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Background: To compare the content and quality of 3D YouTube videos with 2Ds as additional educational tools for phacoemulsification surgery., Methods: This cross-sectional study included 2D and side-by-side 3D phacoemulsification videos found on YouTube by searching for "phacoemulsification," "phaco," and "cataract." Data was collected on video length (min), time since upload (days), number of views, likes, dislikes, cataract type, chop technique, and visualization system. Video popularity and interaction were calculated by video power index, interaction index, and viewing rate. Two senior ophthalmologists (SOs) and two ophthalmology residents (ORs) evaluated videos using the DISCERN, global quality score (GQS), and usefulness scoring systems. Inter-rater reliability was assessed using intra-class correlation coefficient (ICC)., Results: A total of 457 videos were screened, with 85 in 2D and 85 in 3D deemed appropriate for analysis. 2D videos received significantly more views, likes, dislikes, days since upload, video power index, and viewing rate than 3Ds (p < 0.001). Video length and interaction index in 3D videos were significantly greater than in 2Ds (p < 0.001). All video scoring systems revealed that 3D videos outperformed 2Ds in ORs (p < 0.05). ICC confirmed good inter-rater reliability agreement even at the lowest value (SOs: 0.924, 95% CI, 0.910-0.937; ORs: 0.892, 95% CI, 0.878-0.908)., Conclusions: 3D YouTube videos as additional educational tools could help not only SOs but also ORs fully comprehend the breadth and depth of ocular surgeries, particularly phacoemulsification, by improving depth perception. They can also be used to review previously learned procedures, observe new ones, and recall old ones., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: This study intended to illustrate a rare case of pyogenic granuloma (PG) in retinal vein occlusion (RVO) patient after dexamethasone (DEX) implant therapy., Case Description: A 58-year-old female who underwent DEX implant therapy a month ago due to RVO presented with a mass in her right eye. Anterior segment analysis revealed a slowly enlarging, round, fleshy vascular mass indicating PG located at the injection site. Although surgical excision was planned, because of the Covid-19 pandemic, a patient could not come for surgery. Ocular examination revealed a spontaneous PG disappearance three months later. A small mass could, however, be detected using an anterior segment optical coherence tomography., Conclusion: While superficial PG regression can only be observed by slit-lamp biomicroscopy, extensive root ingrowth can be clearly differentiated by anterior segment optical coherence tomography. Besides, depending on the nature, size, location, and associated symptoms, some PG may be left to regress but with close monitoring.

Background: Capsular bag distension syndrome (CBDS) can be effectively treated using either Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser capsulotomy or surgery. Assessing anterior segment, particularly immediately after Nd:YAG laser capsulotomy, could provide clinically relevant information on ocular dynamics, refractive changes, and complication mechanisms, especially in late postoperative CBDS. Objective: To explore the acute effects of Nd:YAG laser posterior capsulotomy on anterior segment parameters in late postoperative CBDS. Methods and results: In this study, 20 patients underwent Nd:YAG laser posterior capsulotomy after cycloplegia, during which milky-white fluid material migrated into the anterior vitreous. Anterior segment parameters were assessed before and immediately after laser using Scheimpflug-Placido topographer. The main outcome measures were differences in best-corrected visual acuity (BCVA), aqueous depth (AqD), anterior chamber volume (ACV), iridocorneal angle (ICA), corneal volume (CV), and central corneal thickness (CCT) at the baseline versus at immediately after laser. The mean age and duration since surgery for CBDS presentation were 70.25 ± 6.21 and 6.15 ± 1.31 years, respectively. The AqD, ACV, ICA, and spherical equivalent increased significantly compared with baseline (4.18 vs. 4.02 mm, p  = 0.001; 177 vs. 173.55 mm 3 , p  = 0.004; 51.15° vs. 50.15°, p  = 0.023; -1.00 vs. -2.00 D, p  = 0.003, respectively). These changes were also associated with significantly improved BCVA an hour after capsulotomy [0.2 (0.05-0.2)] relative to baseline [0.3 (0.2-0.5)], ( p  = 0.001). CCT and CV decreased nonsignificantly; horizontal AC diameter and K 1 and K 2 increased nonsignificantly ( p  > 0.05). Conclusions: Nd:YAG laser posterior capsulotomy appears to be an effective CBDS treatment for acutely improving vision, potentially due to immediate refractive changes caused by altered anterior segment parameters.

Objectives: To assess hearing function in chronic glaucoma patients in comparison to healthy individuals., Materials and Methods: This cross-sectional study included 24 primary open-angle glaucoma (POAG) patients (24 ears) and 22 pseudoexfoliative glaucoma (PEG) patients (22 ears) who were followed for at least 5 years in the Afyonkarahisar Health Sciences University Ophthalmology Department, as well as 21 age- and gender-matched healthy individuals (21 ears, control group). Following a thorough ophthalmological examination that included visual acuity and intraocular pressure measurements, as well as anterior and posterior slit-lamp biomicroscopy, audiometry was performed in all participants to determine hearing function., Results: Mean ages in the POAG, PEG, and control groups were 64.50±7, 66.90±4.51, and 64.38±4.36 years, respectively. The mean deviation in standard automated perimetry was -14.47±2.89 in the POAG group and -15.02±2.87 in the PEG group (p=0.306). When compared with the control group, the POAG group had significantly higher hearing thresholds at 500 (p=0.011) and 1,000 Hz (p=0.003), while the PEG group had significantly higher hearing thresholds at 250 (p=0.009), 500 (p=0.009), 1,000 (p=0.001), 2,000 (p=0.005), 4,000 (p=0.001), 8000 (p=0.010), and 10,000 Hz (p=0.009)., Conclusion: Both glaucoma and hearing loss are common chronic diseases that have an impact on the well-being of older people. Potential hearing problems in chronic glaucoma patients make routine ocular and otolaryngology examinations in older patients critical for prompt diagnosis and treatment., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2023 by Turkish Ophthalmological Association | Turkish Journal of Ophthalmology, published by Galenos Publishing House.)

