Prospective case series on trabecular-iris angle status after an acute episode of phacomorphic angle closure

AIM:To investigate the trabecular-iris angle with ultrasound biomicroscopy (UBM) post cataract extraction after an acute attack of phacomorphic angle closure.METHODS: This prospective study involved 10 cases of phacomorphic angle closure that underwent cataract extraction and intraocular lens insertion after intraocular pressure (IOP) lowering. Apart from visual acuity and IOP, the trabecular-iris angle was measured by gonioscopy and UBM at 3 months post attack.RESULTS: In 10 consecutive cases of acute phacomorphic angle closure from December 2009 to December 2010, gonioscopic findings showed peripheral anterior synechiae (PAS) ≤ 90° in 30% of phacomorphic patients and a mean Shaffer grading of (3.1±1.0). UBM showed a mean angle of (37.1°±4.5°) in the phacomorphic eye with the temporal quadrant being the most opened and (37.1°±8.0°) in the contralateral uninvolved eye. The mean time from consultation to cataract extraction was (1.4±0.7) days and the mean total duration of phacomorphic angle closure was (3.6±2.8) days but there was no correlation to the degree of angle closure on UBM (Spearman correlation P=0.7). The presenting mean IOP was (50.5±7.4) mmHg and the mean IOP at 3 months was (10.5±3.4) mmHg but there were no correlations with the degree of angle closure (Spearman correlations P=0.9).CONCLUSION:An open trabecular-iris angle and normal IOP can be achieved after an acute attack of phacomorphic angle closure if cataract extraction is performed within 1 day - 2 days after IOP control. Gonioscopic findings were in agreement with UBM, which provided a more specific and object angle measurement. The superior angle is relatively more narrowed compared to the other quadrants. All contralateral eyes in this series had open angles.     

Changes in anterior chamber configuration after cataract surgery as measured by anterior segment optical coherence tomography

Purpose

To evaluate the changes in anterior chamber depth (ACD) and angle width induced by phacoemulsification and intraocular lens (IOL) implantation in normal eyes using anterior segment optical coherence tomography (AS-OCT).

Methods

Forty-five eyes (45 patients) underwent AS-OCT imaging to evaluate anterior chamber configuration before and 2 days after phacoemulsification and IOL implantation. We analyzed the central ACD and angle width using different methods: anterior chamber angle (ACA), trabecular-iris angle (TIA), angle opening distance (AOD), and trabecular iris surface area (TISA) in the nasal and temporal quadrants. Comparison between preoperative and postoperative measurement was done using paired t-tests and each of the angle parameters was analyzed with Pearson correlation testing. Subgroup analyses according to the IOL and axial length were performed with a general multivariate linear model adjusted for age.

Results

Before surgery, the mean anterior chamber angle widths were 23.21 ± 6.70° in the nasal quadrant and 24.89 ± 7.66° in the temporal quadrant. The mean central ACD was 2.75 ± 0.43 mm. After phacoemulsification and IOL implantation, the anterior chamber angle width increased significantly to 35.16 ± 4.65° in the nasal quadrant (p = 0.001) and 36.03 ± 4.86° in the temporal quadrant (p = 0.001). Also, central ACD increased to 4.14 ± 0.31 mm (p = 0.001). AOD, TISA, and TIA increased significantly after cataract surgery and showed positive correlation with ACA.

Conclusions

After cataract surgery, the ACD and angle width significantly increased in eyes with cataract. AS-OCT is a good method for obtaining quantitative data regarding anterior chamber configuration.     

Serial intracameral visualization of the Ahmed glaucoma valve tube by anterior segment optical coherence tomography

Purpose

To investigate serial changes of the Ahmed glaucoma valve (AGV) implant tube in the anterior chamber by anterior segment optical coherence tomography (AS-OCT).

Methods

Patients who had received AGV implantation without complications (n=48) were included in this study. Each patient received follow-up examinations including AS-OCT at days 1 and 2, week 1, and months 1, 3, 6, and 12. Tube parameters were defined to measure its length and position. The intracameral length of the tube was from the tip of the bevel-edged tube to the sclerolimbal junction. The distance between the extremity of the tube and the anterior iris surface (T–I distance), and the angle between the tube and the posterior endothelial surface of the cornea (T–C angle) were defined. Factors that were related to tube parameters were analysed by multiple regression analysis.

