cause of irreversible blindness, worldwide. While the experimental research using animal models provides growing information about cellular and molecular processes, parallel analysis of the clinical presentation of glaucoma accelerates the translational progress towards improved understanding, treatment, and clinical testing of glaucoma. Optic nerve axon injury triggers early alterations of retinal ganglion cell (RGC) synapses with function deficits prior to manifest RGC loss in animal models of glaucoma. For testing the clinical relevance of experimental observations, this study analyzed the functional correlation of localized alterations in the inner plexiform layer (IPL), where RGCs establish synaptic connections with retinal bipolar and amacrine cells. Participants of the study included a retrospective cohort of 36 eyes with glaucoma and a control group of 18 non-glaucomatous subjects followed for two-years. The IPL was analyzed on consecutively collected macular SD-OCT scans, and functional correlations with corresponding 10–2 visual field scores were tested using generalized estimating equations (GEE) models. The GEE-estimated rate of decrease in IPL thickness (R = 0.36, P0.05). These findings support early localized IPL alterations in correlation with progressing visual field defects in glaucomatous eyes. Considering the experimental data, glaucoma-related increase in IPL thickness/density might reflect dendritic remodeling, mitochondrial redistribution, and glial responses for synapse maintenance, but decreased IPL thickness/density might correspond to dendrite atrophy. The bridging of experimental data with clinical findings encourages further research along the translational path.

To evaluate the clinical findings and possible risk factors of patients with aphakic glaucoma following congenital cataract surgery and identify the factors affecting response to glaucoma treatment. A retrospective chart review of 173 patients was performed who underwent congenital cataract surgery before the age of 12 months and 40 eyes of 25 patients with aphakic glaucoma were enrolled. Age of the patients at the time of the cataract surgery, postoperative complications, additional ocular pathologies and the type of glaucoma treatment needed were investigated. Mean age of 25 patients at the time of cataract surgery was 3.31 ± 2.28 (range 1–11) months with a mean follow-up period of 79 ± 30.5 (32–176) months. Out of 40 eyes, medical therapy was effective in 20 (50%) eyes, whereas 20 (50%) eyes needed surgery for glaucoma. In these 20 eyes, 6 (30%) eyes underwent only 1, 4 (20%) eyes underwent 2 and 10 (50%) eyes underwent 3 or more procedures. Age at the time of cataract surgery, pupillary membrane formation and additional ocular pathologies were not significantly associated both with the need for glaucoma surgery or the number of operations (p ≥ 0.05). Aphakic glaucoma following congenital cataract surgery is a serious complication which requires surgery in half (50%) of the patients. Usually, more than one surgical procedure (70%) is needed. It can be detected even years after cataract surgery (range 0.3–94 months), so long-term careful follow-up is necessary.

WOS: 000393279900004, PubMed ID: 28058151, Objectives: To define characteristic fundus autofluorescence (FAF) findings in eyes with active polypoidal choroidal vasculopathy (PCV). Materials and Methods: Thirty-five eyes of 29 patients with active PCV who were diagnosed at Ege University Faculty of Medicine, Department of Ophthalmology, Retina Division between January 2012 and November 2014 were included in the study. All the patients underwent a complete ophthalmological examination including fundus photography, spectral -domain optical coherence tomography, fluorescein angiography, FAF photography, and indocyanine green angiography (ICGA). ICGA was used to diagnose active PCV and identify lesion components. FAF findings were described at the retinal site of the corresponding lesions identified and diagnosed using ICGA. Results: The mean age of the 29 study patients (15 men, 14 women) was 64.6 7.5 years (range, 54-82 years). ICGA revealed active PCV in 35 eyes, consisting of polypoid lesions in 11 eyes (31.4%), branching vascular networks (BVN) in 10 eyes (28.6%), and a combination of polypoid lesions and BVNs in 14 eyes (40%). On FAF images, 4 different patterns were detected at the corresponding retinal sites of 25 polypoid lesions detected by ICGA: confluent hypoautofluorescence with a hyperautofluorescent ring in 18 eyes (72%), hyperautofluorescence with hypoautofluorescent ring in 2 eyes (8%), confluent hypoautofluorescence in 1 eye (4%), and granular hypoautofluorescence in 1 eye (4%). The remaining 3 eyes (12%) demonstrated blocked hypoautofluorescence because of the excessive hemorrhaging in the macula. The FAF images showed the granular hypoautofluorescent FAF pattern in all 24 BVNs (100%) consistent with the location of the lesions on ICGA. Conclusion: The typical PCV lesions, polypoid lesions and BVNs had characteristic autofluorescent findings on FAF imaging. Noninvasive, quick, and repeatable FAF imaging can be considered a reliable and helpful diagnostic technique for the diagnosis of active PCV.