Evaluation of retinal microvascular network in patients with systemic sclerosis: An optical cohorence tomography angiography study

PURPOSE

To investigate the long-term effect of systemic sclerosis on the optic disk and retinal capillary network and to see whether the drugs used in the treatment of SSc affected optical coherence tomography angiography (OCTA) parameters.

MATERIALS AND METHODS

This cross-sectional case-control study included 40 systemic sclerosis patients and 40 healthy individuals. We included only one eye of each patient in the study. Macular layers and angiography scanning were performed with a Zeiss Cirrus 5000 OCTA system. Such values as macular thickness, retinal nerve fiber layer (RNFL), ganglion cell inner plexiform layer (GC-IPL) were obtained. For central vessel and perfusion density (VD, PD), central 6 mm were obtained and were evaluated by dividing it into 3 groups as inner, outer, and full. The FAZ was evaluated through 3 parameters: area, perimeter, circularity index.

RESULTS

Statistically significant difference was found between the groups in terms of the mean and foveal macular thickness values (p=0.008, p=0.033). Significant differences were also found between the two groups in terms of the VD and PD parameters in all regions except for 1 mm center (p<0.05). There were no significant differences in RNFL and GC-IPL values between two groups. Also, a positive correlation was observed between parapapillary perfusion density values and RNFL and GC-IPL thicknesses in SSc group. When the subgroups were compared in terms of vasodilator drug use, the subgroup using vasodilators was seen to have higher mean RNFL and inferior RNFL thicknesses (p=0.045 and p=0.035, respectively). In addition, there was a significant positive correlation between parapapillary VD and RNFL values in the SSc subgroup treated with vasodilators.

CONCLUSIONS

The results of this study demonstrate microvascular loss in individuals with systemic sclerosis, compared with healthy subjects. Also, it has been determined that OCTA is an important test for screening retinal and optic disk microvascular changes over time in cases of systemic sclerosis and may be used to evaluate the response to vasodilator drugs used in the treatment of SSc disease.

Primary transcanalicular diode laser-assisted dacryocystorhinostomy: long-term success rates and risk factors for recurrence

OBJECTIVE

The aim of the study was to investigate the long-term success rates of transcanalicular endolaser dacryocystorhinostomy (TC-DCR) surgery along with the factors that possibly affect surgical success.

METHODS

Patients (n = 300) who underwent unilateral TC-DCR operations in the department of ophthalmology of our university hospital between January 2011 and June 2021 were included in the study. The subjects were divided into 2 groups, with group 1 showing no recurrence (n = 205) and group 2 showing recurrence (n = 95).

RESULTS

The mean follow-up period for the 300 patients was 26.7 ± 7.0 months (range, 11-33 months). The overall success rate was 205 of 300 (∼68%). Although, based on the univariate risk analysis, age, operative time, total laser power, tube removal time, septum deviation, fistulisation, and intraoperative hemorrhage were found to be risk factors, in multivariate risk analysis, only total laser power, septum deviation, and intraoperative bleeding were determined to be the main risk factors.

CONCLUSION

The success rate of TC-DCR was lower than that of traditional external DCR, but because TC-DCR is a minimally invasive aesthetic surgery with a short operative time, it may become a preferred option by more ophthalmologists, especially for young patients without intranasal pathology and coagulation disorders and elderly patients at risk for general anaesthesia. It should be taken into account that the chances of success are relatively lower among patients with total laser power applied during surgery, intraoperative hemorrhage, fistulization, and septum deviation. In TC-DCR, bleeding control, short operative time, and low laser power are important to achieve a high success rate. Also, 1 year after TC-DCR, even the presence of anatomic drainage may lower the functional success of patients, so follow-up should be continued.

Evaluation of acute effects of pulmonary involvement and hypoxia on retina and choroid in coronavirus disease 2019: An optic coherence tomography study

PURPOSE

We investigated the acute subclinical choroidal and retinal changes caused by Coronavirus Disease 2019 (COVID-19) in patients with and without pulmonary involvement, using spectral domain optic coherence tomography.

