Emine Esra Karaca

Reproducibility of choroidal thickness measurements in healthy Turkish subjects.

Purpose: To assess intraobserver and interobserver reproducibility of the measurement of choroidal thickness by using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: A prospective, cross-sectional study was performed at Gazi University Ophthalmology Department. The macular areas of the right eyes of 110 healthy volunteers with no ophthalmic or systemic disease were recruited. Choroidal thickness was measured at the fovea and at 1000-μm intervals from the foveal center in both temporal and nasal directions. Each examiner measured choroidal thickness 30 days after the first measurement to assess intraobserver variability. Interobserver and intraobserver reproducibility were described by intraclass correlation coefficient (ICC) and coefficient of variation (CV). Results: The mean age was 44.0 ± 14.7 years (range 18-70 years). The mean choroidal thickness at the fovea was 315.5 ± 78.6. All the parameters evaluated were highly reproducible. Intraobserver CV of choroidal thickness measurements ranged from 24.76% to 35.74%, and the CV of subfoveal choroidal thickness was 24.92. The intraobserver and interobserver intraclass correlation coefficient was greater than 0.90 for all the parameters. Repeatability was slightly better at locations not exceeding 400 μm. Conclusions: Choroidal thickness measurements obtained by EDI-OCT showed good repeatability for healthy Turkish subjects; EDI-OCT examinations of choroid are reliable in healthy eyes.

Neutrophil-to-lymphocyte ratio may predict progression in patients with keratoconus.

Purpose: Neutrophil-to-lymphocyte ratio (NLR) is a new potential predictor of systemic inflammation in several diseases. In this study, we aimed to evaluate NLR in patients with keratoconus. Methods: This cross-sectional observational study included 54 patients with keratoconus and 25 age- and sex-matched control subjects. All participants underwent a detailed ophthalmological examination and corneal topography. The patients were divided into progressive and nonprogressive keratoconus groups on the basis of topographic parameters. Serum samples were obtained from all subjects, and the NLR was calculated. Results: The NLR was 3.27 ± 1.37 in the progressive keratoconus group versus 1.87 ± 0.39 and 1.87 ± 0.52 in the nonprogressive and control groups, respectively (P < 0.01). There was a positive correlation between NLR and progression (P < 0.05). In the receiver-operating characteristic analysis, an NLR ≥ 2.24 predicted the presence of progression with 79% sensitivity and 81% specificity. Conclusions: The NLR is a simple and inexpensive marker of systemic inflammation. The NLR was found to be higher in patients with progressive keratoconus than in the nonprogressive group and controls.

Choroidal and peripapillary retinal nerve fiber layer thickness in adults with anisometropic amblyopia.

Purpose To evaluate choroidal thickness, macular thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopic eyes compared to fellow and normal control eyes using high-definition spectral-domain optical coherence tomography (SD-OCT). Methods Fifty-four without any systemic problem and ocular disease participated in this prospective study. Inclusion criteria included individuals older than 18 years with anisometropic amblyopia. Choroidal thickness, central macular thickness (CMT), and RNFL thickness were measured by using enhanced depth imaging SD-OCT. The choroidal thickness was measured at the fovea and at 500 μm intervals from the foveal center in both temporal and nasal directions. Axial length measurements of the cases were also recorded. Results Mean peripapillary RNFL thickness of the amblyopic, fellow, and control eyes was 107.5 ± 15.5 μm, 109.3 ± 12.7 μm, and 108.8 ± 8.6 μm, respectively (p = 0.343). The average CMT was 231.7 ± 14.7 μm in amblyopic eyes, 232.5 ± 15.7 μm in fellow eyes, and 230.8 ± 14.8 μm in control eyes (p = 0.599). Mean subfoveal choroidal thickness was significantly greater in the amblyopic eyes than in the fellow and control eyes (396.3 ± 104.3 μm, 361.0 ± 103.9 μm, 390.6 ± 91.7 μm). Mean axial measurement in amblyopic eyes was 22.7 ± 1.3 mm (20.5–26.1), in fellow eyes 23.1 ± 0.9 mm (20.9–25.0), and in control eyes 23.3 ± 0.9 mm. Conclusions In adults with anisometropic amblyopia, subfoveal, temporal, and nasal choroidal thickness of amblyopic eyes are significantly thicker than in fellow eyes. However, no significant differences in peripapillary RNFL thickness or CMT were found between amblyopic and fellow or control eyes.

