Çağrı İLHAN, Mehmet ÇITIRIK, Mahmut KAYA
Çağrı İLHAN, Mehmet ÇITIRIK, Mahmut KAYA
Purpose: To evaluate the frequency of macular optical coherence tomography fi ndings in patients with retinitis pigmentosa in Turkish community. Methods: In this case series study, the medical records of the adult retinitis pigmentosa cases those are followed in a tertiary referral center in Ankara, were retrospectively investigated. Demographic data and clinical fi ndings were obtained from the medical records. Macula optical coherence tomography images recorded in the system were examined in detail for vitreomacular interface diseases, intraretinal hyper-refl ective spots, foveal atrophy, and intraretinal cyst fi ndings. Results: The study included 145 eyes of 77 retinitis pigmentosa cases. The mean age of the subjects was 37.42 ± 15.3 years (18 – 65). 44 (57%) of the cases were male and 33 (43%) of the cases were female. The mean best corrected visual acuity was 0.51 ± 0.27 logMAR (0.00 – 1.50). The most common macula optical coherence tomography fi nding was vitreomacular interface disorders in 72 eyes (49.7%) (bilaterality rate 35.8%). Other common macula optical coherence tomography fi ndings were intraretinal hyper-refl ective spots in 69 eyes (47.6%) (bilaterality rate 85.9%), foveal atrophy in 66 eyes (45.5%) (bilaterality rate 65.6%), and intraretinal cyst in 45 eyes (31.0%) (bilaterality rate 27.5%), respectively. Conclusion: A wide range of macular optical coherence tomography fi ndings can be occurred in patients with retinitis pigmentosa that is a progressive degenerative disease. While the most common fi nding in retinitis pigmentosa cases in Turkish community is vitreoretinal interface diseases, the fi nding has the highest bilaterality rate is intraretinal hyper-refl ective spots.
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Buğra KARASU, Orçun SÖNMEZ
Buğra KARASU, Orçun SÖNMEZ
Purpose: To evaluated the effi cacy of switching to intravitreal afl ibercept (IVA) injection to treat polypoidal choroidal vasculopathy (PCV) refractory to intravitreal ranibizumab (IVR). Materials and Methods: In this retrospective study, medical records of 29 eyes of 29 patients with PCV treated with IVA (2 mg / 0.05 mL) followed by IVR switch were reviewed. A treatment history of 3 consecutive monthly IVR as loading dose followed by a pro re nata regimen phase over 6 months was seen for all patients and followed by the last for 3 consecutive monthly of IVR received. All patients who were refractory to IVR (defi ned as recalcitrant subretinal or intraretinal fl uid in optical coherence tomography (OCT) and unchanged or decreased visual acuity (VA) compared with those at time of fi rst IVR injection, despite receiving the last 3 consecutive monthly IVR injections following 12 months. The switch time to IVA was accepted as the baseline. Visual and anatomical changes were recorded at baseline and at months 1, 3 and 6, respectively. Results: Visual acuity levels signifi cantly improved from 0.73 ± 0.49 logarithm of the minimum angle of resolution (log MAR) at baseline to 0.58 ± 0.38 log MAR 6 months after switching to afl ibercept (p = 0.037). The central macular thickness decreased signifi cantly from 349.58 ± 101.81 at baseline to 308.68 ± 94.58 at month 6 (p= 0.001). Of 16 eyes with polypoidal lesions at baseline, the polypoidal lesions regressed completely in 6 eyes (37%) at month 6. Conclusion: Administering intravitreal afl ibercept injection for patients with polypoidal choroidal vasculopathy refractory to ranibizumab maintained or improved visual acuity and reduced or eliminated exudative lesions and occluding polypoidal lesions without adverse events with short-term follow-up.
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Buğra KARASU, Özgür ARTUNAY
Buğra KARASU, Özgür ARTUNAY
Purpose: To compare visual and anatomical results of anti- vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) versus only performing anti- VEGF therapy in eyes with polypoidal choroidal vasculopathy (PCV). Materials and Methods: Retrospective review of 60 PCV patients who underwent anti- VEGF combined with PDT (Group 1) or solely performing anti- VEGF therapy (Group 2) were enrolled. The best corrected visual acuity (BCVA), central macular thickness (CMT), presence of subretinal fl uid (SF) were compared among the groups during the follow-up periods at baseline, 1st month, 3rd month, 6th month, 9th month, 12th month,18th month, 24th month and fi nal visit, respectively. Results: The mean age of the patients was 71.96 ± 8.50 years (range, 52-88 years), and the mean follow-up period was 53.83 ± 14.86 (range, 20-85 months). The mean number of injections was observed as 10.56 ± 1.88 (range, 7 -15) in the fi rst group and 11.83 ± 2.61 (range, 7 - 17) in the second group, respectively (p = 0.039). In group 1, BCVA decreased from the logarithm of the minimum angle resolution (log MAR) of 0.59 ± 0.39 to 0.70 ± 0.41 log MAR in the fi nal examination (p = 0.016), CMT initial 355.562 ± 95.54 μm decreased from to 296,76 ± 105,03 μm at the last examination (p <0.001), the presence of SRF showed a statistically signifi cant decrease in follow-up periods compared to the initial period (p <0.001). In group 2, BCVA decreased from initial 0.65 ± 0.61 log MAR to 0.82 ± 0.56 log MAR in the fi nal examination (p <0.001), CMT decreased from baseline 372.60 ± 114.21 μm to 287.06 ± 64.32 μm at the last examination (p = 0.001), the presence of SF showed a statistically signifi cant decrease in follow-up periods compared to the initial period (p <0.001). In the last examination, there was no statistically signifi cant difference between the groups in terms of presence of SF (p = 0.305). Conclusion: Both full-dose PDT combined with anti-VEGF and only anti-VEGF applications are effective in the treatment of PCV. There was no signifi cant difference in visual or anatomical results among the two groups. However, we observed that full dose PDT administration combined with anti-VEGF reduces the need for anti-VEGF usage.