METHODS

This prospective case-control study included COVID-19 patients: 50 with pulmonary involvement and 118 with non-pulmonary involvement. All patients were examined 1 month after recovering from COVID-19. The changes were followed using optic coherence tomography parameters such as choroidal and macular thickness and retinal nerve fibre layer and ganglion cell complex measurements.

RESULTS

All choroidal thicknesses in the pulmonary involvement group were lower than in the non-pulmonary involvement group and the subfoveal choroidal thickness differed significantly (p=0.036). Although there were no significant differences between the central and average macular thicknesses in the two groups, they were slightly thicker in the pulmonary involvement group (p=0.152 and p=0.180, respectively). A significant decrease was detected in the pulmonary involvement group in all ganglion cell complex segments, except for the outer nasal inferior segment (p<0.05). In addition, a thinning tendency was observed in all retinal nerve fibre layer quadrants in the pulmonary involvement group compared to the non-pulmonary involvement group.

CONCLUSION

In COVID-19 patients with pulmonary involvement, subclinical choroidal and retinal changes may occur due to hypoxia and ischemia in the acute period. These patients may be predisposed to ischemic retinal and optic nerve diseases in the future. Therefore, COVID-19 patients with pulmonary involvement should be followed for ophthalmological diseases.

Evaluation of subclinical changes in recently diagnosed pediatric hypertension patients without hypertensive retinopathy: an OCT study

PURPOSE

To investigate subclinical choroidal and retinal changes in recently diagnosed pediatric hypertension (HT) patients.

METHODS

This prospective case-control study consisted of 62 treatment naive HT patients (34 essential HT and 28 renal-induced HT) and 62 control subjects aged 10-16 years. All demographic data and ocular parameters were noted. Macula and choroid measurements were acquired by spectral domain optical coherence tomography (SD-OCT). Choroidal measurements were obtained by taking the mean of the measurements taken from 3 nasal and 3 temporal locations at 500µ intervals (mean nasal, mean temporal) in addition to the subfoveal area.

RESULTS

All choroidal thickness (ChT) values in HT subjects were significantly lower than in the healthy group (p < 0.001 for all). Also, there was no statistically significant difference between central macular thickness (CMT) and mean macular thickness (MMT) between the two groups. Subfoveal ChT, mean ChT, and CMT values were statistically lower in patients with renal-induced HT compared to essential HT subjects (p < 0.001, p = 0.04, p = 0.014, respectively). No significant correlation was observed between choroidal thicknesses and blood pressure values in essential and renal HT groups except weak correlation between mean temporal ChT and systolic blood pressure (SBP) in renal HT group (r =  - 0.464, p ₌ 0.013).

CONCLUSION

This study demonstrated that choroidal thickness decreased even during the subclinical period in treatment naive pediatric HT subjects. In addition, it has been shown that the choroid is more affected in renal-induced HT compared to essential HT group.

Nasal vein occlusion after COVID-19: A case report

To present a case of nasal vein occlusion that has not been reported after the coronavirus disease 2019 (Covid-19) pandemic. A 53-year-old patient reported a complaint of floaters after a recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. His best corrected visual acuity (BCVA) was 20/20 for both the eyes. On examination, a flame-shaped hemorrhage was observed in the left eye around the infero-nasal area adjacent to the optic disc. Temporal branch vein occlusion has been widely reported in association with SARS-CoV-2 infection. We emphasize that nasal vein occlusions triggered by Covid-19, which do not cause vision loss, should also be considered.

Subclinical alterations in retinal layers and microvascular structures with OCTA in ANCA-associated vasculitides

PURPOSE

Using OCTA, investigate the capillary network and retinal layers in granulomatosis with ANCA associated vasculitis (AAV) patients who did not manifest apparent ocular involvement and compare the findings with healthy subjects.

METHOD

The present study, which is designed as a prospective and case-control study, includes 22 AAV patients and 35 control participants. OCTA parameters were noted.

RESULTS

In most of the regions, AMT, RNFL and GC-IPL thicknesses were significantly lower in the AAV group than in the control group. While the vascular indices were lower in the AAV group, except for the center 1 mm region, the FAZ parameters were similar between the two groups.

