Irfan Perente

Comparison of efficacy between low-fluence and half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy.

Purpose To compare the efficacy of low-fluence photodynamic therapy (PDT) and PDT with half-dose verteporfin in chronic central serous chorioretinopathy (CSC). Patients and methods The medical records of 64 eyes from 60 patients with chronic CSC were retrospectively reviewed; 36 eyes received low-fluence PDT (25 J/cm2) and 28 eyes received half-dose verteporfin PDT (3 mg/m2). The primary outcome measure was the proportion of eyes with complete resolution of subretinal fluid. Secondary outcome measures were the changes in best corrected visual acuity (BCVA) and central foveal thickness, and the proportion of eyes that showed an increase of ≥5 letters in BCVA at the last visit. Results The mean follow-up period was 12.5±4.3 months and 13.1±4 months in the low-fluence group and half-dose group, respectively (P=0.568). Thirty-three eyes (91.6%) in the low-fluence group and 26 eyes (92.8%) in the half-dose verteporfin group showed complete resolution of subretinal fluid (P=0.703). BCVA increased by a mean of 7.4 letters and 4.8 letters in the low-fluence group and half-dose group, respectively (P=0.336). Seventeen eyes (52.8%) in the low-fluence group and 14 eyes (50%) in the half-dose group experienced a gain of ≥5 letters in BCVA (P=0.825). In the low-fluence and half-dose verteporfin group, the mean baseline central foveal thickness was 351±90 μm and 341±96 μm, and significantly decreased to 188±61 μm and 181±47 μm, respectively (P<0.01). Conclusion Both treatments resulted in complete subretinal fluid resolution in most of the eyes, with significantly better visual acuity outcomes compared to baseline at the last visit.

Effect of Tafluprost 0.0015% on Central Corneal Thickness in Patients With Primary Open-angle Glaucoma

Abstract Purpose: To evaluate the effect of tafluprost on the central corneal thickness (CCT) in patients with primary open-angle glaucoma (POAG). Methods: This was a prospective study and included 100 eyes of 54 patients with POAG. All patients received tafluprost 0.0015% (Saflutan®) once daily in one or both eyes. CCT was measured by using noncontact pachymetry prior to the treatment and after 6 and 12 months. Results: Mean CCT of all treated eyes (nu2009=u2009100) was 547.79u2009±u200929.48u2009μm at baseline, 535.61u2009±u200926.54u2009μm after 6 months and 533.55u2009±u200926.45u2009μm after 12 months (Student’s t test, pu2009<u20090.0001). Ninety-three percent of all treated eyes showed a decrease of CCT. CCT reduction was more significant within the first six months of the treatment period (Student’s t test, pu2009<u20090.0001). After 12 months, a CCT reduction >25u2009μm occurred in 5% of all treated eyes. There was a significant positive correlation between the magnitude of corneal thinning and the initial CCT (Pearson, ru2009=u20090.49, pu2009<u20090.0001) but not between the magnitude of corneal thinning and intraocular pressure (IOP) reduction (Pearson, ru2009=u20090.145, pu2009=u20090.15). Discussion: Long-term use of tafluprost may decrease the CCT in patients with POAG. Consequently, clinicians must be aware of prolongated CCT variations that may arise throughout the follow-up period for proper IOP targeting and management.

Ranibizumab for the treatment of degenerative ocular conditions

Degenerative ocular conditions, such as age-related macular degeneration, diabetic retinopathy, retinal vein occlusions, and myopic degeneration, have become a major public health problem and a leading cause of blindness in developed countries. Anti-vascular endothelial growth factor (VEGF) drugs seem to be an effective and safe treatment for these conditions. Ranibizumab, a humanized monoclonal antibody antigen-binding fragment, which inhibits all biologically active isoforms of VEGF-A, is still the gold standard treatment for the majority of these pathological entities. In this review, we present the results of the most important clinical trials concerning the efficacy and safety of ranibizumab for the treatment of degenerative ocular conditions.

Changes in anterior segment morphology after intravitreal injection of bevacizumab and bevacizumab-triamcinolone acetate combination.