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Tacettin KURU, Fatih ASLAN
Tacettin KURU, Fatih ASLAN
Purpose: To investigate the relationship between Acute Central Serous Chorioretinopathy (CSCR) and psychological parameters. Methods: Acute CSCR patients, myopia patients and healthy volunteers compatible in terms of age and gender, were included in the study. Acute CSCR diagnosis is based on clinical evaluation, optic coherence, and fl uorescein angiography. All volunteers were evaluated using a sociodemographic form, State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Health Anxiety Inventory (HAI) and Short Form 36 (SF-36). Results: We determined a higher mean trait anxiety level in the acute CSCR group (x̄ = 44.33), compared to the control (x̄ = 36.72, p = 0.048) and myopic (x̄ = 35.22, p = 0.021) groups. There was no signifi cant difference between the groups in terms of state anxiety (p = 0.295), depression (p = 0.763), and health anxiety (p = 0.405). In addition, there was no difference between the groups in terms of sub-parameters of quality of life, such as physical functionality (p = 0.925), physical role limitation (p = 0.110), emotional role limitation (p = 0.474), vitality (p = 0.078), mental health (p = 0.532), social functionality (p = 0.335), pain (p = 0.352) and general health (p = 0.074). Conclusion: Our study results revealed the relationship between acute CSCR and anxiety. This relationship suggests that it is not a natural and temporary stress response caused by having any eye disease.
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Callie DENG, Cagri G. BESİRLİ
Callie DENG, Cagri G. BESİRLİ
Gene therapy is an emerging therapeutic modality that has demonstrated early success in treating genetic ocular disorders. The approval of voretigene neparavovec-ryzl (tradename Luxturna®), the first single-dose in vivo gene therapy and only on-market treatment for Leber congenital amaurosis Type 2, marked a turning point for inherited retinal diseases. Since then, dozens of in vivo gene therapy products have reached clinical development for other IRDs, including retinitis pigmentosa, achromatopsia, Leber hereditary optical neuropathy , X-linked retinoschisis, and Usher syndrome type 2. This review highlights the clinical and genetic landscape of inherited retinal diseas es targeted by ongoing clinical-stage gene therapy development and outcomes to date for patients treated with voretigene neparvovec. Finally, we discuss trends in gene therapy pricing and approaches in determining the cost effectiveness of single-dose gene therapies for IRDs.
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Hakan BAYBORA
Hakan BAYBORA
Purpose: Although cataracts can be seen after pars plana vitrectomy, also be seen with vitreomacular interface pathologies such as a mac ular hole and epiretinal membrane. Since this may cause difficulties in imaging the surgical field, cataract surgery combined with surgery for primary pathology may be required. With the development of small incision microsurgical techniques and more precise biometric measurements, results close to emmetropic can be obtained today. Since internal limiting membrane peeling is performed together in hole and ERM surgery, we planned this study to investigate whether there is a signi ficant difference between the final refraction and the refraction of noncomplicated phacoemusification performed control group. Also, we wanted to find any difference between expected and final refraction in our study group Materials and methods: Retrospective combined phacoemulsification - Pars plana vitrectomy-internal limiting membrane peeling 33 macular holes and 10 epiretinal membrane patients and 43 control patients with the only phacoemulsification were included in the study. Intraocular lens power to be implanted was measured by low coherence interferometry. Comparison of expected postoperative refraction with result refraction Wilcoxon test and comparison with the control group was performed with the Mann-Whitney U test. Results: There was no significant difference between the combined surgery group and the control group refraction results (p = 0.41, p> 0.05) and also between expected refraction and final refraction in the surgery group (p = 0.16, p> 0.05).