Importance: Patients with nonneovascular age-related macular degeneration (AMD) are encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis. The test is widely recommended, suggesting a belief that it signals worsening AMD, warranting its use in home monitoring., Objective: To systematically review studies of the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD and to perform diagnostic test accuracy meta-analyses., Data Sources: A systematic literature search was conducted in 12 databases for relevant titles from database inception until May 7, 2022., Study Selection: Studies included those with groups defined as having (1) neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index test was the Amsler grid. The reference standard was ophthalmic examination. After removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened the remaining references in full text for potential eligibility. Disagreements were resolved by a third author (Y.S.)., Data Extraction and Synthesis: Two authors (J.B. and I.P.) independently extracted all data and evaluated quality and applicability of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2. Disagreements were resolved by a third author (Y.S.)., Main Outcomes and Measures: Sensitivity and specificity of the Amsler grid for detecting neovascular AMD with comparators being either healthy control participants or patients with nonneovascular AMD., Results: Of 523 records screened, 10 studies were included with a total of 1890 eyes (mean participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively, when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63% (95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular AMD. Overall, potential sources of bias were low across studies., Conclusions and Relevance: Although the Amsler grid is easy and inexpensive to use for detection of metamorphopsia, its sensitivity may be at levels typically not recommended for monitoring. Coupling this lower sensitivity with only moderate specificity to identify neovascular AMD in a population at risk, these findings suggest that such patients typically should be encouraged to undergo ophthalmic examination regularly, regardless of any results of Amsler grid self-assessment.

Background: Investigation of retinal ultrastructural, electrophysiological, and microvascular morphological changes, as well as correlations between these changes and visual outcome in naïve diabetic macular edema (DME) patients after intravitreal bevacizumab therapy (IVBT)., Methods: This prospective interventional study enrolled 31 DME patients' eyes treated with monthly IVBT for three months. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and fundus fluorescein angiography, optical coherence tomography (OCT), microperimetry, as well as optical coherence tomography angiography (OCTA) were performed before and after IVBT. Patients were grouped based on BCVA improvement after three consecutive IVBT: group 1: > 10 letters, group 2: ≤ 5 letters, and group 3: between 6 and 10 letters., Results: Mean BCVA increased significantly from 34.2 to 39.9 letters (p < 0.001). Central macular thickness decreased significantly from 335.1 to 276.4 μm (p < 0.001). Fixation stability, retinal sensitivity, and local deficit all improved significantly (p < 0.001 for all). There was no statistically significant change in IOP (p = 0.665). Although OCTA parameters did not change significantly, lower foveal avascular zone (FAZ) area, higher foveal vessel density 300 μm area around FAZ and deep plexus vascular density were associated with highly improved BCVA, retinal sensitivity, and local deficit. Also, there were no significant intergroup differences in gender, age, baseline BCVA, HbA1c, IOP, phakic/pseudophakic lens ratio, concomitant hypertension, and superficial capillary plexus vascular density., Conclusions: IVBT was associated with significantly improved BCVA, retinal ultrastructural integrity, and electrophysiological patterns in naive DME patients. Improvements in retinal electrophysiology correlated with ultrastructural improvements, which could be predicted using OCTA., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: To investigate changes in retinochoroidal microvascular morphology after caffeinated versus decaffeinated coffee consumption in age- and gender-matched healthy individuals using optical coherence tomography (OCT) and OCT angiography (OCTA)., Methods: In this prospective, randomized clinical study, a staff member in charge of record keeping randomly assigned 48 healthy volunteers to two groups: caffeinated coffee consumers (24 eyes) and decaffeinated coffee consumers (24 eyes). Participants' ages and genders were recorded before consumption, and a comprehensive ophthalmologic exam was performed, followed by OCT and OCTA analyses before, 30 min, one, six, and 24 h after blindly consuming either of the coffees., Results: Caffeinated and decaffeinated coffee consumers had mean ages of 23.45 ± 0.92 and 22.73 ± 1.13, respectively (p = 0.407). The following parameters changed significantly in caffeinated coffee consumers 30 min and 1 h post-consumption (pre-consumption versus 30 min versus one hour post-consumption; p < 0.05): a) parafoveal superficial capillary plexus vessel density (%): 54.45 versus 51.8 versus 51.92, b) parafoveal deep capillary plexus vessel density (%): 55.16 versus 52.45 versus 52.83, c) outer retinal flow area (%): 8.87 ± 1.91 versus 8.03 ± 1.88 versus 8.11 ± 1.93, d) choriocapillaris flow area (mm 2 ): 20.95 ± 0.98 versus 19.82 ± 1.20 a versus 19.62 ± 0.95, and e) sub-foveal choroidal thickness (µm): 295.06 ± 5.45 versus 277.08 ± 5.33 versus 260.71 ± 58.61. No significant differences in any OCT and OCTA parameters were found between consecutive measurements in decaffeinated coffee consumers (p > 0.05)., Conclusions: Caffeinated coffee appears to transiently reduce parafoveal vessel density, capillary flow area, and sub-foveal choroidal thickness. Lack of these microvascular morphological changes in decaffeinated coffee suggests a potential caffeine-induced vasoconstrictive effect., Competing Interests: Declaration of Competing Interest The author(s) declare(s) no conflict of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To investigate changes in the retinal and optic disc (OD) morphology in prolactinoma patients without optical chiasmal compression and/or visual field defects using optical coherence tomography angiography (OCTA)., Methods: In this cross-sectional imaging study, 16 consecutive prolactinoma patients (group 1, 32 eyes) and 15 age- and gender-matched healthy subjects (group 2, 30 eyes) underwent a thorough neuro-ophthalmological examination, which included testing for the presence of any intracranial compressive lesion that could cause optic neuropathy. Retinal morphological parameters, outer retinal and choriocapillaris flow areas, as well as OD vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in for quadrants were then measured using OCTA., Results: Mean age (p = 0.537) and gender (p = 0.385) of participants in groups 1 and 2 did not differ significantly. The mean BCVA for both groups was 0.00 ± 0.00 logMAR. Microadenomas made up the majority of prolactinomas (87.1 %). All retinal morphological parameters in deep capillary plexus (excluding foveal VD) differed significantly between groups 1 and 2 (whole: p < 0.001, parafoveal: p = 0.021, and perifoveal: p < 0.001). Peripapillary RNFL thickness in temporal (p < 0.001), nasal (p = 0.010), and inferior (p = 0.007) quadrants also differed significantly between the two groups. Foveal deep (r = -0.304, p = 0.035) and choriocapillaris flow (r = -0.511, p = 0.008) were negatively correlated with tumor size at diagnosis., Conclusions: Significant microvascular morphological changes, particularly in the deep retinal layer, as well as in the peripapillary RNFL thickness, were observed in prolactinoma patients. OCTA appears to be capable of detecting non-manifest circumpapillary and even intra-retinal microvascular changes even when there are no obvious signs of prolactinoma-related ocular complications caused by chiasmal compression., Competing Interests: Declaration of competing interest The authors claim no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: This report describes a case with paracentral acute middle maculopathy revealing a giant aortic aneurysm., Case Description: A 41-year-old man presented with unilaterally unexplained sudden vision loss in the left eye. Fundoscopy revealed a slightly pale r -26etinal reflex in the superior retinal hemifield. SDOCT revealed blurred boundaries between retinal segments and prominent edema in the middle retinal layers. OCTA revealed decreased vascular density in the deep capillary plexus. FA showed low arterial circulation mainly in the superior retinal hemifield. Humphrey VFT revealed an inferior altitudinal defect in the left eye, implying a related circulatory disturbance in the corresponding region.A thorough systemic work-up, including a cardiovascular etiological investigation, revealed giant aortic aneurysm in the ascending aorta, necessitating emergency surgery., Conclusion: This report highlights the importance of a systemic etiological investigation in patients with PAMM to rule out any potential cardiovascular issues.