Results

The mean change in tube length was −0.20±0.17 mm, indicating that the tube length shortened from the initial inserted length. The mean T–I distance change was 0.11±0.07 mm and the mean T–C angle change was −6.7±5.6°. Uveitic glaucoma and glaucoma following penetrating keratoplasty showed the most changes in tube parameters. By multiple regression analysis, diagnosis of glaucoma including uveitic glaucoma (P=0.049) and glaucoma following penetrating keratoplasty (P=0.008) were related to the change of intracameral tube length.

Conclusions

These results suggest that the length and position of the AGV tube changes after surgery. The change was prominent in uveitic glaucoma and glaucoma following penetrating keratoplasty.     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation

Purpose

To evaluate the visual acuity and quality-related satisfaction of patients implanted with a refractive design multifocal intraocular lens (IOL), and evaluate the factors predicting it including angle kappa.

Setting

Dr Agarwal''s Eye Hospital and Eye Research Centre, Chennai.

Methods

In this prospective trial, 50 eyes of 44 consecutive patients were included. All patients underwent phacoemulsification with multifocal IOL implantation (Rezoom IOL, Abbott Medical Optics). The preoperative and postoperative assessment included slit lamp biomicroscopy, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and kappa angle assessment. At 1 year, 37 patients (43 eyes), who finished follow-up, were asked to rate their symptoms on a graded questionnaire (0–5 for five queries).

Results

The decimal scores for UCVA and BCVA were 0.38±0.21 and 0.47±0.17 (preoperative), and 0.75±0.22 and 0.99±0.11 (postoperative), respectively. Symptom scores were haloes 0.98±1.7, glare 0.69±1.48, blurred distance 1.0±1.7, intermediate 1.34±1.6, near 1.06±1.8. On regression analysis haloes depended on angle kappa and distance UCVA (R ²=0.26, P=0.029), and glare on angle kappa (R ²=0.26, P=0.033). Poor satisfactions with distance, intermediate, and near vision were linked with distance UCVA (R ²=0.17, P=2.3 × 10⁻⁴), distance UCVA (R ²=0.1, P=0.04), and near UCVA (R ²=0.12, P=0.03), respectively. The strongest predictor, however, for overall visual discomfort was distance UCVA (R ²=0.1, P=0.04).

Conclusions

Our study suggests that there may be a role of misalignment between the visual and pupillary axis (angle kappa) in the occurrence of photic phenomenon after refractive multifocal IOL implantation.     

Role of lens vault in subtypes of angle closure in Iranian subjects

Purpose

The purpose of this study is to quantify anterior chamber (AC) parameters and to determine the proportion of eyes with exaggerated lens vault (LV) in different subtypes of angle closure disease using anterior segment optical coherence tomography (AS-OCT).

Patients and methods

In this prospective study, 115 eyes of 115 Iranian patients with angle closure disease were included and categorized into three groups: (1) fellow eyes of acute angle closure (AAC; 40 eyes); (2) primary angle closure glaucoma (PACG; 39 eyes); and (3) primary angle closure suspect (PACS; 36 eyes). Complete ophthalmic examination including gonioscopy, A-scan biometry, and AS-OCT were performed. Angle parameters, LV, and iris thickness (IT) were measured using AS-OCT. An exaggerated LV was defined as LV more than one-third the distance between the corneal endothelium and a line drawn to connect the nasal and temporal scleral spurs.

Results

Fellow eyes of AAC had the shallower AC (P=0.01), greater iris curvature (I-curve; P=0.01), and higher LV (P=0.02) as compared with PACS and PACG eyes. There was no statistically significant difference in the mean IT at 750 μm from scleral spur among the three groups (P=0.45). Exaggerated LV was found in 67.5, 35.9, and 40% of fellow eyes of AAC, PACG, and PACS, respectively, (P=0.008) with an odds ratio of 1.92 (P=0.005) for fellow vs PACG and 1.68 (P=0.01) for fellow vs PACS.

