Feyzahan Ekici

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.

The Impact of Visual Field Clusters on Performance-based Measures and Vision-Related Quality of Life in Patients With Glaucoma

PURPOSE To investigate how visual field (VF) clusters affect performance-based measures of the ability to perform activities of daily living and subjective measures of vision-related quality of life (QoL) in patients with glaucoma. DESIGN Prospective, cross-sectional study. METHODS setting: Institutional - Wills Eye Hospital. STUDY POPULATION 322 eyes of 161 patients with moderate-stage glaucoma. OBSERVATION VF tests were conducted using the Humphrey 24-2 Swedish Interactive Thresholding Algorithm standard perimeter. The VFs of each patient were divided into 5 clusters: nasal, temporal, central, paracentral, and peripheral. The score for each cluster was the averaged total deviation scores of all tested points within the cluster. Each cluster score was correlated with performance-based measures of visual function and subjective assessment of vision-related QoL. MAIN OUTCOME MEASURES The Compressed Assessment of Ability Related to Vision, the National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25), and the Modified Glaucoma Symptom Scale. RESULTS The central VF cluster in the better eye was positively correlated with all Compressed Assessment of Ability Related to Vision (performance-based measure) subscales. The strongest correlation for the better eye was between the central VF cluster and total Compressed Assessment of Ability Related to Vision score (0.39, P < .001). The inferior VF hemisphere in both eyes was positively correlated with most Compressed Assessment of Ability Related to Vision subscales. Central VF clusters in the better eye were positively correlated with a majority of the NEI VFQ-25 subscales. There were no significant correlations between VF clusters and Modified Glaucoma Symptom Scale subscales. CONCLUSIONS Scores of central VF defects in the better eye and inferior hemisphere defects in both eyes were positively correlated with performance-based measures of the ability to perform activities of daily living. Glaucoma patients with central defects in the better eye were more likely to have reduced scores on assessments of vision-related QoL.

Tube shunt coverage with gamma-irradiated cornea allograft (VisionGraft).

Purpose To investigate the clinical outcomes of tube shunt coverage using sterile gamma-irradiated cornea allograft. Patients and methods The Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the medical records of 165 patients who underwent glaucoma tube shunt procedures using sterile gamma-irradiated cornea allograft (VisionGraft) between December 2012 and November 2013. Demographic characteristics, type of tube shunt, and position were noted. Complications were recorded at 1 day; 1 week; 1, 3, 6, and 12 months; and on the final postoperative visit. Results One hundred and sixty-nine eyes of 165 patients were included. The mean follow-up time was 4.8±3.5 (ranging from 1 to 16) months. There was no evidence of immunological reaction, infection, or exposure in 166 eyes (98.2%). Three eyes (1.8%) experienced graft or tube exposure within the first 3 postoperative months. Two of the cases had underlying diseases: bullous pemphigoid and chronic allergic conjunctivitis. Conclusion Coverage of tube shunts using gamma-irradiated cornea allograft had a low exposure rate and was well tolerated. The graft can be stored long term at room temperature and has an excellent postoperative cosmetic appearance.

Outcomes of Sequential Glaucoma Drainage Implants in Refractory Glaucoma.

Purpose:To describe the outcomes of eyes that have undergone a second glaucoma drainage implant (GDI) surgery. Methods:A retrospective review of eyes that underwent a second GDI surgery from 2006 to 2013 was conducted. Primary outcome measures included intraocular pressure (IOP) reduction and success rates. Secondary outcome measures included glaucoma medication use, visual acuity, and number of reoperations. Success was defined as 6⩽IOP⩽21 with at least 20% IOP reduction, and no increase in the number of glaucoma medications from baseline at 3 months of follow-up or more. Results:Sixty-five eyes (63 patients) had a mean follow-up of 22.4±19.9 months. The most frequently placed second GDIs were an Ahmed FP7 (49%) or a Baerveldt 250 (26%) in the inferotemporal (46%) or inferonasal (35%) quadrant. At 3-year follow-up, IOP was reduced from 25.8±7.7 to 17.4±9.9 mm Hg (P=0.004) and the number of glaucoma medications decreased from 3.6±1.2 to 2.5±1.4 (P=0.01) compared with baseline. The median time to failure was 24.7±5.8 months. There was no significant difference in failure rates for type of sequential GDI (P=0.80) or plate location (P=0.34). There was no significant difference in visual acuity between baseline and 3-year follow-up (P=1.0). The most common postoperative complication was corneal edema (n=9, 14%). Conclusions:Most eyes undergoing a second GDI achieve adequate IOP control with fewer antiglaucoma medications. Failure rates were similar regardless of quadrant selection or GDI type.

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.

Current and Future of Laser Therapy in the Management of Glaucoma

There has been tremendous progress in the past decades in the utilization of lasers for treating patients with glaucoma. This article reviews the use of lasers in different areas of glaucoma, including the shift from argon laser trabeculoplasty (ALT) to selective laser trabeculoplasty (SLT), laser trabeculoplasty as an initial treatment for glaucoma, new laser trabeculoplasty procedures under investigation, and other recent laser treatment modalities such as endoscopic cyclophotocoagulation and laser-assisted deep sclerectomy.

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.

Effect of the Toll-Like Receptor 4 Antagonist Eritoran on Retinochoroidal Inflammatory Damage in a Rat Model of Endotoxin-Induced Inflammation

Purpose. We investigated the effect of eritoran, a Toll-like receptor 4 antagonist, on retinochoroidal inflammatory damage in an endotoxin-induced inflammatory rat model. Methods. Endotoxin-induced inflammatory model was obtained by intraperitoneal injection of 1.5 mg/kg lipopolysaccharide (LPS). Group 1 had control rats; in groups 2-3 LPS and 0.5 mg/kg sterile saline were injected; and in groups 4-5 LPS and 0.5 mg/kg eritoran were injected. Blood samples were taken and eyes were enucleated after 12 hours (h) (groups 2 and 4) or 24 hours (Groups 3 and 5). Tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) levels in the serum and retinochoroidal tissue and nuclear factor kappa-B (NFκB) levels in retinochoroidal tissue were determined. Histopathological examination was performed and retinochoroidal changes were scored. Results. Eritoran treatment resulted in lower levels of TNF-α, MDA, and NFκB after 12 h which became significant after 24 h. Serum TNF-α and retinochoroidal tissue NFκB levels were similar to control animals at the 24th h of the study. Eritoran significantly reversed histopathological damage after 24 h. Conclusions. Eritoran treatment resulted in less inflammatory damage in terms of serum and retinochoroidal tissue parameters.