Purpose: The purpose of this study was to compare the results of 4 different autorefractometer devices with the results of retinoscopy in children. Methods: A total of 120 eyes of 60 patients aged between 6 and 18, who applied to Afyonkarahisar Health Sciences University unit of Pediatric Ophthalmology, were included in the study. Refraction with Plusoptix A09 (photoscreener) without cycloplegia was the first to be measured. Spherical and cylindrical values were recorded. Then, half an hour after the patients were instilled 2 drops of cyclopentolate with an interval of 5 minutes, dilated retinoscopy was performed, and spherical and cylindrical values were recorded. Autorefractometer measurements with cycloplegia were performed with Canon RK-F1 autorefractometer, Nidek Tonoref III and Retinomax K-Plus 3, and spherical and cylindrical values were recorded. Results: The mean age of the patients was 11.02 ± 2.1. The mean spherical equivalents were Canon RKF1 autorefractometer +0.045 ± 2.49, Nidek TonoRef III +0.023 ± 2.48, Retinomax K-Plus 3 +0.078 ± 1.42, Plusoptix A09 -0.119 ± 2.20, retinoscopy +0.124 ± 2.65. Moreover, the mean cylindrical values were Canon RK-F1 autorefractometer -0.893 ± 0.69, Nidek TonoRef III -0.927 ± 0.72, Retinomax K-Plus 3 -0.888 ± 0.73, Plusoptix A09 -0.883 ± 0.719, retinoscopy -0.923 ± 0.71. The statistical values compared with retinoscopy; Canon RKF1 spherical equivalent (p=0.376), cylindrical (p=0.515), Nidek TonoRef III spherical equivalent (p=0.485), cylindrical (p=0.198), Retinomax K-Plus 3 spherical equivalent (p=0.141), cylindrical (p=0.058), Plusoptix A09 spherical equivalent (p=0.085) and cylindrical (p=0.086) values were not different. Conclusions: In spherical and cylindrical refractive error detection, all 4 devices showed reasonable and consistent results compared to retinoscopy., (#x00A9; The Authors.Romanian Society of Ophthalmology.)

Background: The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis., Methods: A total of 72 patients with type 2 diabetes mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study., Results: The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), standard deviation of the average NN intervals (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all P<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (P<0.001)., Conclusions: We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.

Background: Tea, second only to water, is one of the most regularly consumed drinks in the world. Its potentially beneficial effects on general health may be enormously important. Optical coherence tomography angiography (OCTA) now allows clinicians to examine the acute retinal morphological changes caused by black tea consumption. The purpose of this study was to investigate the acute impacts of a Camellia sinensis fermentation end-product (black tea) on retinal microvasculature in healthy individuals using OCTA., Results: In this study, 60 healthy people were divided into two groups: group 1 (n = 30) received black tea (2 mg/250 mL of water) and group 2 (n = 30) received only 250 mL of water. Following consumption, AngioVue Analytics software automatically analyzed the foveal, parafoveal, perifoveal macular superficial and deep vascular plexus densities, foveal avascular zone (FAZ) area, FAZ perimeter and foveal vessel density in a 300 μm wide region around the FAZ (FD-300). Male-to-female ratios were 19:11 and 15:15 in groups 1 and 2, respectively (P = 0.217). Mean age was 33.27 ± 7.92 years in group 1 and 31.00 ± 7.30 years in group 2 (P = 0.254). Changes in foveal, perifoveal and parafoveal macular vessel density between groups 1 and 2 were not statistically significant. In addition, no significant differences regarding FAZ, FAZ perimeter and FD-300 were observed., Conclusion: There were no acute effects of black tea on macular microcirculation in healthy individuals. The authors, however, believe that this study could serve as a model for future research on the relationship between regular tea consumption and general ocular physiology. © 2021 Society of Chemical Industry., (© 2021 Society of Chemical Industry.)