Conclusions

Exaggerated LV is highly prevalent in fellow eyes of AAC. These eyes have shallower AC depth, greater I-curve, and higher LV when compared with PACG and PACS.     

Damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma

AIM: To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). METHODS: Twenty-four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after admission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled under 21mmHg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 months after IOP was controlled. Repeated measures ANOVA was used to examine the changes of RNFL thickness at different time after IOP being controlled in both acute attack eyes and unaffected fellow eyes of APACG and eyes with CPACG. RESULTS: The mean RNFL thickness for the APACG- attacked eyes increased significantly within 3 days (121.49±23.84)μm after acute onset and then became thinner along with time [(107.22±24.72)μm at 2 weeks,(93.58±18.37)μm at 1 month, (84.10±19.89)μm at 3 months and (78.98±19.17)μm at 6 months]. In APACG-attacked eyes, there were significant differences of average RNFL thickness at 5 different times after IOP was controlled (P＜0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness at 5 different times(F=0.450, P=0.104 in APACG unaffected fellow eyes and F=1.558, P=0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F=1.912, P=0.003). CONCLUSION: RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.     

Detection of progressive macular thickness loss using optical coherence tomography in glaucoma suspect and glaucomatous eyes

Aims

To examine the rate of macular thickness loss using time-domain optical coherence tomography (OCT) in functionally progressing versus non-progressing eyes, determined by standard automated perimetry (SAP).

Methods

Glaucoma suspects (GS) and glaucomatous (G) eyes underwent SAP and OCT imaging every 6 months. Functional progression was determined using pointwise linear regression, defined as 2 contiguous locations losing ≥1.0 dB/year at P<1.0% in the same hemifield. The annual rate of macular thickness loss was calculated from inner and outer regions of the macular map.

Results

72 eyes (43 GS and 29G) with ≥30 months of follow-up were enroled. Fourteen eyes demonstrated SAP progression. The annual rate of macular thickness loss (μm/year) in progressing eyes was faster (all P<0.05) than non-progressing eyes in temporal outer (−1.90±2.97 vs 0.33±2.77), nasal inner (−1.70±2.66 vs 0.14±2.76), superior inner (−2.15±4.57 vs 0.51±2.99), temporal inner quadrants (−2.58±5.05 vs −0.38±2.34), and the average of inner macular quadrants (−1.84±2.90 vs 0.03±2.10). The rate of loss in the nasal inner (P=0.02) and temporal outer (P=0.02) macular regions was associated with optic disc haemorrhage.

Conclusions

Eyes with SAP progression have significantly greater rates of macular thickness loss consistent with glaucomatous retinal ganglion cell atrophy, as compared with non-progressing eyes.     

Effect of pupil size on higher-order aberrations in high-myopic pseudophakic eyes with posterior staphyloma

Purpose

To evaluate the effect of pupil size on higher-order aberrations (HOAs) in high-myopic pseudophakic eyes with posterior staphyloma using KR-1W aberrometer.

Methods

Forty eyes of 40 high-myopic cataract patients with posterior staphyloma and 20 eyes of 20 age-related cataract patients with normal axial length were recruited. At 1 month after phacoemulsification and intraocular lens implantation, ocular and internal HOAs as well as the visual quality data in the two groups were evaluated with KR-1W analyzer before and after mydriasis.

Results

Compared with normal axial length eyes, high-myopic pseudophakic eyes with posterior staphyloma had significantly lower values of internal coma both under 4-mm and 6-mm pupil sizes (P<0.001 and 0.020), as well as internal total HOAs (P<0.001) and third-order aberrations at 6-mm pupil size (P=0.018). Statistically significant differences were also found in the variation from 4- to 6-mm pupil sizes for internal coma (P=0.001), internal third-order aberrations (P=0.009), internal total HOAs (P=0.007), and ocular coma aberrations (P=0.006) between two groups. After mydriasis, Strehl ratio increased significantly in high-myopic eyes, whereas decreased slightly in normal axial length eyes (P=0.032 when compared with the variation between the two groups). Statistically significant differences were also found for the variation of modulation transfer functions (MTFs) at frequencies of 15, 30, 45, and 60 cycles/degree between the two groups (P=0.002, 0.002, 0.004, and 0.010, respectively).

