Publications by authors named "Mumin Hocaoglu"

54 Publications

Characteristics and management of macular hole developing after rhegmatogenous retinal detachment repair.

Jpn J Ophthalmol 2021 Mar 18. Epub 2021 Mar 18.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7 Fulya, Şişli, 34349, İstanbul, Turkey.

Purpose: To report characteristics of patients developing full-thickness macular hole (MH) after rhegmatogenous retinal detachment (RRD) repair surgery. We also compared patients developing MH with and without accompanying RRD recurrence regarding anatomical and visual outcomes of MH repair.

Design: Retrospective study.

Methods: Medical records of patients who developed MH after RRD repair between January 2002 and January 2018 were reviewed.

Results: We performed 1661 primary RRD operations during the study period and 14 of these developed MH, an incidence of 0.8%. Nine patients had their primary RRD repair surgery in another clinic and were referred to our clinic after development of MH. In total 23 patients with MH secondary to RRD repair were included in the study. The type of RRD repair surgery was scleral buckling only in 4 patients (17%), pars plana vitrectomy (PPV) only in 14 patients (61%), and sequential scleral buckling and PPV in 5 patients (22%). Nineteen patients (83%) had macula-off RRD. In 12 patients (52%), MH developed within 3 months after RRD repair. Surgery for MH repair was performed in 18 patients. Postoperative best corrected visual acuity (BCVA) was better than preoperative BCVA in the group with RRD recurrence as well as in the group without RRD recurrence (both P < 0.05). There wasn't a significant difference between these groups regarding postoperative visual gain and anatomical success (P > 0.05).

Conclusion: MH can develop after various surgical methods of RRD repair. Anatomic closure and visual acuity gain can be achieved even if patients have accompanying RRD recurrence.
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http://dx.doi.org/10.1007/s10384-021-00833-9DOI Listing
March 2021

QUANTITATIVE ASSESSMENT OF THE FOVEAL AVASCULAR ZONE USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER SURGERY FOR IDIOPATHIC EPIRETINAL MEMBRANE.

Retina 2021 Jan;41(1):54-59

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To investigate, using optical coherence tomography angiography, the foveal avascular zone (FAZar), the FAZ perimeter (FAZp), the acircularity index of the FAZ (FAZai), and the density of vessels surrounding the FAZ (FAZvd) before and after idiopathic epiretinal membrane surgery, and associations of these parameters with postoperative best-corrected visual acuity, letter score gain, and central foveal thickness.

Methods: We retrospectively reviewed preoperative and postoperative (sixth month) medical records of 28 eyes of 28 patients who undergone epiretinal membrane surgery and had an intact ellipsoid zone.

Results: There were significant increases in best-corrected visual acuity, FAZar, and FAZp and decreases in central foveal thickness and FAZai (all P < 0.05). Postoperative best-corrected visual acuity was not significantly correlated with any preoperative parameters. Postoperative letter score gain and central foveal thickness correlated negatively with preoperative FAZar and preoperative FAZp (all P < 0.05). Multivariable linear regression analysis revealed that preoperative FAZp was independently associated with postoperative letter score gain (P < 0.05).

Conclusion: The FAZ enlarges and becomes more circular after epiretinal membrane surgery. Postoperative best-corrected visual acuity is not associated with any FAZ parameters. In eyes with an intact foveal ellipsoid zone, especially a smaller preoperative FAZp is associated with more postoperative letter score gain.
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http://dx.doi.org/10.1097/IAE.0000000000002794DOI Listing
January 2021

Features of neovascularization in pachychoroid neovasculopathy compared with type 1 neovascular age-related macular degeneration on optical coherence tomography angiography.

Jpn J Ophthalmol 2020 May 10;64(3):257-264. Epub 2020 Mar 10.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7, Fulya-Şişli, 34349, Istanbul, Turkey.

Purpose: To compare neovascular membrane features of pachychoroid neovasculopathy (PNV) and type 1 neovascular age-related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA).