Purpose: To evaluate the effects of metformin alone and combined treatment with metformin and an SGLT2 inhibitor on retinal microvascular morphology using optical coherence tomography angiography (OCTA) in isolated type 2 diabetes mellitus (DM) patients with HbA1c above the expected target (>7%)., Methods: Fifty patients with isolated DM, 7%

Purpose: To evaluate the effects of a single dose of oral 5-mg tadalafil on macular microcirculation as measured using optical coherence tomography (OCT) and angiography (OCTA) in healthy volunteers. Methods: Twenty-two healthy, middle-aged, sexually active, and male health care worker volunteers were included in this prospective study. All volunteers have a history of occasionally using off-label 5 mg tadalafil to enhance sexual performance. Superficial and deep capillary plexus vascular densities, foveal avascular zone parameters, outer retina, and choriocapillaris flow areas were performed using the OCTA, and subfoveal-choroidal thickness (CT) was performed by using the OCT. Measurements were performed preintake, 30 min, 1, 4, 24 h, 2, 3, 4, and 7 days after the intake of tadalafil off-label. Results: Twenty-two eyes of 22 male volunteers were included in the study. The mean age was 37.16 ± 4.52 years. At 30 min, 1 h, and 4 h after intake, a statistically significant increase was observed in the choriocapillaris flow area and CT compared with preintake ( Friedman test , P  = 0.034 and P  < 0.001, respectively). Conclusion: This study showed that a single dose of oral 5-mg tadalafil causes an increase in choriocapillaris flow and CT. To evaluate the effects of tadalafil on the retina and choroid, an OCTA assessment may be helpful.

Purpose: To determine the levels of serum oxidative, antioxidative markers and inflammatory cytokines in patients diagnosed with diabetic macular edema (DME) whose hyperreflective spots (HRS) were detected by optical coherence tomography (OCT)., Methods: In this prospective cross-sectional clinical study included a total of 88 patients; 31 patients (group-1) with DME and HRS detected by OCT, 29 patients (group-2) with DME without HRS, and 28 patients (group-3) diagnosed with diabetes mellitus (DM) without any diabetic retinopathy findings. The main outcomes were best-corrected visual acuity (BCVA), CMT (central macular thickness), CMV (central macular volume), TMV (total macular volume), CT (choroidal thickness), serum TAS (total antioxidant status), TOS (total oxidant status), VEGF (vascular endothelial growth factor), FGF (fibroblast growth factor) and IL-1b levels. OCT parameters and biochemical measurements were compared statistically between the three groups., Results: A total of 88 patients (43 females (48.9%) and 45 males (51.1%)) were included in the study. The mean age was 56.29 ± 9.23 years. There was no difference between the three groups in age-and-sex. In group-1 and 2, BCVA(LogMAR) was statistically higher than group 3. CMT, CMV, TMV, TAS, TOS, VEGF and FGF were significantly higher in group-1 than in group-3. CMT, CMV, TMV, VEGF and FGF were significantly higher in group-2 than group 3. TOS and VEGF were significantly higher in group-1 than group-2., Conclusions: This study demonstrates that in patients with DME and HRS, TOS and VEGF levels were higher than those without HRS. Hence, hyperreflective spots may be an inflammatory biomarker.

We investigated the antioxidant effects of vitamin E on a glucocorticoid (GC) induced model of cataracts in chick embryos. We used 70 fertilized eggs divided into seven groups as follows: phosphate-buffered saline (PBS) group, olive oil treatment (OO) group, hydrocortisone treatment (HC) group, olive oil and hydrocortisone treatment (OO + HC) group, 50 mg/kg vitamin E and hydrocortisone treatment (HC + VE (50)) group, 25 mg/kg vitamin E and hydrocortisone treatment (HC + VE (25)) group and 15 mg/kg vitamin E and hydrocortisone treatment (HC + VE (15)) group. On day 17, chick embryos were removed from the eggs and lens and liver tissues were excised. Cataract formation was evaluated and total antioxidant status (TAS), total oxidant status (TOS), malondialdehyde (MDA) and glutathione peroxidase (GPx) were measured in lens and liver tissues; MDA was measured only in liver. The lenses in the HC + VE (50) group exhibited significantly higher levels of GPx and TAS, and lower levels of TOS than for HC and OO + HC groups. The livers of the HC + VE (50) group exhibited significantly higher levels of GPx and lower levels of MDA than for the HC and OO + HC groups. The HC + VE (50) group lenses were evaluated as grade 1, because the nuclei were completely free of cataracts, likely due to the antioxidative effect of high dose VE. VE is an effective antioxidant agent that exhibits a dose-response effect, for ameliorating the negative effects of GCs.