CONCLUSION

In AAV patients, subclinical changes in the retinal layers and superficial vascular plexus have been shown. In the future maybe a non-invasive method such as OCTA will become available in scoring systems for prognosis determination in AAV.

Changes in anterior segment parameters and presence of dry eye disease in patients with acromegaly: A Sirius topography study combined with meibography

PURPOSE

To investigate anterior segment parameters (ASPs) and dry eye disease (DED), including the status of the meibomian glands, in patients with acromegaly.

METHODS

In this cross-sectional, comparative study, 36 acromegaly patients and 40 healthy sex- and age-matched controls were included. Participants received a comprehensive ophthalmological examination, including intraocular pressure measurements with Goldmann applanation tonometry (IOP_GAT) and central corneal thickness corrected intraocular pressure (IOP_CCT) measurements, and were evaluated for ASPs and DED. For ASPs, white-to-white (WTW), apical (ACT) and thinnest corneal thickness (TCT), corneal volume (CV), keratometry readings (K₁, K₂, and K_mean), anterior chamber depth (ACD) and volume (ACV), and iridocorneal angle (ICA) were obtained via Sirius topography. DED was assessed with Schirmer's test, tear breakup time (TBUT), and Ocular Surface Disease Index (OSDI) scores. Meibography scores (MSs) were obtained with the Sirius topography device.

RESULTS

Patients had higher mean IOP_GAT (P = .006), IOP_CCT (P = .01), ACT (P = .024), and TCT (P = .005) but narrower ICA (P = .014) than controls. Although Schirmer's test did not differ between the groups (P = .442), patients had higher OSDI (P < .001), higher MS (P = .001), and shorter TBUT (P = .002).

CONCLUSION

Patients with acromegaly have greater IOP, greater corneal thickness, but narrower ICA than healthy individuals, as well as DED with increased MSs, which suggests meibomian gland dysfunction.

Evaluation of subclinical alterations in retinal layers and microvascular structures with OCT and OCTA in healthy young short-term smokers

PURPOSE

To detect the changes that can be determined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in young and short-term smokers.

METHOD

In this cross-sectional, observational, and comparative study, 45 "healthy" smokers and 45 healthy non-smoker control participants were included. Those with a smoking history between 1 year to 5 years and an average of 10-30 cigarettes per day were included in the study. OCT and OCTA measurements were made at least 60 min after smoking and at least 8 h after caffeine-containing beverages in order to end the effect of nicotine on systemic and retinal blood flow in the smoking group.

RESULTS

The mean smoking period was 2.2 ± 0.13 years. Mean macular thickness(MMT), retinal nerve fiber layer(RNFL), and choroidal thickness(Cht) were significantly lower in the smoker group, while ganglion cell-inner plexiform layer(GC-IPL) thickness was higher. Vessel density(VD) values were similar between groups, while perfusion density(PD) values were significantly higher in the smoker group. There were significant correlations between MMT and outer VD, outer PD, foveal avascular zone(FAZ) perimeter and circularity index. FAZ area and central VD and PD were inversely correlated. Also, FAZ circularity index and subfoveal, nasal, and temporal ChTs were positively correlated.

CONCLUSION

Despite the short-term smoking, ischemic effects were observed in retinochoroidal and vascular structures.

Optical coherence tomography detection of changes in inner retinal and choroidal thicknesses in patients with early retinitis pigmentosa

PURPOSE

To evaluate the inner retinal and choroidal thicknesses in patients with early retinitis pigmentosa.

METHODS

We analyzed spectral-domain optical coherence tomography images of 35 retinitis pigmentosa patients and 40 healthy individuals. We measured macular and ganglion cell complex thicknesses. We took choroidal thickness measurements in the subfoveal region and 500, 1,000, and 1,500 mm from the foveal center.

RESULTS

Patients with retinitis pigmentosa had significantly thinner macular thicknesses and choroidal thicknesses in all measurements, and their individual ganglion cell complex thickness measurements were lower than those in healthy individuals. The mean ganglion cell complex thickness was significantly lower in patients with retinitis pigmentosa than that in controls. The mean macular thickness was significantly correlated with the mean choroidal and mean ganglion cell complex thicknesses. (We found no correlation between the mean choroidal thickness and the mean ganglion cell complex thickness).