Design: Retrospective study.

Methods: We assessed 34 treatment-naïve eyes with a diagnosis of PNV and 36 treatment-naïve eyes with a diagnosis of type 1 nAMD. Morphological patterns of neovascular membranes were categorized, and lesion sizes and flow areas were calculated by using en face images on the AngioVue (Optovue) OCTA system.

Results: Statistically significant differences were found between groups in age (P=0.001), baseline best corrected visual acuity (P=0.005), and baseline subfoveal choroidal thickness (P<0.001). However, there were no statistically significant differences in membrane morphology (P=0.86), lesion size (P=0.80), or flow area (P=0.96). All membranes that could be detected by OCTA could also be detected by indocyanine green angiography (ICGA). However, OCTA could not identify the neovascularization in 11.8% of the eyes with PNV and 16.7% of the eyes with nAMD, which could be identified on ICGA images.

Conclusions: PNV is seen in younger patients and in patients with thicker choroids, but in terms of morphological characteristics and vessel density, membranes detected by OCTA are not different from those of nAMD. Dye angiography remains the gold standard for identifying neovascularization, especially in treatment-naïve patients, owing to blockage of fluid and hemorrhage and scattering of OCTA signals.
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http://dx.doi.org/10.1007/s10384-020-00730-7DOI Listing
May 2020

Spectral domain optical coherence tomography classification of diabetic macular edema: a new proposal to clinical practice.

Graefes Arch Clin Exp Ophthalmol 2020 Jun 9;258(6):1165-1172. Epub 2020 Mar 9.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7 Fulya - Şişli, 34349, Istanbul, Turkey.

Purpose: To classify the types of diabetic macular edema (DME) and evaluate its morphological features on spectral domain optical coherence tomography (SD-OCT) and determine correlations between visual acuity and OCT findings.

Methods: We assessed 406 eyes of 309 patients with a diagnosis of DME retrospectively. Three types based on SD-OCT were identified: diffuse macular edema, cystoid macular edema, and cystoid degeneration. Morphological features such as serous macular detachment (SMD), vitreomacular interface abnormalities (VMAI), hard exudates, photoreceptor status, and correlations between visual acuity and those morphological features were also evaluated by SD-OCT.

Results: The most common type of DME was cystoid edema (68.5%). No statistically significant difference was found between groups in sex (P = 0.40), type of diabetes (P = 0.50), or diabetic retinopathy (P = 0.78). However, the duration of symptoms and BCVA was significantly lower in the group with cystoid degeneration compared with the group with cystoid edema (P < 0.001) and the group with diffuse macular edema (P < 0.001). In the group with cystoid degeneration compared with the groups with cystoid and diffuse edema, the central fovea and central subfield were significantly thicker (both (P < 0.001), the subfoveal choroid was significantly thinner (P = 0.049), rate of serous macular detachment was significantly lower (P < 0.001), and the rate of outer retinal damage was significantly higher (P < 0.001).

Conclusions: Cystoid macular degeneration, which is consistent with poor functional and morphological outcomes, should be differentiated from cystoid macular edema. Serous macular detachment, which is mostly seen in eyes with early stages of DME, should be evaluated as an accompanying morphological finding rather than a type of DME.
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http://dx.doi.org/10.1007/s00417-020-04640-9DOI Listing
June 2020

Outcomes of Vitrectomy Under Air for Idiopathic Macular Hole

Turk J Ophthalmol 2019 12;49(6):328-333

İstanbul Retina Institute, Ophthalmology Clinic, İstanbul, Turkey

Objectives: To evaluate the outcomes of 23-gauge pars plana vitrectomy (PPV) under air compared with standard PPV for idiopathic macular hole (MH).

Materials And Methods: In this prospective, comparative, interventional case series, 42 eyes of 42 patients with idiopathic MH were enrolled. Twenty-one eyes had vitrectomy with an air-infused technique and 21 eyes underwent vitrectomy with a traditional balanced salt solution-infused technique as a control group. Effective vitrectomy time, total surgery time, microperimetry (MP1), and anatomical and functional results were evaluated.