Purpose: To analyze the macular microvascular changes after panretinal photocoagulation (PRP) in patients with non-proliferative diabetic retinopathy (NPDR) and a large foveal avascular zone area, using optical coherence tomography angiography., Methods: Twenty-four eyes of 24 patients with peripheral ischemia, superficial foveal avascular zone (FAZ) area of larger than 0.350 mm 2 , naive severe NPDR, and no clinically significant diabetic macular edema were included in this prospective study. The PRP was applied in 360-degree in a single session. The main outcome measures of the study were the difference in best-corrected visual acuity, central macular thickness, superficial and deep vascular plexus vessel densities, FAZ features, choroidal and outer retinal flow areas at the baseline versus at one and six months after PRP treatment., Results: The study group consisted of 13 men and 11 women with a mean age of 68.11 ± 6.47 years. The baseline FAZ area was higher than at one and six months after PRP (0.416 ± 0.70, 0.399 ± 0.065 and 0.407 ± 0.066 mm 2 ; p = 0.001 and p = 0.002, respectively). At one month after PRP, deep capillary plexus vascular density in perifoveal region was statistically significantly lower than at six months after PRP and the baseline. (45.43 ± 4.27, 47.91 ± 4.26 and 49.04 ± 5.64 %; p = 0.001 and p = 0.001, respectively)., Conclusion: The PRP effects retinal microvascular morphology in patients with NPDR and a large FAZ area., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Evaluation of anatomical and functional recovery of the retina after aflibercept therapy in neovascular age-related macular degeneration., Materials and Methods: This prospective study enrolled 33 eyes of 33 naive age-related macular degeneration patients with an average age of 69 (55-82) years. Following a thorough ophthalmological examination, baseline color fundus photography, optical coherence tomography and fluorescein angiography were used to assess the angiographic characteristics and classification of the lesions. Multifocal electroretinography and microperimetry were recorded. In the first three months, all patients received three consecutive intravitreal aflibercept injections on a monthly basis. After the initial three doses, non-responders received additional afibercept injections. The baseline, 3rd and 6th month data were recorded for analysis., Results: The baseline average best-corrected visual acuity (1.05 log MAR) improved dramatically to 0.9 log MAR in the 3rd and 6th months, respectively. The baseline average central macular thickness of 358.5 ± 232.1 μm decreased significantly to 273.0 ± 109.9 μm and 245.5 ± 109.3 μm in the 3rd and 6th months, respectively. The average thickness of the central 1 mm macular region decreased significantly from 349.5 ± 96.4 μm to the 3rd and 6th month values of 320.6 ± 101.9 and 290.5 ± 86.4 μm, respectively. While the mean retinal sensitivity increased significantly from 4.7 ± 3.0 dB to 6.9 ± 3.4 Db, local deficit decreased from -11.6 ± 4.6 dB to -9.4 ± 4.6 dB. Significant improvements were also observed in all rings of N1 and P1 waves., Conclusion: Intravitreal aflibercept therapy resulted in significant morphological improvements that were easily identifiable during the 3rd month. Electrophysiological improvements were delayed only to become statistically significant in the 6th month. However, it has been shown that visual acuity and optical coherence tomography parameters alone may be insufficient for both the morphological and functional assessment of the retina., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Purpose: It was aimed to assess the role of thiol-disulphide homeostasis and ischemia-modified albumin (IMA) level in the development of diabetic macular edema (DME) in patients with diabetes mellitus type 2 (T2DM)., Materials and Methods: Sixty-six study patients were divided into two groups. Group I included 43 patients with T2DM and DME, and Group 2 included 23 patients with T2DM without eye involvement. A novel colorimetric method was used to assess thiol-disulphide homeostasis. Between the two groups IMA, total anti-oxidant, and total oxidant levels were measured and compared., Results: In Group 1, total and native thiol levels and disulphide levels were lower compared to Group 2 ( p = .025, p < .001 and p = .013, respectively). Disulphide/native thiol, disulphide/total thiol ratios and native thiol/total thiol were similar between the groups. Total anti-oxidant level (TAL) reduced whereas total oxidant level (TOL) increased in Group 1 compared to Group 2 ( p = .001, p = .002, respectively). Albumin level decreased, whereas IMA level increased in Group 1 compared to Group 2 ( p < .001 for both)., Conclusions: The disruption in thiol/disulphide homeostasis, increased IMA and oxidative stress have an impact on the development of diabetic macular edema.

Purpose: To evaluate anatomical and neuroretinal functional aspects in patients with diabetic macular edema (DME) after intravitreal anti-vascular endothelial growth factor (VEGF) therapy, in particular aflibercept., Materials and Methods: This prospective single-centered interventional study was performed at Afyonkarahisar Health Science University Faculty of Medicine, Department of Ophthalmology, where 32 eyes of 32 patients with DME were investigated. All patients received five intravitreal aflibercept injections on a monthly basis and were followed up for ≥ 6 months. After a comprehensive ophthalmological examination, including the measurements of visual acuity and intraocular pressure, and an antero-posterior segment slit-lamp biomicroscopy before and after full pupil dilation, fundus fluorescein angiography and optical coherence tomography were performed at baseline and during the third and sixth months post-therapy. Microperimetry and multifocal electroretinography were also performed at baseline and during the sixth months., Results: Mean visual acuity increased from 0.73 to 0.57 and 0.33 logarithm of the minimum angle of resolution (logMAR) during the third and sixth months, respectively (p < 0.001). Changes in intraocular pressure were not statistically significant (p = 0.472). There was statistically significantly decreased mean central macular thickness from 390.2 μm to 242.6 and 289.7 μm during the third and sixth months, respectively (p < 0.001). Significantly improved fixation patterns during the sixth month, along with significantly increased macular sensitivity from 8.2 to 14.2 dB (p < 0.001) and significantly decreased local deficit from - 10.3 to 5.5 dB (p < 0.001) were observed. Further, there was a significantly increased N1 amplitude in the first ring and significantly increased P1 amplitude in all rings (p for each parameter < 0.05). There was also significantly decreased N1 wave implicit time in all rings and significantly decreased P1 wave in the second, third, fourth and fifth rings (p for each parameter < 0.05)., Conclusions: Patients with DME showed profound improvement in the retinal neurophysiological function, which was also accompanied by anatomical and ultrastructural integrity recovery after intravitreal aflibercept therapy. In the pathogenesis of DME, the influence of neurodegeneration has been increasingly gaining significant attention. Consequently, the need to assess neurophysiological effects of anti-VEGF therapy using a variety of diagnostic measures like electrophysiological studies and multimodal imaging technologies is undeniably growing.