EPIRETINAL MEMBRANES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: Effect on Outcomes of Anti-vascular Endothelial Growth Factor Therapy.

Purpose: To iatients with neovascular age-related macular degenernvestigate the role of epiretinal membrane (ERM) on outcomes of anti-vascular endothelial growth factor therapy in pation (nAMD). Methods: This study is a retrospective observational case series and was conducted at the Gazi University School of Medicine, Ankara, Turkey. The reports of the patients with a diagnosis of new-onset nAMD, who were aged at least 50 years and treated with intravitreal anti-vascular endothelial growth factors (ranibizumab or bevacuzimab) between October 2010 and September 2013 in our retina clinic, were reviewed for the vitreomacular interface changes. Results: The study included 90 eyes of 90 patients with nAMD. The mean age of the patients was 70 ± 7.5 years, with 35 (38.9%) being male and 55 (61.1%) being female. According to the examinations with optical coherence tomography and B-mode ultrasonography, 43 patients had “concurrent” vitreomacular adhesion (30 focal, 13 broad; Group 1). Twenty-nine patients had complete posterior vitreous detachment (Group 2) and 18 patients (Group 3) had ERM. The number of injections was highest for the patients with ERM (Group 3), and this difference was statistically significant (P < 0.001). The mean interval between injections and the mean longest interval were shorter in Group 3 (P < 0.05). Conclusion: The presence of ERM in association with nAMD seems to increase the number of anti-vascular endothelial growth factor injections and decrease the injection intervals for the treatment of nAMD. Although the anatomical and functional results are similar in eyes with or without ERM, the increased need for anti-vascular endothelial growth factors may mean that these membranes may decrease the penetration of the drugs through these membranes, which may act as a physical barrier. Additionally, increased inflammation in patients with ERM probably requires more frequent injections.

Evaluation of Anterior Segment Parameters in Obesity.

Purpose To investigate anterior segment parameters in obese patients in comparison to healthy individuals. Methods Thirty-four obese subjects and 34 age-sex-matched healthy subjects were enrolled in this prospective cross-sectional study. Ophthalmological examinations including intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and axial length (AL) measurements were performed on each subject. Height and weight of all subjects were recorded and body mass index (BMI) was calculated. Results IOP was significantly higher in the obese group (p = 0.003). The mean ACD in obese subjects was significantly lower than that in control subjects (p = 0.036). AL, ACV, ACA and CCT were not significantly different between the groups. There was a positive correlation between BMI and IOP (r = 0.404, p < 0.001). ACD and ACA were negatively correlated with BMI. Conclusions IOP was significantly higher and ACD was significantly lower in obese subjects. AL, ACV, ACA and CCT were not significantly different between the groups. The impact of obesity on anterior chamber parameters should be further investigated.

The Role of Magnesium in the Pathogenesis and Treatment of Glaucoma

Glaucoma is characterized by chronic optic neuropathy resulting in progressive vision loss. Not only is glaucoma considered as a condition of elevated intraocular pressure (IOP), but also other risk factors may play a role in the pathogenesis of glaucomatous optic nerve damage. Vascular dysregulation in ocular blood flow and oxidative stress are currently suggested as important risk factors for glaucomatous retinal ganglion cell loss. New treatment modalities that improve ocular blood flow and reduce oxidative stress have been investigated in many studies. Magnesium (Mg) is thought to be one of the molecules that has a treatment potential in glaucoma. Mg has been shown to improve blood flow by modifying endothelial function via endothelin-1 (ET-1) and endothelial nitric oxide (NO) pathways. Mg also exhibits neuroprotective role by blocking N-methyl-D-aspartate (NMDA) receptor-related calcium influx and by inhibiting the release of glutamate, and hence protects the cell against oxidative stress and apoptosis. Both improvement in ocular blood flow and prevention of ganglion cell loss would make magnesium a good candidate for glaucoma management. Further studies on the effect of Mg may open a new therapeutic era in glaucoma.

