Salih Uzun

Optical coherence tomography parameters in patients with photosensitive juvenile myoclonic epilepsy

PURPOSE Juvenile myoclonic epilepsy (JME) is commonly associated with photoparoxysmal response (PPR) with a reported prevalence of 25-42%. In this study, we aim to explore the relationship between the PPR and Optical Coherence Tomography (OCT) parameters in order to determine whether optic nerve fiber layer or other structural differences have a pathophysiological role of photosensitivity in patients with JME. METHODS We studied 53 consecutive patients with Juvenile myoclonic epilepsy (JME) at our outpatient department. The interictal electroencephalogram (EEG) findings for each patient were analyzed for the presence of photoparoxysmal features. The peripapillary Retina Nerve Fiber Layer (RNFL) thickness, ganglion cell thickness, macular thickness and choroid thickness levels were analyzed using OCT. RESULTS We classified the patients into two groups as those with PPR (Group 1) and those without PPR (Group 2). There were statistically significant differences in the average RNFL thickness values of the left eye between the two groups (p<0.001). Although the RNFL thickness of the right eye was higher in Group 1, no statistically significant difference was observed between the two groups. The RFNL thickness of the superior quadrants both in the right and the left eyes was significantly higher in Group 1 patients (p<0.001). Macular thickness of the right and left eyes were significantly thinner in Group 1 patients (p<0.001). Choroid thickness of the left eye was significantly higher in Group 1 than in Group 2 patients (p<0.001). Although the choroid thickness of the right eye was higher in Group 1 patients, no statistically significant difference was observed between the two groups. CONCLUSION This is the first study to our knowledge which has investigated the relation between the OCT parameters and photosensitivity in patients with JME. We concluded that these microstructural features may be related to photosensitivity in patients with JME.

Evaluation of the Macular Choroidal Thickness Using Spectral Optical Coherence Tomography in Pseudoexfoliation Glaucoma.

Purpose:To evaluate the choroidal thickness (CT) in pseudoexfoliative (PEX) glaucoma and age-matched healthy subjects using spectral optical coherence tomography (SD-OCT). Patients and Methods:In this prospective study, 32 eyes of 32 PEX glaucoma patients and 30 eyes of 30 age-matched healthy subjects were enrolled. The CT is measured perpendicularly (from the outer edge of the hyperreflective retinal pigment epithelium to the inner sclera) at the fovea, and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal to the fovea using SD-OCT (RTVue-100). Results:The groups were similar regarding the mean age and axial length values (both, P>0.05). The CT measurements were 182.12±39.88 and 201.56±32.00 &mgr;m at 1.5 mm nasal to the fovea (P=0.039), and 126.47±32.12 and 146.60±31.37 &mgr;m at 3.0 mm nasal to the fovea (P=0.015) in the PEX glaucoma and control groups, respectively. There were no significant differences in the subfoveal and temporal CT measurements among the 2 groups (all, P>0.05). Conclusions:The findings of this study indicate that PEX glaucoma causes significant thinning in the nasal choroid. Thus, measuring the CT with SD-OCT may be the way of better clarification of the relationship between PEX and glaucomatous optic neuropathy.

Retinal structural changes in systemic arterial hypertension: an OCT study

Purpose To assess retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and macular thickness changes in young adults with systemic arterial hypertension. Methods This study included 80 young patients (age 23.8 ± 2.8 years) with systemic hypertension (sHT) without any known systemic or ocular disease and 80 age-matched (23.5 ± 2.1 years) healthy controls. Retinal nerve fiber layer thickness, macular thickness, and GCC thickness were measured with spectral-domain optical coherence tomography. Results Mean disease duration was 3.45 ± 1.48 years (range 2-10). Differences in intraocular pressure, body mass index, axial length, and spherical equivalent between the groups were insignificant (p>0.05). The differences in RNFL thickness did not differ between the groups. Patients with sHT had significantly lower central macular thickness (p = 0.037), inner superior macular thickness (p = 0.045), and outer temporal superior and outer temporal inferior GCC (p<0.001 for both). The RNFL thickness did not differ significantly in all quadrants between the groups (p>0.05). Systolic and diastolic blood pressure were significantly correlated with inner temporal superior and inner temporal inferior GCC thickness in a negative manner (p<0.05 for all). Conclusions Ganglion cell complex thickness decrease is possibly a better retinal marker for hypertensive changes with respect to RNFL and macular thickness.

Evaluation of choroidal thickness changes after phacoemulsification surgery

Purpose The aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT). Methods In this prospective study, 38 eyes of 38 patients having phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including preoperative axial length (AXL) measurement with optical biometry and intraocular pressure (IOP) measurement preoperatively and 1 month postoperatively. The CT was measured perpendicularly at the fovea and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal using SD-OCT preoperatively and 1 month postoperatively. Changes in the CT after surgery and correlation of this change with age, AXL, preoperative IOP, and IOP change were evaluated. Results There was a statistically significant increase in the CT at all regions evaluated. This increment was more prominent in the nasal and subfoveal regions. The IOP decreased significantly 1 month after surgery (16.14±4.94 mmHg vs 13.91±4.86 mmHg; P<0.001). The change in IOP was correlated with the CT changes at all regions, whereas age, AXL, and preoperative IOP had no significant correlations with the changes in CT. Conclusion Phacoemulsification surgery may cause significant increase in CT, which is correlated with surgery-induced IOP change in the short term. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

Orbital richter syndrome.