Background: To investigate the effects of bimatoprost, latanoprost and travoprost on angiogenesis in the chick chorioallantoic membrane (CAM) model in ovo., Materials and Methods: Fifty fertilized specific-pathogen-free chick eggs were used in this preclinical, prospective, experimental embryo study. Eggs were randomly distributed into 5 groups of ten eggs. Eggs were placed in the incubator after disinfection of their shells with alcohol and monitored appropriate temperature and humidity. On the 3rd day of incubation, a small window was opened on the eggshell. Bimatoprost in group 1, latanoprost in group 2, travoprost in group 3, bevacizumab in group 4, phosphate-buffered-saline (PBS) used in group 5 was applied by injection to CAM. The sterile film was glued onto the broken part of the shell and the eggs were placed in the incubator again. On the 8th day of incubation, eggs were opened and vascular structures on CAMs were examined. Digital photographs were taken, analysed in the ImageJ open source image processing software and differences between groups were evaluated. Thereafter, VEGF (Vascular endothelial growth factor) levels were measured appropriately in the embryo samples., Results: All embryos in the prostaglandin groups and the PBS control group were observed to have life signs confirmed by heart rate. In 8 embryos in the bevacizumab group, no life signs were confirmed, while 2 embryos with life signs showed severe hypoplasia. Vascular density, number of vessels and VEGF levels in the bimatoprost, latanoprost and travoprost groups, there were statistically significantly higher than the PBS control group., Conclusion: This study demonstrates that topical prostaglandin drops increase angiogenesis in the chick CAM model in ovo.

Purpose: To analyze the vascular morphology changes after consumption of Ginkgo biloba in healthy volunteers by optical coherence tomography angiography (OCTA)., Methods: Sixty healthy volunteers without systemic and ocular disease were included in this prospective pilot study. After receiving the informed consent of the volunteers, Ginkgo biloba extract (120 mg oral capsule) was administered to sixty volunteers for 4 weeks, once a day in the morning. The main outcome measures were the difference between before and after four-week of consumption in best-corrected visual acuity (BCVA), retinal nerve fiber layer (RNFL) and subfoveal choroidal thickness (sfCT) with optical coherence tomography; whole, foveal, parafoveal and perifoveal regions' superior and deep macular vascular plexus vessel density, foveal avascular zone area (FAZ), FAZ perimeter (PERIM), vessel density in a 300 µm wide region around FAZ (FD-300), choroidal and outer retinal flow area, radial peripapillary capillary (RPC) vascular density of whole, inside the disc, peripapillary and four quadrants with OCTA., Results: The study group consisted of sixty eyes of 32 women and 28 men with a mean age of 20.57 ± 1.16 years. In post-consumption measurements, peripapillary and superior, inferior, temporal quadrant RPC vascular density (%) was statistically significantly higher than pre-consumption measurements (p 0.020, p 0.021, p 0.008 and p 0.014, respectively). No significant difference was observed for BCVA, sfCT, other macular or RPC vascular density and flow area OCTA parameters between measurements., Conclusion: Four-week consumption of Ginkgo biloba leads to vascular morphological changes in RPC. Further clinical studies are needed to demonstrate its use and effects/benefits in glaucoma, optic neuropathy and other diseases affecting the optic nerve.

Purpose: Evaluation of retinal and choroidal changes after energy drink consumption by optical coherence tomography and optical coherence tomography angiography., Methods and Material: Forty-two healthy volunteers with neither systemic nor ocular diseases were enrolled in the study. The energy drink (250 mL Red Bull energy drink) was provided to all volunteers. The vascular density of superficial (SCP) and deep capillary plexus (DCP), vascular density in FAZ region, its circumference (PERIM) and vascular density around 300 micron (FD-300), and blood flow in outer retinal and choriocapillaris were measured by OCT-A (AngioVue RTVue XR Avanti, Optovue, Fremont, CA) before and 30 min after consumption of energy drink, in an interval of 1, 2, 3, 6, and 24 h. Central macular thickness (CMT) was measured by OCT (Heidelberg Engineering, Inc., Heidelberg, Germany), whereas choroid thickness (CT) and retinal nerve fibre layer (RNFL) measurements of the optic nerve were measured by enhanced depth imaging OCT. For control comparison, the same measurements were made after drinking 250 mL of water in the same healthy group. The obtained data were statistically analysed., Results: Among 42 volunteers enrolled in the study, 25 (59,5%) were males and 17 (40,5%) were females, with an average age of 20,58 ± 0,71. The vascular density measurements of parafoveal and perifoveal deep capillary plexus obtained after energy drink consumption were statistically significant. This increase in vascular density of the deep capillary plexus after energy drink consumption seemed to start after half an hour and continued until measurement at 24th hour. On the other hand, the changes in measurements of vascular density from other regions, the blood flows, FAZ, CMT, CT and RNFL values were not statistically significant. In water consumption measurements; despite a statistically significant increase in choroidal thickness at 30 min and 1 h ( p  = 0.027, p  = 0.045, respectively), no significant difference was found in other parameters between consecutive measurements., Conclusion: The consumption of energy drinks acutely leads to changes in retinal vascular density parameters.

Background: The purpose of this study was to report the effects of smoking on retinal vascular parameters., Methods: In this cross-sectional study design, 24 smokers were included as a study group and 26 age- and sex-matched non-smokers as a control group. A detailed ophthalmic examination including review of medical history, visual acuity testing, intraocular pressure measurement by Goldmann applanation tonometry, ocular movement and pupillary reflex examination, slitlamp biomicroscopy as well as dilated funduscopic examination were undertaken in all participants. Participants underwent optical coherence tomography angiography (OCT-A) scanning with RTVue XR Avanti AngioVue OCT-A (Optovue, Fremont, CA, USA) as well as the measurement of axial length using an AL Scan (Nidek Co., Ltd., Gamagori, Japan)., Results: The study comprised of 18 men and six women with a mean age of 28.1 ± 4.8 years in the study group and 19 men and seven women with a mean age of 27.4 ± 2.7 years in the control group. The mean exposure to cigarette smoking was 3.3 ± 1.0 pack-years. Total vascular density, parafoveal vascular density and perifoveal vascular density in the deep capillary plexus observed with OCT-A were significantly lower in the smoking group compared to the control group (p = 0.02, 0.01 and 0.01, respectively)., Conclusion: Retinal vascular changes caused by cigarette smoking may occur even at low pack-year exposure. These changes, which can be demonstrated by OCT-A, may reflect the early impact of cigarette smoking on the microvascular system., (© 2020 Optometry Australia.)