CONCLUSIONS

The choroid was mildly affected in our patients with early retinitis pigmentosa. The tendency toward significance in the inner retina was possibly caused by a good visual acuity.

Comparison of intravitreal anti-vascular endothelial growth factor agents and treatment results in Irvine-Gass syndrome

AIM

To compare the efficacy of bevacizumab, ranibizumab, and aflibercept in pseudophakic cystoid macular edema (CME) patients with Irvine-Gass syndrome (IGS).

METHODS

This study is designed as retrospective consecutive case series. Those who developed postoperative pseudophakic CME that refractory to topical treatment and were treated with anti-vascular endothelial growth factor (VEGF) agents included in the study. Optical coherence tomography (OCT) examination including central macular thickness (CMT), total macular volume (TMV), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (ChT) measurements at the baseline, 1^st, 3^rd and 6^th month controls were performed.

RESULTS

Fifty-nine eyes of 59 patients with CME and other healthy eyes of the patients (Control group) were evaluated. There were 22 eyes of 22 patients in the bevacizumab group (group 1), 19 eyes of 19 patients in the ranibizumab group (group 2), and 18 eyes of 18 patients in the aflibercept group (group 3). There was no difference in terms of age, gender, axial length, IOP, and spherical equivalent values. The baseline subfoveal and mean ChT were higher in the IGS group. The difference between the baseline and sixth month values of subfoveal and mean ChT were compared in the CME groups, thinning was observed in all three groups. GCL was thinner in the patient group at the 6th month of treatment. The resolution time of CME was observed faster in group 1.

CONCLUSION

All three anti-VEGF agents seem to be effective in CME but bevacizumab appears to be slightly more cost-effective than the other two alternatives.

Evaluation of subclinical retinopathy and angiopathy with OCT and OCTA in patients with systemic lupus erythematosus

PURPOSE

To evaluate the choroidal and retinal layers with optical coherence tomography (OCT) and retinal microvascular structures with optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE) patients.

METHOD

In this prospective, cross-sectional and comparative study, a total of 35 SLE patients and 35 healthy control participants were included. SLE patients who were using hydroxychloroquine (HCQ) and/or immunosuppressive agents are evaluated with OCT and OCTA. SLE patients who have no HCQ maculopathy observed in OCT were included in the patient group.

RESULTS

Mean macular thickness and ganglion cell inner plexiform layer (GC-IPL) thicknesses were thinner in the patient group. When the parameters obtained with OCTA were evaluated, vessel (VD) and perfusion density (PD) were significantly lower in the patient group. Central foveal thickness and foveal avascular zone parameters were negatively correlated. In addition, VD and PD, and GC-IPL thicknesses were positively correlated.

CONCLUSION

Application of OCTA for the evaluation of microvasculature in SLE patients may be useful in subclinical changes.

AB0544 EVALUATION OF MACULAR AND OPTIC DISC MICROVASCULAR NETWORK IN PATIENTS WITH SYSTEMIC SCLEROSIS: AN OPTICAL COHORENCE TOMOGRAPHY ANGIOGRAPHY STUDY

Background:

Systemic sclerosis (SSc) is characterized by fibrosis of the skin, internal organs and vasculopathy. Invivo, the retina provides a unique opportunity to assess the microcirculation in the eye. Previous studies have been evaluated the changes in the retinal and choroid layer and showed thinning of the choroid layer and reduced retinal microvascular density.

Objectives:

To analysis the retinal and optic disc capillary network in patients with SSc without clinical signs of retinal involvement by using optical coherence tomography angiography (OCTA).

Methods:

In total 40 SSc patients who classified according to the ACR/EULAR criteria and 40 healthy control subjects were included in the analysis. All patients underwent a detailed ophthalmologic examination by the same ophthalmologist. After pupil dilatation, macular angiography was performed with 6x6 mm area scanning using standardized system and images of the retinal capillary plexus were analyzed by Cirrus OCTA software. Mean macular thickness, retinal nerve fiber layer (RNFL) and the Ganglion cell inner plexiform layer (GC-IPL), vessel density (VD), perfusion density (PD), optic disc PD, reflux index and foveal avascular zone (FAZ) parameters were measured by the same experienced operator.