Results: The mean effective vitrectomy time was significantly lower in the air group than in the control group (7.5±0.3 min and 13.3±0.5 min, respectively, P<0.001). The mean total surgery time was significantly lower in the air group than the control group (21.8±2.0 min and 25.9±1.1 min, respectively, P<0.001). There were no statistically significant changes between preoperative and 3-month postoperative retinal sensitivity values evaluated by MP1 in either group. Anatomical success at 3 months was 100% in both groups. Intraoperative complications noted during the air-infused vitrectomy were retinal touch (10%) and sudden hypotony (10%); in the two pseudophakic eyes, migration of air into the anterior chamber occurred in one (50%) and fogging of the intraocular lens in one eye (50%).

Conclusion: Vitrectomy under air infusion for idiopathic MH showed some advantages over a traditional vitrectomy technique in terms of vitreous visualization, effective vitrectomy time, and total surgery duration, without significantly increasing intraoperative and postoperative complication rates. Postoperative microperimetry results indicated no specific damage to the retina or optic nerve related to the continuous air infusion.
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http://dx.doi.org/10.4274/tjo.galenos.2019.89804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961075PMC
December 2019

Relationships between corneal biomechanics and the structural and functional parameters of glaucoma damage.

Arq Bras Oftalmol 2020 Mar-Apr;83(2):132-140

Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Purpose: To investigate the relationships between (i) thickness of the retinal nerve fiber layer, optic nerve head topography, and visual field parameters and (ii) corneal biomechanical properties in normal controls and patients with ocular hypertension and primary open-angle glaucoma.

Methods: This observational, cross-sectional study included 68 eyes with primary open-angle glaucoma, 99 eyes with ocular hypertension and 133 control eyes. Corneal biomechanical properties, optic nerve head topographic features, retinal nerve fiber layer thickness, and visual fields were assessed in all cases. Corneal biomechanical properties, retinal nerve fiber layer thicknesses, and optic nerve head topographic features were compared among the groups. The associations between structural and functional measures of glaucomatous damage and corneal biomechanical factors were also evaluated.

Results: Significantly lower corneal hysteresis and corneal resistance factor values were observed in the primary open-angle glaucoma and ocular hypertension groups as compared with the control group, but there were no significant differences between the primary open-angle glaucoma and ocular hypertension groups. In the ocular hypertension group, no associations were observed between the corneal hysteresis and corneal resistance factor with values and the structural and functional parameters. In the primary open-angle glaucoma group, positive correlations were observed between the corneal hysteresis values and the global retinal nerve fiber layer thickness (p<0.01, r=0.27), mean retinal nerve fiber layer thickness (p<0.01, r=0.33), and mean deviation (p<0.01, r=0.26), and negative correlations were observed between the corneal resistance factor values, and the cup area (p<0.01, r=-0.39), cup-to-disk ratio (p=0.02, r=-0.28), linear cup-to-disk ratio (p=0.02, r=-0.28), and cup shape (p=0.03, r=-0.26). In the control group, weak correlations were detected between the corneal hysteresis and the cup area (p=0.03, r=0.19), cup-to-disk ratio (p=0.01, r=0.21), and linear cup-to-disk ratio (p=0.01, r=0.22).

Conclusions: Distinct correlations were identified between the corneal hysteresis and corneal resistance factor values and the functional and structural parameters in the primary open-angle glaucoma and control groups. Corneal hysteresis and corneal resistance factor may have different roles in the pathophysiology of glaucoma.
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http://dx.doi.org/10.5935/0004-2749.20200019DOI Listing
May 2020

Dislocated Intraocular Lens Extraction and Iris-Claw Lens Implantation in Vitrectomized and Non-vitrectomized Eyes

Turk J Ophthalmol 2019 Oct;49(5):277-282

İstanbul Retina Institute, İstanbul, Turkey

Objectives: To compare the outcomes and complications of dislocated intraocular lens (IOL) extraction and secondary iris-claw IOL (ICIOL) implantation in vitrectomized and non-vitrectomized eyes.