Objectives: This study was an analysis of the retinal layer thickness in multiple sclerosis (MS) patients using spectral-domain optical coherence tomography (SD-OCT)., Methods: A total of 42 patients diagnosed in the neurology clinic with MS according to the McDonald Criteria and 21 healthy individuals were included in the study and 4 groups were created. The first group comprised 21 eyes of 21 MS patients without eye involvement, the second group was made up of 21 eyes of 21 MS patients with a history of optic neuritis, the third group included the other eye of patients in the second group without a history of optic neuritis, and the fourth group was a control group of 21 eyes of 21 healthy individuals. SD-OCT was used to visualize and measure the retinal layers and the thickness was analyzed using the device software., Results: The mean age of the patient groups was 35.39±7.52 years, while it was 32.86±2.60 years in the control group. The mean duration of the disease was 9.81±6.65 years with a mean of 4.84±2.38 attacks. The ganglion cell layer (GCL) and the inner plexiform layer (IPL) of all of the patients were thinner compared with the control group in the parafoveal and perifoveal areas. All regions of the retinal nerve fiber layer (RNFL) of patients in the second group were thinner than those of the control group. The RNFL, GCL, and IPL in the central, parafoveal and perifoveal macular rings in group 3 were thinner than the group 1 measurements; however, this difference was not statistically significant. Although the RNFL, GCL, and IPL layer thicknesses were lower in group 2 than group 3, only the difference in the parafoveal GCL thickness was statistically significant., Conclusion: This study demonstrated that MS affects retinal layer thickness, and particularly the inner retinal layers., Competing Interests: Conflict of Interest: None declared., (Copyright: © 2020 by Beyoglu Eye Training and Research Hospital.)

Purpose: To evaluate the effects of intravitreal aflibercept (IVA) treatment on retinal vein parameters and choroidal thickness used in the treatment of diabetic macular oedema (DME). Methods: This retrospective study administered Afyonkarahisar Health Sciences University Department of Ophthalmology. Twenty-nine patients who were diagnosed with naive DME in a single eye were included in the study. A three consecutive, monthly intravitreal injection of 2 mg aflibercept were administered to patients. Each patient's contralateral (untreated) eyes, which did not diagnose DME and did not receive any treatment, were the control group. The central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery-vein ratio (AVR) values were measured using a semi-automatically computer-based software before the first IVA injection and 30 d after the first, second, and third injections. The main outcome measurements were the central macular thickness (CMT), best-corrected visual acuity (BCVA), subfoveal choroidal thickness (sf-CT), CRAE, CRVE, and AVR. Results: The mean age of patients was 59.25 ± 9.48 years. Patients were 15 males and 14 females. A significant vasoconstriction of the retinal arterioles, a thinning of sf-CT and CMT, and an increase of BCVA have observed in IVA-treated eyes compared to baseline (respectively, p  < 0.001, p  < 0.001, p  < 0.001, p  < 0.001). But, no significant differences were found for CRVE and AVR in IVA-treated eyes compared to baseline. No significant difference was found for all parameters in untreated eyes compared to baseline. Conclusions: This study demonstrates that IVA treatment can change retinal blood flow by reducing retinal artery diameter and thinning in the choroid.

Purpose: The etiopathogenesis of steroid-induced cataracts is unknown. One hypothesis is that the higher reactive oxygen species (ROS) levels play an important role in the pathogenesis of several disorders, including the evolution of cataracts. This study investigated the antioxidant effects of piperine in our steroid-induced chick embryo lens model., Methods: The study included 36 specific pathogen-free (SPF) fertilized eggs divided into six groups: phosphate buffer saline (PBS, pH 7.4 Saline Solution (0.9%) isotonic) group (G1), hydrocortisone succinate sodium (HC)-treated group (G2), 100 mg/kg piperine and HC treated group (G3), 50 mg/kg piperine and HC treated group (G4), 25 mg/kg piperine and HC treated group (G5), and 10 mg/kg piperine and HC treated group (G6). On the 15th day of incubation, the SPF eggs in the six groups were removed from the incubator; all were injected using insulin injectors into the chorioallantoic membrane. On day 17, all of the chick embryos were removed from the eggs and all lenses were dissected from the embryos. Cataract formation was evaluated in all lenses, and total antioxidant status (TAS), total oxidant status (TOS), reduced glutathione (GSH), and lipid peroxidation (MDA, malondialdehyde) levels were measured in all lens., Results: The lenses in the G1 group had higher levels of GSH and TAS (p < 0.01), and lower levels of MDA and TOS than the G2 group (p < 0.05 and p < 0.01, respectively). Group 3 had higher levels of GSH and TAS (p < 0.001 and p < 0.001 respectively), and lower levels of MDA and TOS than the G2 group (p < 0.01 and p < 0.001, respectively)., Conclusion: Steroid therapy causes a decrease in GSH and TAS levels and an increase in TOS and MDA levels in lens tissues, indicating increased oxidative stress. Piperine exerts its effects as an antioxidant substance, in increasing doses.

Purpose: The aim of this study was to present an experimental optical coherence tomography (OCT)-guided anterior segment (AS) imaging chick embryo model. Through this model, we aimed to reveal similarities and differences between human cornea, AS tissues, and chick embryo tissues by quantitative image analysis., Methods: Ex vivo, the chick embryos' globes were determined by detailed AS camera of spectral-domain (SD)-OCT in 10 fertilized specific pathogen-free eggs on the 20 th day. Quantitative image analysis of anterior chamber tissues was performed with SD-OCT in detail. After imaging, cross sections of the chick embryo globes containing cornea with anterior chamber were histologically examined and compared with human tissues. The similarities of our model with data in the human cornea and AS studies in the literature were compared., Results: SD-OCT imaging was able to successfully delineate the AS tissues of chick embryos such as the cornea, iris, lens, pupil, conjunctiva, ciliary body, anterior chamber, and lens. Quantitative semi-automated measurements showed the following: mean central corneal thickness: 213.4 ± 7.05 μm (197-223 μm), mean anterior chamber depth: 878.9 ± 41.74 (804-919 μm), mean anterior chamber area: 2.43 ± 0.16 mm 2 (2.17-2.73 mm 2 ), mean corneoscleral junction (limbal) thickness: 322.8 ± 20.05 μm (289-360 μm), and mean iris thickness: 230.4 ± 13.27 μm (203-245 μm). In addition, detailed histological comparisons of the AS tissues with human tissues were evaluated to be very similar., Conclusion: In conclusion, this chick embryo model mimics human tissues and it can be considered as a platform for the study of teratogen-induced malformations and AS dysgenesis during gestation of AS tissues. In addition, this study demonstrates the feasibility of SD-OCT in the quantitative assessment of AS structures in chick embryo model., Competing Interests: None