Results:

There was no significant difference between SSc and controls in terms of age, sex, spherical equivalent (SE), intra ocular pressure (IOP), and axial length (AL). Central and mean macular thickness, nasal and inferior RNFL thicknesses were significantly thinner in SSc patients (Table). Additionally GC complex thicknesses were significantly thinner in all quadrants compared to controls.

Central vessel density (CVD) and central perfusion density (CPD) values were found significantly decreased in all regions in patients with SSc. Optic disc perfusion density values were also decreased in SSc group. An inverse correlation was found between central macular thickness, FAZ area and perimeter values (rho:-0.300, p:0.007; rho:-0.276, p:0.013, respectively).There was no relationship between the disease duration and the OCTA measures.

Conclusion:

Vascular and perfusion density were found decreased in patient with SSC at the results of OCTA measures. These findings may help to understand vasculopathy in the pathogenesis of the disease and OCTA may be a new method providing objective and non-invasive information about capillary network in SSc.

Table

Demographic and ocular parameters of study population

ParametersSSc(n = 40)Control(n = 40)pAge, years; mean (SD)47.2 (8.6)47.5 (8.1)0.631Male sex, n (%)24(60)16 (40)0.087Disease duration, months; mean (SD)81.3 (38.0)N/A-Foveal MT(µ)246.3 ± 19.4252.6 ± 15,30.033Average MT(µ)280.8 ± 12,4286.5± 8.70.008Vessel density (mm-1), 6 mm total area; mean (SD)17.60 ± 1.3118.66 ± 0.640.006Perfusion density, 6 mm total area; mean (SD)43.25 ± 3.3245.94 ± 1.520.002Circularity index; mean (SD)0.72 ±0.090.73 ± 0.060.049RNFL nasal (µ); mean (SD)74.37±12.3674.05±8.480.011RNFL inferior (µ); mean (SD)122.62±17.87127.40±12.630.023Inferior nasal GCC(µ); mean (SD)85.72 ± 8.5385.82 ± 4.840.001Inferior temporal GCC(µ); mean (SD)82.70 ± 8.6284.95 ± 4.150.001Superior nasal GCC(µ); mean (SD)86.35 ± 7.7386.8 ± 5.700.012Superior temporal GCC(µ); mean (SD)47.2 (8.6)47.5 (8.1)0.631

MT: Maculer thickness; RNFL: Retinal nerve fiber layer; GCC: Ganglion cell complex

Disclosure of Interests:

None declared

Retinal and choroidal vascular structures are affected in axial spondyloarthritis: an optical coherence tomography study

PURPOSE

The aim of this study is to evaluate the retinal and choroidal structures in r- and nr-axSpA patients using spectral domain optical coherence tomography (SD-OCT) and to compare changes with healthy controls.

METHODS

In this cross-sectional study, 70 axSpA patients (50 radiographic- and 20 nr-axSpA) and 50 healthy control subjects were included. Choroidal thickness (ChT), macular thickness, retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) were measured by SD-OCT. For ChT values, seven lines at nasal and temporal were drawn at 500-μm intervals, centering the subfoveal sclerochoroidal junction. Analysis of the data was performed with the SPSS program. Mann-Whitney U test was performed for comparison of non-normally distributed continuous data; Student's t test was used for normal distributed data.

RESULTS

No significant difference was observed between 70 (66% male; mean age 39.7 ± 10.4 years) axSpA patients (50 radiographic and 20 nr-axSpA) and 50 (mean age 41.2 ± 6.2 years) healthy control subjects (p 0.417). R-axSpA and nr-axSpA groups and control group were similar in terms of spherical equivalent, intraocular pressure, axial length, and body mass index (p 0.574, p 0.874, p 0.918, p 0.344, respectively). While mean macular and GCC thicknesses were significantly lower in the patient group than in the healthy group, there was no significant difference between the two groups in terms of RNFL thickness.