Materials And Methods: This retrospective study included 19 vitrectomized eyes and 11 non-vitrectomized eyes that underwent dislocated IOL extraction and secondary anterior chamber ICIOL implantation between June 2014 and September 2017 and had at least one year of follow-up.

Results: There were no significant differences between the groups in terms of demographic data, operative time, baseline anatomic and functional measurements, or postoperative changes in these measurements (all p>0.05). Postoperative best corrected visual acuity was significantly higher than preoperative values in both groups (both p<0.05). Complication rates did not differ between the groups (all p>0.05). In both groups, endothelial cell density was significantly lower at postoperative 1 year compared to preoperative measurements. There was no significant difference between groups regarding endothelial cell loss (p=0.49). One vitrectomized eye had corneal decompensation. Other complications included hyphema, transient increase of intraocular pressure, secondary glaucoma, pupillary irregularity, and dislocation of ICIOL. Mean operative time was 26.4±5.9 minutes.

Conclusion: Dislocated IOL extraction and secondary anterior chamber ICIOL implantation is a safe treatment option in both vitrectomized and non-vitrectomized eyes.
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http://dx.doi.org/10.4274/tjo.galenos.2019.79735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823582PMC
October 2019

Risk-based Algorithm-guided Treatment Protocol for the Management of Neovascular Age-related Macular Degeneration

Turk J Ophthalmol 2019 Oct;49(5):258-269

İstanbul Retina Institute, İstanbul, Turkey

Objectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration.

Materials And Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The “short-term monthly injections” protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the “short-term treat-and-extend (TREX)” protocol. The “extended TREX” protocol was for patients with high-risk lesions and low fellow-eye visual acuity.

Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year.

Conclusion: The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.
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http://dx.doi.org/10.4274/tjo.galenos.2019.26235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823591PMC
October 2019

Factors associated with macular complications in highly myopic eyes with dome-shaped macular configuration.

Graefes Arch Clin Exp Ophthalmol 2019 Nov 4;257(11):2357-2365. Epub 2019 Sep 4.

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To investigate the associations between macular complications and demographic, clinical, and optical coherence tomography characteristics (OCT) of highly myopic eyes with a dome-shaped macula (DSM).

Methods: We retrospectively analyzed the findings of 90 patients (167 eyes) with DSM who had vertical and horizontal OCT scans between January 2011 and June 2018. Demographic data, clinical characteristics, and OCT-derived morphologic parameters were determined, and the associations of these parameters with macular complications were evaluated.

Results: Among 167 eyes, the following patterns were observed: horizontally oriented DSM (71%), symmetric DSM (27%), and vertically oriented DSM (2%). Complications or abnormalities involving the macular area were detected by OCT in 63% (106/167) of the eyes. Specific complications were as follows: choroidal neovascularization (CNV) (37.1%), macular retinoschisis (9.0%), serous retinal detachment (RD) (7.8%), epiretinal membrane (4.2%), lamellar macular hole (3.0%), and macular hole (2.4%). The eyes with CNV had thinner choroid (P < 0.001) and lower macular bulge height (P = 0.04). The eyes with serous RD had thicker choroid (P < 0.001) and higher macular bulge height (P < 0.001). Serous RD was significantly more common when the macular height was greater than 250 μm (P = 0.001) and if the DSM pattern was vertical (P < 0.001).

Conclusions: A greater bulge height and thicker choroid in highly myopic eyes with DSM may be protective against the development of myopic CNV. A thicker choroid, a higher macular bulge (> 250 μm), and a vertical DSM pattern are associated with a risk of developing serous RD.
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http://dx.doi.org/10.1007/s00417-019-04449-1DOI Listing
November 2019

Membrane patterns in eyes with choroidal neovascularization on optical coherence tomography angiography.