Conclusions

High-myopic pseudophakic eyes with posterior staphyloma had significantly lower internal coma and less coma variations during mydriasis.     

Effects of caffeinated coffee consumption on intraocular pressure, ocular perfusion pressure, and ocular pulse amplitude: a randomized controlled trial

Purpose

To examine the effects of caffeinated coffee consumption on intraocular pressure (IOP), ocular perfusion pressure (OPP), and ocular pulse amplitude (OPA) in those with or at risk for primary open-angle glaucoma (POAG).

Methods

We conducted a prospective, double-masked, crossover, randomized controlled trial with 106 subjects: 22 with high tension POAG, 18 with normal tension POAG, 20 with ocular hypertension, 21 POAG suspects, and 25 healthy participants. Subjects ingested either 237 ml of caffeinated (182 mg caffeine) or decaffeinated (4 mg caffeine) coffee for the first visit and the alternate beverage for the second visit. Blood pressure (BP) and pascal dynamic contour tonometer measurements of IOP, OPA, and heart rate were measured before and at 60 and 90 min after coffee ingestion per visit. OPP was calculated from BP and IOP measurements. Results were analysed using paired t-tests. Multivariable models assessed determinants of IOP, OPP, and OPA changes.

Results

There were no significant differences in baseline IOP, OPP, and OPA between the caffeinated and decaffeinated visits. After caffeinated as compared with decaffeinated coffee ingestion, mean mm Hg changes (±SD) in IOP, OPP, and OPA were as follows: 0.99 (±1.52, P<0.0001), 1.57 (±6.40, P=0.0129), and 0.23 (±0.52, P<0.0001) at 60 min, respectively; and 1.06 (±1.67, P<0.0001), 1.26 (±6.23, P=0.0398), and 0.18 (±0.52, P=0.0006) at 90 min, respectively. Regression analyses revealed sporadic and inconsistent associations with IOP, OPP, and OPA changes.

Conclusion

Consuming one cup of caffeinated coffee (182 mg caffeine) statistically increases, but likely does not clinically impact, IOP and OPP in those with or at risk for POAG.     

The biomechanical properties of the cornea in patients with systemic lupus erythematosus

Pupose:

The purpose of this study was to compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with systemic lupus erythematosis (SLE) and age-matched controls.

Patients and Methods:

In this prospective study, 30 healthy individuals (control group) and 30 patients with SLE (study group) underwent Reichert ocular response analyzer (ORA) measurements. In the right eye of each participant, the corneal hysteresis (CH), corneal resistance factor (CRF), and Goldman-related IOP (IOPg) were recorded using the ORA.

Results:

Mean CH, CRF, IOPg were significantly different between groups. Mean CH was 10.2±0.6 mm Hg in the study group and 11.3±1.3 in the control group (P=0.02); mean CRF was 9.7±1.1 mm Hg and 11.9±1.5 mm Hg, respectively (P=0.001). Mean IOP_g was 13.9±2.9 mm Hg in the study group and 16.9±2.6 mm Hg in the control group (P=0.001).

Conclusion:

The biomechanical properties of the cornea are altered in patients with SLE compared with normal controls. These findings should be taken into account when measuring IOP values in patients with SLE as IOP readings may be underestimated in SLE eyes.     

Pupil dynamics in Chinese subjects with angle closure

Objective

To evaluate the speed of pupil constriction (SPC) in response to a standardized change in illumination from dark to light using anterior segment optical coherence tomography (AS-OCT) in eyes with closed angles, compared to those with open angles.

Methods

This was a prospective, comparative, observational study. Study subjects with primary angle-closure glaucoma (PACG) and/or primary angle-closure (PAC) were recruited along with a group of normal as controls. Videos of iris and anterior segment changes in response to illumination were captured with real-time video recording from AS-OCT and analysed frame by frame, beginning from a dilated to a constricted pupil. Customized software was used to measure speed of iris constriction, anterior chamber depth (ACD), anterior chamber width (ACW), iris thickness, and pupil diameter (PD). SPC was defined as the rate of pupil diameter change in response to illumination.