CONCLUSION

The present study showed that there was no significant relationship between markers and scores indicating disease activity and ChT, MT, RNFL, and GCC thicknesses. However, an increase in choroidal thickness and involvement of the retinal layers has also been demonstrated in patients with spondyloarthritis. In addition, the relationship between disease activity and retinal layer involvement is remarkable in the r-axSpA group.

Evaluation of the anterior segment parameters after Nd: YAG laser Capsulotomy: Effect the design of intraocular lens Haptic

Objective:

To evaluate the changes in anterior segment parameters after neodymium–yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy in 1-piece and 3-piece IOLs.

Methods:

In an institution, 65 eyes of 65 consecutive pseudophakic patients with posterior capsule opacification underwent Nd:YAG laser capsulotomy. The patients were divided into two groups according to the IOL type. Group-1 consisted of 35 subjects with 1-piece IOL and Group-2 consisted of 30 subjects with 3-piece IOL. Anterior segment parameters were measured with the Sirius rotating camera before, one week and one month after Nd:YAG laser capsulotomy.

Results:

Mean age was 72.3±5.2 years in 1-piece IOL and 72.3±6.8 years in 3-piece IOL. There were no statistically significant differences before capsulotomy for IOP, axial length, spherical equivalent, anterior chamber depth, central corneal thickness, anterior chamber angle and anterior chamber volume between two IOL groups. BCVA improved after capsulotomy in both groups (p=0.001). Both IOL groups had statistically significant myopic shift compared with the baseline values (P= 0.03 and P=0.01 resp.). Both IOL groups had statistically significant decrease in ACD, from baseline to the 1st week and 1^st month (p=0.04 and 0.03 resp.).

Conclusion:

To achieve the highest percentage of refractive and anterior segment stability surgeons may prefer to implant the 1-piece IOL design.

Diabetic Macular Edema

Diabetic macular edema (DME), one the most prevalent causes of visual loss in industrialized countries, may be diagnosed at any stage of diabetic retinopathy. The diagnosis, treatment, and follow up of DME have become straightforward with recent developments in fundus imaging, such as optical coherence tomography. Laser photocoagulation, intravitreal injections, and pars plana vitrectomy surgery are the current treatment modalities; however, the positive effects of currently available intravitreally injected agents are temporary. At this point, further treatment choices are needed for a permanent effect.

Early Neurodegeneration of the Inner Retinal Layers in Type 1 Diabetes Mellitus

Purpose: This study explores retinal structural changes in type 1 diabetes without clinically diagnosed diabetic retinopathy (DR). Methods: Peripapillary retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, and macular thickness (MT) were measured in 90 type 1 diabetic patients by using spectral domain optical coherence tomography. The values were compared with 100 sex- and age-matched healthy controls. The independent t test was used to assess differences in the mean age, mean diabetic and ocular parameters, and the thickness values between the diabetic and control groups. Multiple linear regression analysis was performed to investigate the correlation between the thickness values and diabetic and ocular parameters. Results: Whole-RNFL, the superior and inferior quadrants, and the superior half of the peripapillary RNFL thicknesses were significantly thinner in diabetic patients compared with controls (p < 0.05). GCC thicknesses in the average macular, outer temporal superior and outer temporal inferior sectors were significantly thinner in diabetic patients (p < 0.05). Central and average MTs were similar in both groups (p > 0.05). There were significant negative correlations of the duration of type 1 diabetes with the inner nasal MT, inner temporal superior GCC thickness, inner nasal inferior GCC thickness, and outer nasal superior GCC thickness (p < 0.05). Similarly, there were significant negative correlations of the level of HbA1c with the whole-RNFL thickness, superior-half-RNFL thickness, and superior-quadrant-RNFL thickness (p < 0.05). Conclusions: Type 1 diabetic patients without clinically diagnosed DR had neurodegeneration in the inner retinal layers compared with healthy controls.