Eye (Lond) 2019 08 1;33(8):1280-1289. Epub 2019 Apr 1.

Istanbul Retina Institute, Istanbul, Turkey.

Background: To evaluate morphologic patterns of choroidal neovascular membranes using optical coherence tomography angiography (OCTA) in patients with treatment-naive, continuously treated, and previously treated exudative age-related macular degeneration (AMD).

Subjects: We assessed retrospectively 184 eyes of 153 patients diagnosed with type 1, type 2, and mixed-type neovascularization associated with AMD. The type of neovascularization and clinical activity were assessed by clinical examination and spectral domain optical coherence tomography (SD-OCT). Morphological patterns of neovascular membranes were categorized using en face images on the AngioVue (Optovue) OCTA system.

Results: The mean age of patients was 77.9 ± 8.6 years (range, 52-96 years). The most frequently identified type of membrane morphology was well-defined in the treatment-naive group (69% of the eyes) and in eyes receiving ongoing anti-VEGF treatments (77% of the eyes). Long-filamentous morphology was the most frequent type in the previously treated group (53%), in which only 33% had a well-defined membrane. All clinically active cases had a well-defined pattern, such as a medusa or sea-fan shaped pattern, or an ill-defined pattern, and none had a long-filamentous neovascular network. Almost half of the clinically inactive cases (47%) had well- or ill-defined, identifiable membrane morphology on OCTA. A long-filamentous membrane pattern, which was consistent with chronicity of lesion, was seen only in eyes with inactive neovascularization.

Conclusions: The membrane morphology on OCTA was not associated with clinical activity, except that the presence of long dilated filamentous linear vessels was associated with chronicity and lesion inactivity.
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http://dx.doi.org/10.1038/s41433-019-0415-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005760PMC
August 2019

MACULAR TELANGIECTASIA TYPE 2: Acircularity Index and Quantitative Assessment of Foveal Avascular Zone Using Optical Coherence Tomography Angiography.

Retina 2020 Jun;40(6):1132-1139

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: The purpose of this study was to investigate the foveal avascular zone area and its perimeter, the acircularity index of the foveal avascular zone, the vessel density surrounding the foveal avascular zone, and the vessel density in the foveal, parafoveal, and perifoveal areas and their associations with best-corrected visual acuity, central foveal average thickness, and volume of ellipsoid zone-retinal pigment epithelium in patients with macular telangiectasia Type 2 (MacTel 2).

Methods: We retrospectively reviewed medical records of 22 eyes of 22 patients with MacTel 2 and 24 eyes of 24 healthy controls. Eyes with MacTel 2 were graded according to optical coherence tomography angiography: 1) vascular anomalies temporal to the fovea; 2) vascular anomalies temporal and nasal to the fovea; 3) markedly diffuse circumferential vascular anomalies; and 4) neovascularization in the outer retina.

Results: Acircularity index was higher and superficial-parafoveal vessel density was lower, in MacTel 2 group (all P < 0.05). Acircularity index was associated with the severity of the disease and had strong correlations with best-corrected visual acuity, ellipsoid zone-retinal pigment epithelium thickness, and ellipsoid zone-retinal pigment epithelium volume (all P < 0.05).

Conclusion: In conclusion, the increase in acircularity index is correlated with the severity of the disease, the decrease in ellipsoid zone-retinal pigment epithelium thickness and volume, and the decrease in best-corrected visual acuity. It may be used to monitor patients with MacTel 2.
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http://dx.doi.org/10.1097/IAE.0000000000002510DOI Listing
June 2020

Morphological and Functional Changes Immediately After Half-Time Photodynamic Therapy in Patients With Central Serous Chorioretinopathy.

Ophthalmic Surg Lasers Imaging Retina 2018 12;49(12):932-940

Background And Objective: To evaluate early treatment outcomes of half-time photodynamic therapy (PDT) in patients with central serous chorioretinopathy (CSC).