Purpose: To determine the effect of proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture and fluorescein strip on anterior segment parameters commonly used in routine ophthalmology practice., Methods: 115 healthy volunteers without any systemic or ocular disease were divided into two groups. 57 volunteers were in the proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture group, and 58 volunteers were in the fluorescein strip group. Measurements (CCT (central corneal thickness), topographic pupil diameter, AD (aqueous depth), ACV (anterior chamber volume), ICA (iridocorneal angle), LLD (limbus-limbus distance), and CV (corneal volume)) were taken before and at 1, 5, 15, and 30 minutes after application., Results: 59 (51.3%) participants were female, and 56 (48.7%) were male. The mean age of the drop application group was 26.88 ± 8.03, and the mean age of the strip application group was 26.33 ± 7.28. The mean CCT was 556 ± 32  μ m before drop application and 569 ± 30  μ m in the 1st minute, 560 ± 32  μ m in the 5th minute, and 559 ± 31  μ m in the 15th minute. The change was statistically significant ( p < 0.001, p =0.005, and p =0.013, resp.). Before the strip application, mean CCT was 552 ± 36  μ m, while it increased to 556 ± 36  μ m at the 1st minute, and this change was statistically significant ( p =0.002). The mean CV before dropping was 59.29 ± 3.53 mm 3 and 60.62 ± 3.53 mm 3 at the 1st minute and 59.66 ± 3.70 mm 3 at the 5th minute, which was statistically significant ( p < 0.001 and p =0.034). Mean topographic pupil diameters at the 1st, 5th, 15th, and 30th minute after application of drops and strips were not significantly changed compared to the preapplication values in the AD, ACV, ICA, and LLD measurements., Conclusions: Proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture and fluorescein strip application lead to a temporary change in CCT and CV of the anterior segment parameters. Anterior segment measurements with the Scheimpflug camera have to be done before topical fluorescein application.

Purpose: The purpose of this study is to evaluate anterior segment measurements obtained using CSO Sirius Topographer ® (CSO, Firenze, Italy) and Nidek Axial Length (AL)-Scan ® (Nidek CO., Gamagori, Japan)., Methods: A total of 43 eyes of 43 patients were included in this prospective study. The central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white distance (WTW), flat keratometry (K1), steep keratometry (K2), and mean keratometry (K) values were randomly measured three times with each device by the same examiner. The intraclass correlation coefficient of repeatability was analyzed. The compatibility of both devices was evaluated using the 95% limits of the agreement proposed by Bland and Altman., Results: Examiner achieved high repeatability for all parameters on each device except the WTW measured by Sirius. All measurements except WTW and K1 taken with the Sirius were higher than that taken with the Nidek AL-Scan ® . The difference in CCT, ACD, and WTW values was statistically significant., Conclusion: High repeatability of the measurements was achieved on both devices. Although Km, K1, and K2 measurements of the Sirius and the AL-Scan ® showed good agreement, WTW, CCT, and ACD measurements significantly differed between two devices. Thus, anterior segment measurements except for Km, K1, and K2 cannot be used interchangeably between Sirius and Nidek AL-Scan ® devices., Competing Interests: There are no conflicts of interest.

Purpose: To compare the thicknesses of the retinal layers in smokers with those of nonsmoking healthy subjects using spectral-domain optical coherence tomography (SD-OCT)., Methods: One hundred and eight subjects were included in the study. Two groups were separated as smokers and nonsmokers. Both groups were chosen to be similar in terms of age and gender. SD-OCT images were generated with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). An automated algorithm was developed to segment the macular retina into eight layers and quantitate the thickness of each layer for the fovea, parafovea and perifovea., Results: The mean smoking history was 18.33 ± 8.45 years (range: 10-40). The mean number of pack-years was 22.22 ± 15.51 (range: 10-80). No significant difference was observed regarding retinal layer measurements between the smoker and nonsmoker groups. Also, no significant difference was observed for central macular thicknesses at 1000, 3000, and 6000 μm between two groups., Conclusion: The thickness of retinal layers in healthy smokers was similar to those of healthy individuals.

Purpose: To evaluate the repeatability and reproducibility of automatic segmentation in healthy subjects using a Spectralis optical coherence tomography (OCT) system., Methods: A total of 60 eyes from 60 patients were included in this prospective study. Spectral-domain optical coherence tomography images were generated using the Spectralis OCT system. An automated algorithm was used to segment the macular retina into nine layers and evaluate the thickness of each layer in the foveal, inner, and outer Early Treatment Diabetic Retinopathy Study (ETDRS) subfield rings. The eyes were imaged three times by an examiner to assess intraobserver repeatability and imaged once by a second examiner to assess interobserver reproducibility. The first scan was used for reference, whereas the second and third scans were collected using the device's follow-up mode. Intraclass correlation coefficients (ICCs) of repeatability and reproducibility were analyzed., Results: The examiners achieved high repeatability and reproducibility for all parameters. Good agreement was found for all parameters in all ETDRS subdivisions with an ICC of >0.96 for all measurements., Conclusion: It is possible to obtain cross-sections from the same location using the device's follow-up mode, making it virtually impossible to distinguish between repeated measurements taken with the device by different examiners.