Results

One hundred and sixty three Chinese subjects were recruited in this study. A total of 137 of 163 eligible videos (82.5%) were available for analysis, comprising 87 subjects with closed angles (all had undergone laser peripheral iridotomies before) and 50 with open angles. SPC was less in eyes with closed angles (1.22?mm/sec vs 1.56?mm/sec, p?r?>?0.2, all p?p?=?0.016) and PD in dark (β?=?0.129, p?=?0.009), after adjusting for age, ACW, ACD, iris thickness and vertical cup-to-disc ratio.

Conclusions

Compared to those with open angles, eyes with closed angles in Chinese subjects have slower speed of pupil constriction in response to dark–light change, even after adjusting for biometric factors associated with angle closure. The results suggest that differences in irido-pupillary dynamics may play a role in the pathogenesis of angle closure.     

A short-term study of corneal collagen cross-linking with hypo-osmolar riboflavin solution in keratoconic corneas

AIM: To report the 3mo outcomes of collagen cross-linking (CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 μm without epithelium. METHODS: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the procedure. RESULTS: The mean thinnest thickness of the cornea was 408.5±29.0 μm before treatment and reduced to 369.8±24.8 μm after the removal of epithelium. With the application of the hypo-osmolar riboflavin solution, the thickness increased to 445.0±26.5 μm before CXL and recover to 412.5±22.7 μm at 3mo after treatment, P=0.659). Before surgery, the mean K-value of the apex of the keratoconus corneas was 57.6±4.0 diopters, and slightly decreased (54.7±4.9 diopters) after surgery (P=0.085). Mean best-corrected visual acuity was 0.55±0.23 logarithm of the minimal angle of resolution, and increased to 0.53±0.26 logarithm after surgery (P=0.879). The endothelial cell density was 2706.4±201.6 cells/mm2 before treatment, and slightly decreased (2641.2±218.2 cells/mm2) at last fellow up (P=0.002). CONCLUSION: Corneal collagen cross-linking with a hypo-osmolar riboflavin in thin corneas seems to be a promising treatment. Further study should be done to evaluate the safety and efficiency of CXL in thin corneas for the long-term.     

Clinical effect of improved viscocanalostomy for the treatment of primary congenital glaucoma

AIM: To evaluate the clinical effect of improved viscocanalostomy in patients with primary congenital glaucoma. METHODS: Retrospective analysis of improved viscocanalostomy was performed on 51 eyes of 42 patients with primary congenital glaucoma. The outcome evaluation included postoperative intraocular pressure(IOP), corneal diameter, cup/disc ratio and complications. All patients were followed up at week 1, month 1, 3, 6 and 12. RESULTS: The results revealed that postoperative IOP was decreased from (38.57±13.61)mmHg to (10.53±3.91)mmHg, (14.89±5.26)mmHg, (15.42±5.11)mmHg, (13.82±3.46)mmHg, (13.16±5.29)mmHg at follow-up time of 1 week, 1, 3, 6, 12 months (P<0.001). The postoperative corneal diameter was decreased significantly (P=0.002); The mean cup/dish ratio wasn’t significantly different (P=0.148) before and after the surgery, the cup/dish ratio of successful surgery was evidently decreased (preoperative 0.7±0.2, postoperative 0.6±0.3, P=0.007), but the complications like as unformed anterior chamber were not observed. The mean follow-up period was 12 months. CONCLUSION: Improved viscocanalostomy improves the clinical effects of the patients with primary congenital glaucoma, such as higher success rates, lower postoperative mean IOP and fewer complications.     

Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL

Purpose

To evaluate the safety and visual outcomes of two phakic intraocular lenses (IOLs) for correction of high myopia: Artisan and Visian ICL (ICL).

Patients and methods

In this retrospective study, a phakic IOL was implanted in 68 highly myopic eyes of 34 patients; 42 eyes received an Artisan IOL, and 26 eyes received ICL IOL.