Patients And Methods: The anatomical and functional results were assessed for 24 eyes of 23 patients with CSC treated with half-time PDT in this prospective case series. Central foveal thickness (CFT) and subfoveal choroidal thickness (SCT) were evaluated by spectral-domain optical coherence tomography (SD-OCT), and mean retinal sensitivities and fixation characteristics were evaluated by MP-1 microperimetry at baseline and 1 day, 3 days, 1 week, 1 month, and 3 months after treatment.

Results: Observations 1 day after treatment revealed an increase in both SCT and CFT and a decrease in retinal sensitivity (P = .013; P = .02; and P = .02, respectively). The CFT significantly resolved 1 month after treatment (P = .002), and the SCT significantly resolved 7 days after treatment (P = .011). Although an immediate decrease in retinal sensitivity was observed at post-treatment day 1 (P = .02), the greatest reduction in retinal sensitivity was observed 3 days after treatment(P = .009), and then a tendency to increase was seen at subsequent visits.

Conclusions: Despite early anatomical and functional impairments, such as an increase in CFT and SCT and a decrease in retinal sensitivity immediately after half-time PDT, best-corrected visual acuity and retinal sensitivity improved significantly 3 months after treatment. Half-time PDT is associated with early transient deterioration, but not with permanent adverse effect in patients with CSC. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:932-940.].
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http://dx.doi.org/10.3928/23258160-20181203-05DOI Listing
December 2018

Vitrectomy with silicone oil tamponade for retinal detachment associated with giant retinal tears: Favourable outcomes without adjuvant scleral buckling.

Acta Ophthalmol 2019 Mar 3;97(2):e271-e276. Epub 2018 Oct 3.

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To evaluate the outcomes of pars plana vitrectomy with silicone oil tamponade in the management of retinal detachment associated with giant retinal tears.

Methods: We reviewed 45 eyes of 42 patients with primary retinal detachment associated with giant retinal tears over 10 years at a tertiary referral centre. Patients underwent 23-gauge vitrectomy without adjuvant scleral buckling by a single surgeon and had follow-up at least 6 months after silicone oil removal.

Results: Mean follow-up was 37 ± 35 months. Seven eyes (16%) had grade C proliferative vitreoretinopathy, and 16 (36%) had a giant retinal tear ≥180° at baseline. The primary reattachment rate was 84%, and the overall final anatomical success rate was 98%. The mean Snellen visual acuity equivalent at the final visit was 20/58. Final visual acuity ≥20/40 was achieved in 64%. The mean duration of silicone oil tamponade was 10.5 ± 4 weeks. By the final visit, silicone oil had been removed from 44 eyes (98%).

Conclusion: The high rates of anatomical and functional success support management of giant retinal tears-associated retinal detachment with vitrectomy without adjuvant scleral buckling. Removal of silicone oil at the earliest possible time helps to avoid complications such as keratopathy, glaucoma and visual loss without apparent reason.
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http://dx.doi.org/10.1111/aos.13895DOI Listing
March 2019

DEVELOPMENT OF PACHYCHOROID PIGMENT EPITHELIOPATHY AND TRANSFORMATION TO CENTRAL SEROUS CHORIORETINOPATHY AFTER INTRAVITREAL DEXAMETHASONE IMPLANTATION.

Retin Cases Brief Rep 2018 Sep 26. Epub 2018 Sep 26.

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To report first case of sequential development of pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) after repeated intravitreal dexamethasone implantations for diabetic macular edema treatment.

Methods: We present a case of a 54-year-old man having intravitreal dexamethasone implant for bilateral diabetic macular edema.

Results: We observed development of pachychoroid pigment epitheliopathy, seen as a small pigment epithelial detachment on optical coherence tomography after a fourth dexamethasone implantation. A fifth implantation caused transformation of pachychoroid pigment epitheliopathy to central serous chorioretinopathy.