Choroidal Thickness Changes in the Acute Attack Period in Patients with Familial Mediterranean Fever

Purpose: The aim of this study was to evaluate choroidal thickness changes during acute attacks of familial Mediterranean fever (FMF). Methods: Fifty patients with FMF and 50 healthy controls were included. Choroidal thickness of each participant was measured at the foveola and horizontal nasal and temporal quadrants at 500-µm intervals to 1,500 µm from the foveola using spectral-domain optical coherence tomography. White blood cell count, erythrocyte sedimentation rate (ESR) and serum levels of fibrinogen and C-reactive protein (CRP) were evaluated. The clinical findings (peritonitis, arthritis and pleuritis) were noted. Results: Choroidal thickness was significantly thicker at all measurement points in FMF patients compared to healthy controls during an acute attack (p < 0.05). There were positive correlations between the choroidal thickness and ESR, fibrinogen and, particularly, CRP levels. Clinical findings did not change the choroidal thickness significantly (p > 0.05). Conclusions: Increased choroidal thickness in the acute phase of FMF is possibly related to the inflammatory edematous changes in the choroid.

Ocular blast injuries related to explosive military ammunition

OBJECTIVES

To report the clinical features of ocular injuries associated with explosive military ammunition in insurgent attacks in Turkey.

METHODS

The medical records of 48 casualties who were treated for ocular injuries sustained in insurgent attacks at the Combat Region Hospitals in Turkey were retrospectively reviewed. The reviewed data included initial visual acuity, type of explosive military ammunition (ie, improvised explosive device, mine, hand grenade and rocket-propelled grenade), type of globe injury (open-globe vs closed-globe injury), traumatised globe zones, the presence/absence of an intraocular foreign body, medical interventions, status during the explosion and injuries to other parts of the body. The visual acuity differences between different explosive materials and between 'on-foot' and 'inside-vehicle' casualties were investigated.

RESULTS

A total of 83 injured eyes were analysed. The mean patient age was 24.5±6.6 years. The mean initial logarithm of the minimum angle of resolution visual acuity was 0.60±0.63. The injuries were due to improvised explosive devices in 28 cases (58.3%), land mines in 16 cases (33.3%), and hand grenades and rocket-propelled grenades in 2 cases each (4.2%). Forty-seven eyes (56.6%) had open-globe injuries. The most frequently involved zones were zone 1 (50.0%) in closed-globe injuries and all zones (31.9%) in open-globe injuries. Intraocular foreign bodies were present in 45/47 (95.7%) eyes with open-globe injuries. Twelve (14.4%) eyes with no light perception were enucleated, and two (2.4%) eviscerated. The difference in the visual acuities between the on-foot and inside-vehicle casualties and between the injuries that were caused by the different types of explosive ammunitions was also insignificant (p=0.271 and 0.394, respectively).

CONCLUSIONS

The clinical results for eye injuries caused by explosive military ammunition sustained during insurgent attacks in Turkey are disappointing irrespective of the explosive material. The use of protective eyeglasses might improve the outcomes and should be encouraged.

An association between subclinical familial exudative vitreoretinopathy and rod-cone dystrophy

A 21-year-old Caucasian man presented with a complaint of nyctalopia. Visual acuity in both eyes was 20/20 and anterior segment biomicroscopy results were unremarkable. Fundoscopy revealed peripheral avascular zones, minimal peripheral retinal exudation from the retinal vessels, peripheral retinal telangiectasias and anastomosis in both eyes, and retinal vascular dragging toward the temporal periphery in both eyes. Full field electroretinography showed that rod responses were almost absent and that cone responses were reduced. Macular optical coherence tomography showed normal structure in both eyes. Vascular changes were attributed to a subclinical form of familial exudative vitreoretinopathy. This was an interesting case due to the association of familial exudative vitreoretinopathy with rod-cone dystrophy.

The effect of pseudophakia on retinal and cortical functions

AIM

To investigate the effect of pseudophakia on visual electrophysiology.

METHODS

Right eyes of 60 pseudophakic (study group) age- and sex-matched 60 phakic (control group) volunteers were included. Subjects without any ocular and systemic disease, who had visual acuity of more than 9/10 underwent full-field electroretinogram (ERG), pattern electroretinogram (PERG), pattern visual evoked potentials (PVEP) and electro-oculogram (EOG) recordings.