Symptoms reported by patients with varying stages of glaucoma: Review of 401 cases

OBJECTIVE To elucidate the symptoms that patients with glaucoma voluntarily report and to determine the correlation between the symptoms and the stage of glaucoma. DESIGN Retrospective case series. PARTICIPANTS A total of 401 patients who presented to the Glaucoma Service from January 2012 through November 2013. METHODS The Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the medical records of patients who visited the Glaucoma Service from January 2012 through November 2013. We recorded any symptom written in the charts at the last eligible visit of each patient. The patients were classified by different stages according to the mean deviation of the Octopus visual field. RESULTS We analyzed 401 patients, who were graded with mild (n = 170), moderate (n = 106), or severe (n = 125) visual-field loss. The majority of patients did not report any symptoms (56.0%); 24.2% reported ocular surface disease (OSD) symptoms; and 25.8% reported visual complaints. The presence of symptoms positively correlated with the severity of glaucoma (p = 0.01) and the number of surgeries (p = 0.02). Burning/smarting/stinging and blurry vision showed a positive correlation with the severity of glaucoma (p < 0.05). Older patients (> 69 years) showed a significant increase in OSD symptoms (p = 0.001). CONCLUSIONS About one-fourth of the patients with glaucoma reported visual complaints, and another fourth reported OSD symptoms, both of which correlated with glaucoma severity. The high prevalence of OSD symptoms suggests that patients should be specifically questioned about these symptoms and treated as indicated. This information is of value particularly in the new era of nonpreserved glaucoma medications.

A PILOT STUDY OF CHOROIDAL THICKNESS IN LONG-TERM SMOKERS.

Purpose: To compare the choroidal thicknesses in long-term smokers with those of nonsmoking healthy individuals using spectral domain optical coherence tomography. Participants: Forty-six individuals who had been smoking at least for 20 years, but otherwise without systemic problems, participated in this prospective pilot study. The control group comprised 42 nonsmoking individuals. Methods: The ages, refractions, and axial length measurements of the cases were recorded. Central macular thickness and choroidal thickness at the fovea and at 500 &mgr;m intervals from the foveal center in both temporal and nasal directions were measured using spectral domain optical coherence tomography. Results: Although the smoking period of the smokers was mean 32.4 ± 9 years (range: 20–60), the mean pack-years of cigarettes was 35.1 ± 23.8 (range: 10–120). No significant difference was observed regarding refraction value and axial length between smokers and nonsmokers group. In addition, no significant difference was observed for central macular thickness and choroidal thickness values at 500, 1,000, 1,500, and 2,000 &mgr;m nasal and temporal part of the fovea, between 2 groups. Conclusion: Macular and choroidal thicknesses in long-term smokers were observed to be similar to those of healthy individuals.

Measurement and clinical implications of choroidal thickness in patients with inflammatory bowel disease

PURPOSE Ocular inflammation is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD) and may parallel disease activity. In this study, we evaluated the utility of a choroidal thickness measurement in assessing IBD activity. METHODS A total of 62 eyes of 31 patients with IBD [Crohns disease (CD), n=10 and ulcerative colitis (UC), n=21] and 104 eyes of 52 healthy blood donors were included in this study. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. The Crohns disease activity index (CDAI) and the modified Truelove Witts score were used to assess disease activity in CD and UC, respectively. RESULTS No significant differences in mean subfoveal, nasal 3000 μm, or temporal 3000 μm choroidal thickness measurements (P>0.05 for all) were observed between IBD patients and healthy controls. Age, smoking, CD site of involvement (ileal and ileocolonic involvement), CDAI, CD activity, and UC endoscopic activity index were all found to be significantly correlated with choroidal thickness by univariate analysis (P<0.05). Smoking (P<0.05) and the CD site of involvement (P<0.01) were the only independent parameters associated with increased choroidal thickness at all measurement locations. CONCLUSIONS Choroidal thickness is not a useful marker of disease activity in patients with IBD but may be an indicator of ileal involvement in patients with CD.

Isolated foveal hypoplasia: clinical presentation and imaging findings.

Purpose To describe the clinical presentation and imaging findings of a patient with isolated foveal hypoplasia. Case Report A 16-year-old teenager presented to our clinic with mild to moderate visual impairment since early childhood. Lack of foveal depression was noted on both clinical examination and optical coherence tomography, and absence of the foveal avascular zone was demonstrated on fluorescein angiography. His ocular examination was otherwise unremarkable. Conclusions Isolated foveal hypoplasia should be considered in the differential diagnosis of early-onset bilateral visual impairment, especially when the foveal reflexes seem absent.