Conclusion: Consecutive administration of dexamethasone implants may have a cumulative effect on retinal pigment epithelium, Bruch membrane, and choroid.
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http://dx.doi.org/10.1097/ICB.0000000000000820DOI Listing
September 2018

Long-term follow-up of pachychoroid pigment epitheliopathy and lesion characteristics.

Graefes Arch Clin Exp Ophthalmol 2018 Dec 21;256(12):2319-2326. Epub 2018 Sep 21.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7 Fulya - Şişli, 34349, Istanbul, Turkey.

Aims: To investigate conversion of pachychoroid pigment epitheliopathy (PPE) lesions and the development of other pachychoroid spectrum diseases in patients with PPE during follow-up.

Methods: We retrospectively reviewed medical records of 46 eyes of 44 patients who had a diagnosis of PPE and were followed up for at least 3 years.

Results: Eyes with PPE (17.4%) developed central serous chorioretinopathy (CSC), and none developed pachychoroid neovasculopathy or polypoidal choroidal vasculopathy. Of 74 initial PPE lesions, 21.6% were retinal pigment epithelium (RPE) thickening, 36.5% were pigment epithelium detachment (PED), and 41.9% were RPE elevation with microbreak appearance (REwM). Five (62.5%) of the eight initial PPE lesions progressing to CSC were REwM. Two developed directly from the REwM and three REwMs transformed to PED first, and then progressed to CSC. Three initial PEDs progressed to CSC. REwMs can also transform to PED and RPE thickening. No initial PEDs or RPE thickenings transformed to a REwM. Of the new PPE lesions, 60% were REwM, 26.7% were PEDs, and 13.3% were RPE thickening.

Conclusion: The smallest PPE lesion that can be detected is a REwM of RPE. It may be the precursor lesion for pachychoroid spectrum disease, but further large-scale prospective studies are required.
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http://dx.doi.org/10.1007/s00417-018-4144-0DOI Listing
December 2018

First-Operated and Fellow Eyes With Bilateral Idiopathic Macular Hole: Comparison of Anatomical and Functional Postoperative Outcomes.

Ophthalmic Surg Lasers Imaging Retina 2018 08;49(8):571-578

Background And Objective: To report anatomical and functional outcomes of surgery in each of the eyes in cases of bilateral macular hole (MH).

Patients And Methods: The anatomical and functional results for 42 patients with bilateral idiopathic MH were evaluated retrospectively. First-operated and fellow eyes were compared at various time points for preoperative characteristics and postoperative outcomes.

Results: Anatomical success was achieved in all patients after a single operation, and no reopening of an initially closed MH was observed during the follow-up period. There was a statistically significant difference between the first and fellow eyes in mean postoperative logMAR visual acuity (VA) (P = .048). Fellow eyes had better postoperative VA, lower rates of ellipsoid zone, and interdigitation zone disruption, and none of the fellow eyes had external limiting membrane disruption at any time after surgery.

Conclusions: Although anatomical success can be achieved in both eyes after successful surgery, early detection and treatment of fellow eyes is associated with better postoperative VA. The reason for a better outcome in the fellow eye is related to the lower photoreceptor impairment rate because of the earlier stage of the hole. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:571-578.].
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http://dx.doi.org/10.3928/23258160-20180803-04DOI Listing
August 2018

Correction to: Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment.

Int Ophthalmol 2019 01;39(1):125

Department of Biostatistics, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Dear editor and readers, this letter is written to make you aware that the original version of this article unfortunately contained a mistake.
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http://dx.doi.org/10.1007/s10792-018-0981-4DOI Listing
January 2019

TRANSCORNEAL SUTURELESS SILICONE OIL REMOVAL USING 23-GAUGE TROCAR SYSTEM IN APHAKIA.

Retin Cases Brief Rep 2018 Jul 13. Epub 2018 Jul 13.

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To describe transcorneal sutureless silicone oil removal using 23-gauge trocars as an alternative surgical technique in an aphakic eye.