Results

All patients completed a 1-year follow-up. The mean preoperative spherical equivalent (SEQ) was −12.89±3.78, and −12.44±4.15 diopters (D) for Artisan and ICL (P=0.078), respectively. The mean postoperative (1-year) uncorrected distance visual acuity was 0.39±0.13 and 0.41±0.15 logMAR for Artisan and ICL, respectively (P=0.268). The mean postoperative (1-year) corrected distance visual acuity was 0.36±0.12 and 0.31±0.12 logMAR for Artisan and ICL, respectively (P=0.128). The mean postoperative SEQ was −0.86±0.5 and −0.63±0.38 D for Artisan and ICL, respectively (P=0.67). Intraocular pressure change at 1 year was 0.64±2.7 and 1.88±0.6 mm Hg for Artisan and ICL, respectively (P=0.77).

Conclusion

Artisan and ICL showed equal and comparable safety, predictability, and efficacy.     

Application of Lutein and Zeaxanthin in nonproliferative diabetic retin

AIM: To compare serum Lutein and Zeaxanthin (L/Z) concentrations between patients with nonproliferative diabetic retinopathy (NDR) and normal subjects, and to explore the effect of L/Z supplementation on serum L/Z level and visual function in NDR patients METHODS: Subjects were divided into three groups: 30 NDR patients supplied with Lutein 6mg/d and Zeaxanthin 0.5mg/d for three months (DR Group), 30 NDR patients without L/Z supplementation (DR Control Group) and 30 normal subjects (Control Group). Serum L/Z concentrations were measured by liquid high-resolution chromatography (HPLC). Visual acuity was recorded at baseline, 1 month, 2 months and 3 months post initial supplementation. Serum L/Z concentration were measured at baseline, 1 month and 2 months post initial supplementation. Contrast sensitivity (CS) and fovea thickness were recorded at baseline and 3 months post initial supplementation. RESULTS: Mean serum lutein concentrations in DR group were 0.0686±0.0296μg/mL and zeaxanthin concentration was 0.0137±0.0059μg/mL. The L/Z level of DR group was significantly lower compared to the control group( lutein: 0.2302±0.1308μg/mL,zeaxanthin: 0.0456±0.0266μg/m,P = 0.000). The concentration of lutein and zeaxanthin in the DR control group at base line was 0.0714±0.0357μg/mL and 0.0119±0.0072μg/mL, respectively. There was no significant change of L/Z concentration in the DR control group during the study. Serum L/Z concentrations of DR group increased significantly after supplementation（F=109.124,P=0.000;F=219.207,P=0.000）.Visual acuity improved significantly after medication. Compared with pre-medication, the average CS values of 1.5cpd, 3cpd and 6cpd after three months increased significantly (P=0.030,0.013,0.008) and the foveal thickness decreased. (P=0.05) CONCLUSION: Serum L/Z concentrations in DR patients are significantly lower than those in normal subjects, and L/Z intake can improve the visual acuity, CS and macular edema in DR patients, suggesting that L/Z supplementation might be targeted as potential potential therapeutic agents in treating NDR.     

Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy

Purpose

To compare the effectiveness of intravitreal injection of bevacizumab and ranibizumab in patients with treatment-naïve polypoidal choroidal vasculopathy (PCV).

Methods

A total of 66 and 60 eyes of 121 consecutive patients who received intravitreal bevacizumab (1.25 mg) or ranibizumab (0.5 mg) injection for treatment of PCV were retrospectively reviewed. After initial three loading injections by month, injection was performed as needed. Main outcome measures included best corrected visual acuity (BCVA), foveal center thickness (FCT) as assessed by spectral domain optical coherence tomography (SD-OCT), and change in polypoidal lesion on indocyanine green angiography (ICGA).

Results

At 12 months, average number of injections was 4.72±1.84 in the bevacizumab group and 5.52±1.54 in the ranibizumab group. Mean logarithm of the minimum angle of resolution of BCVA from baseline at 12 months after injection improved by 0.11 in the bevacizumab group (P=0.02) and by 0.14 in the ranibizumab group (P=0.01). Average FCT decreased from 368±62.48 to 298±40.77 μm in the bevacizumab group (P=0.01) and from 371±50.79 to 286±36.93 μm in the ranibizumab group (P=0.01). Polyp regression rate was 24.2% (16 eyes out of 66 eyes) in the bevacizumab group and 23.3% (14 eyes out of 60 eyes) in the ranibizumab group. There was no statistically significant difference in BCVA improvement achieved, FCT improvement achieved, and polyp regression rate between groups.