Abstract We report two patients with previously diagnosed chronic lymphocytic leukemia who developed Richter syndrome in the orbit as the sole extranodal site. The medical history, clinical findings, orbital imaging and histopathological features of the patients were reviewed. Treatment protocols and the outcomes were also assessed. The first patient developed Richter syndrome at the age of 64 years, 3 years after the diagnosis of chronic lymphocytic leukemia. The tumor was located at the inferotemporal quadrant of the orbit. The second patient was 59 years old when Richter syndrome arose in the lacrimal gland, 4 years after the diagnosis of chronic lymphocytic leukemia. Incisional biopsy from the orbital tumors were performed. Histopathological findings included diffuse CD20, CD 23, CD5, bcl2, bcl6 positive lymphocytic infiltration. Both patients were treated with chemotherapy and rituximab. During 3 years of follow-up, there was no orbital or systemic recurrence of the disease. Richter syndrome may develop in the orbital soft tissue and the lacrimal gland, and the orbital disease appears to have a better prognosis compared to patients with systemic involvement.

Management of anaplastic lymphoma kinase positive orbito-conjunctival inflammatory myofibroblastic tumor with crizotinib.

Inflammatory myofibroblastic tumor (IMT) is a distinct mesenchymal neoplasm of myofibroblastic spindle cells associated with an inflammatory infiltrate formed by lymphocytes, eosinophils, and plasma cells in a myxoid or collagenous stroma. This tumor has a predilection for children and young adults and most commonly occurs in the lungs, retroperitoneum, abdomen, and pelvis. Ocular and orbital involvement is exceedingly rare. We describe a case of IMT in a 7-year-old girl involving the cornea, conjunctiva, and the anterior orbit treated with crizotinib, resulting in complete tumor remission.

Recurrent subconjunctival hemorrhage due to cavernous hemangioma of the conjunctiva

OBJECTIVE To report 3 patients with conjunctival cavernous hemangioma in association with multiple recurrent episodes of subconjunctival hemorrhage. DESIGN Retrospective clinical case series. PARTICIPANTS We studied 3 patients, 11, 13, and 21 years of age, respectively, each of whom had a small, solitary, and irregular multiloculated vascular mass on the temporal bulbar conjunctiva of the right eye. The tumours were excised for cosmetic reasons. METHODS The medical records and histopathologic slides of the 3 patients were reviewed. RESULTS Histopathologic examination showed that the tumours were composed of large, congested blood vessels separated by thin connective tissue. The patients did not have any recurrence of the tumour or hemorrhage. CONCLUSIONS Cavernous hemangioma had a tendency to develop rapidly in young people on the temporal bulbar conjunctiva of the right eye, causing recurrent subconjunctival hemorrhages.

Re: Associations between choroidal thickness, axial length and spherical equivalent in a paediatric population

EDITOR: We have read the article entitled ‘Associations between choroidal thickness, axial length and spherical equivalent in a paediatric population’ by Bulut and colleagues with great interest. The authors evaluated the choroidal thickness, axial length and spherical equivalent in 117 eyes of 117 children, including 53 myopic eyes and 64 emmetropic eyes. They discovered that the myopic eyes had considerably thinner subfoveal choroid than the emmetropic eyes. In addition, choroidal thickness was negatively correlated with axial length and positively correlated with spherical equivalent in the population that included myopic and emmetropic children. We congratulate the authors for their precious study; however, we would like to ask the authors some important points, which are expected to possibly affect choroidal thickness. Bulut and colleagues mentioned many factors which may affect choroidal thickness in their article. The age range of 117 participants covered by the study was five to 17 years. They stated that 61 participants were female. It is known that menstrual cycle and pregnancy have apparent effects on choroidal thickness. In a prospective study in which 23 females were assessed, Ulaş and colleagues demonstrated that there was a certain decrease in choroidal thickness in mid‐luteal phase and a decrease by 6.47 per cent between early follicular and mid‐luteal phase. In pregnancy, it has been shown that there is an increase in choroidal thickness, particularly in the second trimester. We would like to know whether the status of the menstrual cycle or pregnancy of female participants was taken into consideration. Another point is that we would like to ask Bulut and colleagues whether smoking, exercising, consuming of drinks with or without caffeine, body mass index and systemic blood pressure of participants were assessed immediately before choroidal thickness measurements, as each of these parameters may separately have an effect on choroidal thickness. We think that these points must be considered in relation to this article.