Purpose To evaluate the effects of 2 different amounts of commonly used intravitreal agents on anterior segment morphology in conjunction with intraocular pressure (IOP) changes. Methods Two groups of 46 patients who received intravitreal injection of bevacizumab (group 1, 0.05 mL) or bevacizumab–triamcinolone acetate (TA) combination (group 2, 0.1 mL) were included in this prospective study. All patients underwent anterior segment optical coherence tomography (AS-OCT) imaging with Visante OCT and IOP measurement before and at 5 minutes, 1 hour, and 3 hours after injection. Anterior chamber depth (ACD), angle-opening distance (AOD 500-750), trabecular–iris space area (TISA 500-750), and anterior chamber angle (ACA) were measured. Results were compared between groups and measurement time points. Results The mean change in IOP showed significant difference between baseline and first measurements after the injection in group 1 and group 2 (p = 0.012, p = 0.008, respectively). There was a statistically significant difference from baseline in ACD at the first and second measurements in group 2 (p = 0.005, p = 0.018, respectively). All angle parameters showed insignificant decrease from baseline at all measurement time points in both groups (p>0.05 for each). The difference of angle parameters after injection was not statistically significant between the groups (p>0.05 for each). Conclusions Intravitreal injection of bevacizumab (0.05 mL) or bevacizumab-TA combination (0.1 mL) caused a change in anterior segment configuration determined by AS-OCT. The changes in anterior chamber parameters returned to baseline values with the normalization of IOP values after the first few minutes of injection.

Corneal endothelial cell density in healthy Caucasian population

Aim To reveal the changes of corneal endothelial characteristics with aging among Caucasian population. Methods Non-contact specular microscopy was performed in 564 eyes of 282 healthy Caucasian Turkish patients. Endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were measured. Results The mean age was 42 ± 17.1 (6–85) years. The MCD of the population was 2732 ± 305 cell/mm2 (range, 1904–3802 cell/mm2). The MCA was 368 ± 41 m2 (range, 263–522 m2). The mean CV in cell size was 34 ± 7 (range, 25–68), the mean percentage of hexagonal cells was 46 ± 8% (range, 25–76%), and CCT was 513 ± 39 (range, 407–623). There was statistically significantly negative correlation (p < 0.05) between age and cell density, hexagonality, and pachymetry. There was statistically significant correlation (p < 0.05) between age and MCA. Conclusion We report the normal values of corneal endothelial characteristics in Caucasian Turkish eyes. Over the age of 20, the MCD of Caucasian eyes is more than the Indian and Iranian eyes and less than the Chinese eyes. Caucasian population’s cell density in under the age of 20 is 3101 ± 268 cell/mm2.

Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (P < 0.001), 0.60 ± 0.40 (P < 0.001), and 0.78 ± 0.39 (P = 0.07) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (P < 0.001), 0.99 ± 0.38 (P < 0.001), and 0.72 ± 0.37 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (P < 0.001), 0.64 ± 0.44 (P = 0.036), and 0.46 ± 0.49 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146u2009μm to 242 ± 119u2009μm, 277 ± 131u2009μm, and 402 ± 166u2009μm at 1, 3, and 6 months after IVT (P < 0.001 for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months.

Photoreceptor outer segment layer thickness measured manually on images from spectral domain optical coherence tomography in healthy volunteers.

BACKGROUND AND OBJECTIVEnTo investigate photoreceptor outer segment layer thickness measured with a manual technique on images from spectral domain optical coherence tomography (OCT) in healthy volunteers.nnnMATERIALS AND METHODSnIn 60 eyes of 30 healthy volunteers, a spectral domain OCT device (Spectralis, Heidelberg Engineering) was used to obtain cross-sectional images of the retina. For each volunteer, two images of each eye were obtained in one sitting. Images were digitally enlarged and the manual calipers feature of the devices software was used to measure, at the lowest point in the fovea, the thickness of the photoreceptor outer segment layer. All measurements were performed by the same investigator. Repeatability was evaluated with the Bland-Altman repeatability coefficient, and intersubject variability with Pearsons coefficient of variation.nnnRESULTSnThe mean values of measurements across all the volunteers were as follows: right eye first image 38.1 micrometers, right eye second image 37.9 micrometers, left eye first image 37.9 micrometers, left eye second image 37.9 micrometers. The repeatability coefficient, i.e. the difference between repeated measurements which would be exceeded in only 5% of cases, was 1.6 micrometers. Coefficients of variation for the right eye were 3.4% for the first images and 3.4% for the second images, and for the left eye they were 3.2 and 4.0% respectively.nnnCONCLUSIONnWith a manual method based on spectral domain OCT, the thickness of the photoreceptor outer segment layer at the central fovea can be measured within a useful range of repeatability and appears to be relatively constant across healthy volunteers.