Conclusion

Intravitreal injections of bevacizumab and ranibizumab have similar effects in stabilization of visual acuity, macular edema, and regression of polypoidal complex with PCV eyes.     

Ocular findings in children with thalassemia major in Eastern Mediterranean

AIM: To investigate ophthalmologic findings in children with thalassemia major (TM) and compare the findings with healthy controls. METHODS: In a cross-sectional study, 43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination, tear function tests including the Schirmer test, fluorescein tear break-up time (BUT), ultrasound pachymetry, and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. RESULTS: The mean best corrected visual acuity was 1.34±0.75 in TM and 1.08±0.28 in controls. It was found lower than 0.1 logMAR unit in 10 (23.2%) children with TM and 2 (4.2%) in controls, and the difference was statistically significant (P＜0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98±20.45μm in controls (P＞0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group (P＜0.01). The mean BUT score was 9.62±1.28 in TM and 9.73±0.6s in the control group (P＞0.05). CONCLUSION: In TM, while corneal thickness, axial length, and BUT are close to controls, the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.     

Visual function and vision-related quality of life after vitrectomy for idiopathic macular hole:a 12mo follow-up study

AIM: To investigate the visual function and the relationship with vision-related quality of life (VRQOL) after macular hole repair surgery．METHODS: Prospective case series. Thirty-six consecutive eyes in 36 patients who underwent pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling were included. The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by the participants before and 3 and 12mo after operation. Follow-up visits examinations included best-corrected visual acuity (BCVA), clinical examination, and central macular thickness (CMT) measured by optical coherence tomography (OCT).RESULTS: Macular-hole closure was achieved in 35 of 36 eyes (97.2%). At baseline and months 3 and 12, the logMAR BCVAs (mean±SD) were 1.15±0.47, 0.68±0.53 (P<0.0001 versus baseline), and 0.55±0.49 (P<0.001 versus baseline, P =0.273 versus month 3), respectively; the CMTs (μm) were 330±81, 244±62 (P<0.001 versus baseline), and 225±58 (P<0.001 versus baseline, P=0.222 versus month 3), respectively; the median preoperative VFQ-25 composite score of 73.50 (63.92-81.13) increased postoperatively to 85.50 (80.04-89.63) at 3mo (P<0.001) and 86.73(82.50-89.63) at 12mo (P<0.001) respectively. The improved BCVA was correlated with improvements in five subscales (r=-0.605 to -0.336, P<0.001 to P=0.046) at 12mo.CONCLUSION: PPV with ILM peeling improved anatomic outcome, visual function, and VRQOL. The improved BCVA was an important factor related to the improved VRQOL.     

Pigment epithelium-derived factor protects the morphological structure of retinal Müller cells in diabetic rats

AIM:To investigate if pigment epithelium-derived factor (PEDF) has any protective effect on the retinal Müller cells of Sprague-Dawley rats suffering from diabetes mellitus.METHODS:Sixty Sprague-Dawley rats were randomly divided into a negative control group, a group receiving 0.1 μg/μL PEDF, another group receiving 0.2 μg/μL PEDF, and a group receiving balanced salt solution (BSS). Rats in both the PEDF and BSS groups were treated intravitreally based on previously established diabetic models. After 4wk of treatment, morphological alterations of Müller cells and protein expression of glutamine synthase (GS) and glial fibrillary acidic protein (GFAP) were analyzed.RESULTS:PEDFat either0.1 μg/μL or 0.2 μg/μL significantly improved the structures of both nuclei and organelles of Müller cells compared to the BSS-treated group. Expression of GS was significantly higher in the 0.2 μg/μL PEDF group than that in the BSS group (P=0.012), but expression of GFAP was significantly lower in the 0.2 μg/μL PEDF group than that in the BSS group (P=0.000); however, there were no significant differences in expression of these proteins between the 0.1 μg/μL PEDF group and the BSS group (P=0.608, P=0.152).CONCLUSION:PEDF protects the morphological ultrastructure of Müller cells, improves the expression of glutamate synthase and prevents cell gliosis.