Characteristics of Hyperautofluorescent Choroidal Vessels within the Macular Atrophic Area Using Spectral-Domain Optical Coherence Tomography.

the female patients having participated in the study may significantly affect CT [2] . Secondly, we know that axial length of the globe, intraocular pressure, refractive error, fasting or postprandial statuses of patients, and their habit of sleeping, exercising, smoking and consumption of alcohol or drinks with/without caffeine and also body mass indexes, and the systemic blood pressure affect significantly CT measurement [2, 3] . Thus, we are curious about them. Thirdly, considerable diurnal variation has been shown by CT. Choroid is able to get thickened by 50% in an hour and increase its thickness by four times in a few days [3] . It has been demonstrated by Kee et al. [4] that the choroid can get thinner very fast, by about 100 μm in 3–4 h in chicks. CT in 12 healthy humans was measured in another prospective study by Tan et al. [5] with intervals of 2 h between 9: 00 a.m. and 5: 00 p.m. on two different days, and considerable alterations in CT were determined within all measurement points. It has been found by Tan et al. [5] that the average diurnal amplitude of CT was 33.7 ± 21.5 μm (range: 3–67 μm). The alteration in CT was also correlated with alterations in systemic blood pressure. In consideration of foregoing, it is recommended by us for the authors to optimize every local, systemic, and environDear Editor The article entitled ‘Characteristics of hyperautofluorescent choroidal vessels within the macular atrophic area using spectral-domain optical coherence tomography’ by Shinojima et al. [1] has been read and examined by us with great interest. The authors probed the mean subfoveal choroidal thickness (CT) and the mean foveal retinal thickness in 67 eyes of 43 patients with macular geographic atrophy. The patients were separated into groups with (group 1) and without (group 2) hyperautofluorescent choroidal vessels on fundus autofluorescence imaging. Shinojima et al. [1] discovered that the CT was statistically considerably thinner in group 1 compared to group 2. However, retinal thickness did not differ remarkably between the two groups. We want to congratulate the authors for their precious study and would like to request more details and their support to the article. A lot of local and systemic physiologic/ pathologic conditions may significantly affect CT [2, 3] . Firstly, age range in the study was 31–91 years and it was mentioned that there was a statistical age difference between the two groups. In addition, we wonder whether patients have any systemic (hypertension, hyperlipidemia, diabetes mellitus, vasculopathies, etc.) or local (glaucoma, strabismus, etc.) diseases. Also, pregnancy and menstrual cycle statuses of Received: May 1, 2016 Accepted: June 7, 2016 Published online: June 30, 2016

Comparison of intravitreal aflibercept and ranibizumab injections on subfoveal and peripapillary choroidal thickness in eyes with neovascular age-related macular degeneration

Dear Editor, We have read the article entitled BComparison of intravitreal aflibercept and ranibizumab injections on subfoveal and peripapillary choroidal thickness in eyes with neovascular age-related macular degeneration^ written by Yun et al. with great interest [1]. The authors compared changes in subfoveal and peripapillary choroidal thickness (CT) after intravitreal aflibercept or ranibizumab injections in 54 treatment-naïve patients with neovascular age-related macular degeneration (AMD). They discovered intravitreally injected aflibercept significantly decreased subfoveal CT more than ranibizumab. Additionally, choroidal thinning after aflibercept injection was not limited to the subfoveal area, but extended beyond the macula to the peripapillary area. We congratulate the authors for their valuable studies, and we would like to ask for more details and their contributions to the article. Primarily, many local and systemic physiological/ pathologic elements may affect CT. Effects of diurnal variation, systemic/local diseases and their treatment, drug use, axial length of the glob, intraocular pressure, refractive status, and many other factors on CT have been shown in the literature [2, 3]. In addition, Yun et al. mentioned many factors in their study, and we would like to ask the authors about some important points, which may have an effect on CT. For example, the ages of the 54 patients having participated in the study were mentioned to be >50 years. It has been stated in the study that diabetes mellitus (DM) and hypertension (HT) have no effect on OCT measurement results. However, we wonder if patients were considered in terms of additional systemic diseases (such as neurologic, inflammatory, and rheumatologic diseases, hyperlipidemia, psoriasis, etc.) [2, 3]. However, another important point is that the control status of HT and DM of patients in groups, their stages, and drugs used by patients may affect CT. Moreover, another point is that for subfoveal CT, decreases from 232.2 ± 94.4 μm to 207.1 ± 89.3 μm in the aflibercept group and from 231.5 ± 102.9 μm to 220.0 ± 98.0 μm in the ranibizumab group have been observed at the end of the third month. However, it has been found by Tan et al. that the average diurnal amplitude of CT is 33.7 ± 21.5 μm (range: 3 to 67 μm) in healthy humans [4]. The alteration in CTwas also correlated with alterations in systolic blood pressure (SBP). We are of the opinion that all these parameters may certainly affect OCT measurement results, and we would like have the ideas of the authors on these subjects. Before OCT measurements, we believe that sleeping and exercise conditions, smoking, and drinking alcohol or caffeinated/non-caffeinated drinks must be known. We also wonder if body mass indexes, and the results of SBP evaluation of the patients were considered for these parameters that can considerably change CT status. * Salih Uzun s.uzun84@gmail.com