Macular Thickness Measurement viaHeidelberg Spectralis SD-OCT in Pediatric Patients

Aims: To determine the normative values of the macular thickness measurements via spectral-domain optical coherence tomography (SD-OCT) in healthy pediatrics. Study Design:Prospective study.

Assessment of the macula and choroid in pediatric keratoconus patients

Purpose To present choroidal and macular thickness measurements in pediatric patients with keratoconus and to evaluate a possible correlation between anterior and posterior segment parameters. Methods 50 eyes of 50 patients and 50 eyes of 50 age-matched controls were included in this cross-sectional comparative study. The participants underwent ophthalmologic examination including; refraction, visual acuity, biomicroscopy, corneal topography and optical coherence tomography. The choroidal thickness (CT) was measured at subfoveal area and at 500 microns intervals to the nasal and temporal to the fovea up to 1500 microns. Results The mean age of the patients and controls were 12.4u202f±u202f1.9 and 12.0u202f±u202f2.1u202fyears. The mean thinnest corneal pachimetry was 456u202f±u202f57u202fμm, the mean central macular thickness (CMT) was 258u202f±u202f24u202fμm and the mean subfoveal choroidal thickness was 342u202f±u202f30u202fμm for the patients. There was no significant difference between the patients and controls in regards of CMT and CT at any measured points (pu202f>u202f0.05 for all). There was no correlation between anterior segment parameters and CMT. There was no correlation between anterior segment parameters and subfoveal choroidal thickness. Conclusions We may conclude that keratoconus does not affect the CMT and CT of pediatric keratoconus patients, and we may propose that we do not need a correction for this group of patients when we need to evaluate the CMT and CT.

Ocular pulse amplitude and retinal vessel caliber changes after intravitreal dexamethasone implant

Purpose: The purpose of this study is to evaluate possible changes in ocular pulse amplitude (OPA), retinal arteriole caliber (RAC), and retinal venule caliber (RVC), following the intravitreal injection of dexamethasone implants (DIs). Methods: Thirty-four eyes of 34 patients with macular edema were included. All participants received a full ophthalmologic examination at baseline. RAC and RVC were measured via optical coherence tomography; OPA and intraocular pressure (IOP) were measured via dynamic contour tonometry at baseline, month 1, and month 3. Statistical analysis was performed for before-after comparison of OPA, IOP, RAC, and RVC measurements. Results: The mean OPA (in order to baseline, month 1, month 3) was 2.8 ± 0.8, 2.9 ± 1.0, 2.9 ± 0.9. The mean IOP was 16.8 ± 2.9, 17.3 ± 2.7, 18.4 ± 2.9 mmHg. The mean RAC was 97.8 ± 9.2, 97.2 ± 9.0, 97.6 ± 9.4. The mean RVC was 124.4 ± 8.2, 124.8 ± 8.8, 123.8 ± 8.2. There were no statistically significant changes in RAC (P = 0.688), RVC (P = 0.714), OPA (P = 0.348), and IOP (P = 0.115). There was also no correlation between RAC and OPA (r = 0.12, P = 0.62) or RVC and OPA (r = 0.16, P = 0.68) at the last visit. Conclusion: The intravitreal injection of DI does not significantly affect RAC, RVC, or OPA, which indicates that the treatment does not alter overall retinal-choroidal vasculature or hemodynamics.