RESULTS

The P100 latency to 1º-check was significantly shorter in both pseudophakic groups (study group: 102.98 ± 6.11, control group: 107.06 ± 10.70, p=0.012). The P100 amplitude to 15'-check was significantly higher in the pseudophakic groups (study group: 13.96 ± 7.01, control group: 11.60 ± 4.69, p: 0.033). Regarding ERG, b-wave implicit time in rod response and a-wave implicit time in standard combined response (SCR) were significantly shorter in the pseudophakic group (p=0.017, and less than 0.001, respectively). B-wave amplitude in rod response and a-wave amplitude in SCR were significantly higher in the study group (p less than 0.001 for both). The P1 and N1 amplitude and implicit time differences in 30-Hz flicker response were not significant (p more than 0.05). Conversely, P3/P4 implicit times in oscillatory potentials (OPs) were delayed in the pseudophakic group (p=0.001, and 0.002, respectively). The P1 amplitude increase in OPs in the study group was significant (p less than 0.001). The N95 latency in PERG was significantly delayed (p=0.002) and P50 amplitude was increased (p=0.002) in the pseudophakics. Arden ratio in EOG was similar in both groups (p=0.961).

CONCLUSION

Pseudophakia seems to influence ocular electrophysiological tests. Possible causes of these influences in the patients with pseudophakia should be clarified by further studies.

Effect of pseudophakia on standard perimetry parameters

PURPOSE

To investigate the effect of monofocal spheric acrylic intraocular lenses (IOL) on the visual field (VF) parameters.

MATERIALS AND METHODS

Thirty-six healthy pseudophakics (group 1) and 42 age-matched healthy volunteers (group 2) who had visual acuity of > or = 9/10 Snellen lines underwent central 24-2 threshold VF testing by Humphrey 750i VF analyzer. Subjects of group 1 had undergone VF testing 2 months after cataract surgery. The VFs were divided into three concentric zones for analysis. Age, visual acuity, pupillary size, foveal threshold, mean (MD) and pattern standard deviation (PSD) values, and mean decibel (dB) thresholds. MD and PSD of the three concentric zones were compared between the groups.

RESULTS

There was no significant difference between the groups in regards to age, gender, pupillary size, visual acuity, and mean foveal threshold. Mean MD was -2.4 +/- 2.5 decibel (dB) in the pseudophakics and -1.06 +/- 1.9 dB in the controls (p = 0.01; t = -2.63). Mean PSD values of group 1 and 2 were 2.5 +/- 1.5 dB and 2.06 +/- 1.3 dB, respectively (p = 0.145; t = -1.47). There were statistically significant differences between mean MD values of three concentric zones of both groups (p < 0.003, for all). The reduction of VF sensitivity through peripheral retina was more pronounced in the pseudophakics.

CONCLUSION

Even monofocal spheric acrylic IOLs have relatively insignificant effect on visual acuity, and foveal threshold may influence global indices such as MD on VF testing. Possible causes of reduction in VF sensitivity should be clarified by further studies in pseudophakics.

An assessment of intraocular pressure change in healthy subjects during air flight

PURPOSE

To investigate the effect of air flight on intraocular pressure (IOP).

METHODS

Baseline IOP of 25 healthy volunteers was measured at a ground level of 1760 feet above sea level (ASL) using Tono-Pen XL. Measurements were repeated after reaching an altitude of 19,000 feet and then on the second hour during a routine flight. Cabin pressure was kept around 8000 feet. IOP measurement was repeated after landing (3.5 hr after taking off). Change in the IOP was evaluated.

RESULTS

Mean +/- SD IOP was 14.2 +/- 2.7 mmHg at ground level and was 14.0 +/- 2.2 mmHg after gaining maximum altitude (p = 0.78). Mean IOP dropped to 12.3 +/- 2.5 mmHg on the second hour of flight and 12.0 +/- 1.7 mmHg after landing. Decrease in IOP on the second hour (13.4%, p = 0.005) and after landing (15.7%, p = 0.001) were significant.

CONCLUSION

IOP significantly decreased on the second hour measurements during a routine flight, and this change was sustained after landing.