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Elif ERTAN, Melek MUTLU, Reşat DUMAN, Rahmi DUMAN, Guliz Fatma YAVAŞ
Elif ERTAN, Melek MUTLU, Reşat DUMAN, Rahmi DUMAN, Guliz Fatma YAVAŞ
Macular edema can be occured in cases of retinitis pigmentosa. One of the treatment agent for cystoid macular edema secondary t o retinitis pigmentosa is intravitreal Ozurdex implant. Secondary glaucoma is one of the complication of intravitreal corticosteroid injection for macular edema. In this article the retinitis pigmantosa case with secondary glaucoma resistent to medical treatment after ozurdex implant for refractory macular edema is presented. To present a case with bilateral refractory macular edema secondary to retinitis pigmentosa improved glaucoma in one eye after one month following Ozurdex® (Allergan, Inc., Irvine, CA, USA) implantation. Further studies are needed to confirm the safety and efficacy of intravitreal Ozurdex® for macular edema in retinitis pigmentosa.
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Elif ERTAN, Ali ARSLAN, Sibel İNAN, Ümit Übeyt İNAN
Elif ERTAN, Ali ARSLAN, Sibel İNAN, Ümit Übeyt İNAN
This report represents a rare complication of retinal hole aftrer Nd:YAG laser hyaloidotomy in a case of Valsalva retinopathy s econdary to vaginal strain from labor. The retinal hole spontaneously closed during follow-up.
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Andi Arus VİCTOR, Vivi Rizka YANDANDRİ, Tjahjono Darminto GONDOWİARDJO, Rahayuningsih DHARMA, Sri Widia JUSMAN, Joedoe PRİHARTONO
Andi Arus VİCTOR, Vivi Rizka YANDANDRİ, Tjahjono Darminto GONDOWİARDJO, Rahayuningsih DHARMA, Sri Widia JUSMAN, Joedoe PRİHARTONO
Purpose: The vitreous concentration of Hypoxia-inducible Factor-1α (HIF-1α) and Intercellular Adhesive Molecule-1 (ICAM-1) were related to the permeability of retinal vessels and the grades of macular edema in proliferative diabetic retinopathy (PDR). Prior studi es have showed that pan-retinal photocoagulation (PRP) is beneficial in treating PDR. The aim of this study is to determine how pre-treatment with PRP before vitrectomy affect the vitreous level of HIF–1 and ICAM-1 in patients with PDR. Materials and Methods: A randomized clinical trial study was conducted to 22 eyes in Cipto Mangunkusumo National General Hospital, Indonesia. At the beginning of PRP, just before vitrectomy, and at 2, 4, and 12 weeks after vitrectomy, central macular thickness (CMT) was measured using optical coherence tomography (OCT). Undiluted vitreous humour was extracted during vitrectomy to obtain HIF-1 α and ICAM-1 concentration. Results: In the control and the photocoagulation group, the average level of HIF-1α (ng/mL) were 0.152±0.015 and 0.164±0.033 respectively. The average level of ICAM-1 (ng/mL) in control group and pre-treated group were 17,840±14,140 and 27,027±10,452 respectively. No statistically significant difference was seen in the level of HIF-1α and ICAM-1 between each group. The correlation between vitreous ICAM- 1 and HbA1c was statistically signi ficant (r=0.463, p=0.03). No signi ficant differences for CMT at pre-vitrectomy, or 2 and 4 weeks after vitrectomy. Statistically significant difference was observed at 12 weeks after follow-up (p=0.049). The correlation between vitreous level of HIF-Iα and CMT in the control and laser group are r = 0.447 and r = 0.32, respectively. Conclusion: Laser photocoagulation 1-2 weeks prior to vitrectomy did not lower vitreous concentration of HIF-1α and ICAM-1.
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Purpose: To investigate optical coherence tomography angiography (OCTA) findings in patients with psoriasis.
Materials and Methods: The study included 31 treatment-naive psoriasis patients without ocular involvement and 29 age- and sex- matched
controls. Psoriasis was classified using the psoriasis area and severity index (PASI) score. Superficial and deep vascular densities (SVD, DVD),
foveal avascular zone (FAZ) area, perimetry, foveal density (FD) 300μm around the FAZ, central macular thickness (CMT) and subfoveal
choroidal thickness (SFCT) were measured with the Optovue OCTA device. The groups were compared statistically.
Results: There was no difference between groups regarding age and gender (p:0,6 ve 0,2 respectively). Of the cases with psoriasis, 16% had
arthritis and 45% had nail involvement. Median (min-max) disease duration was 10 years (1-48 years) and PASI score was 10 (2,20-42). The
mean SVD and DVD were comparable between the groups (p:0,73 and 0,97 respectively). There was no significant difference in mean FAZ
area, perimetry and FD between the patients and the controls. There was no correlation between the OCTA metrics and the severity, duration,
nail and joint involvement of the disease (p>0,05 for all values). Additionally there was no significant difference between mild and severe
psoriasis cases (p>0.05).
Conclusion: OCTA is a promising technique for imaging the retinal microvascular system in psoriasis cases. However, it seems to have a
limited role in detecting early subclinical changes in cases without ocular involvement.
Key words: Foveal avascular zone, optical coherence tomography angiography, PASI score, psoriasis, vascular density.
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