Methods: We retrospectively evaluated the management of a 50-year-old male patient who had a history of bilateral congenital cataract removal at the age of 5 and developed rhegmatogenous retinal detachment. A 3-port 23-gauge pars plana vitrectomy, removal of the vitreous up to the vitreous base, 60° temporal retinotomy, and anterior flap retinectomy were performed. Silicone oil (1,000 cSt) was selected as a tamponading agent. The patients underwent active silicone oil removal at subsequent surgery 2 months after the initial vitrectomy.

Results: The silicone oil was successfully extracted from the aphakic eye by using transcorneal 23-gauge trocars. No suture was needed at the corneal wound sites. There were no intraoperative or postoperative complications.

Conclusion: Transcorneal silicone oil removal using 23-gauge trocars can be performed easily with today's modern vitreoretinal surgery systems as an alternative treatment modality.
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http://dx.doi.org/10.1097/ICB.0000000000000780DOI Listing
July 2018

Patient characteristics and risk factors for central serous chorioretinopathy: an analysis of 811 patients.

Br J Ophthalmol 2019 06 12;103(6):725-729. Epub 2018 Jul 12.

Istanbul Retina Institute, Istanbul, Turkey

Aims: To determine the demographic and morphological characteristics of patients with central serous chorioretinopathy (CSC) and describe risk factors for CSC.

Methods: We retrospectively reviewed medical records of 811 patients with CSC and 816 healthy controls referred from 2002 to 2018.

Results: The female/male ratio of patients with CSC was 1/2.7. Mean age of onset was 45.2 years. The peak prevalence for men occurred at 45-49 years. Women had two prevalence peaks, the higher at 55-59 years and the other at 45-49 years. Of these patients, 56.8% had unilateral disease, 42.1% had bilateral disease and 1.1% had only one eye. 671 (82.7%) patients had spectral domain optical coherence tomography (SD-OCT) images and 598 (73.7%) had enhanced depth choroidal images. Pigment epithelial detachment (PED) was detected in 763 (80.7%) of 945 eyes with SD-OCT images. Chronic cases were more likely to be bilateral and multifocal and to have PED (all p<0.001). Subfoveal choroidal thickness (SFCT) did not differ between chronic and classic cases (p=0.74), but SFCT was greater in multifocal cases than unifocal cases (p<0.001). In multivariate regression analyses, older age of onset, longer duration of disease and hyperopia were positively associated with having chronic disease rather than classic disease, and myopia and thyroid hormone replacement were negatively associated. Steroid use, antidepressant or anxiolytic drug use, smoking, pregnancy and hyperopia were risk factors, and myopia was a protective factor for CSC.

Conclusion: This is the largest case-control study of CSC to evaluate demographic morphological characteristics and risk factors. Multiple factors are associated with CSC.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312431DOI Listing
June 2019

Functional and anatomical outcomes following surgical management of persistent fetal vasculature: a single-center experience of 44 cases.

Graefes Arch Clin Exp Ophthalmol 2018 Mar 3;256(3):495-501. Epub 2018 Jan 3.

School of Medicine, Deparment of Biostatistics, Bezmialem Vakif University, Istanbul, Turkey.

Purpose: To investigate the functional and anatomical outcomes following surgical management of persistent fetal vasculature (PFV).

Methods: Single-center, retrospective, interventional consecutive case series of 41 patients (44 eyes) who underwent vitrectomy with or without lensectomy through a limbal or pars plana/plicata approach with diagnosis of anterior, posterior, or combined anterior and posterior segment PFV were included.

Results: The median age at the time of surgery was 3 months (range, 1-36 months), and the mean follow-up period was 37.2 ± 38.1 months (range, 12-164 months). Of the 44 eyes, 5 (11%) had clinical and ultrasonographic findings of anterior PFV, 5 (11%) had posterior PFV, and 34 (78%) had components of both anterior and posterior disease. At the last visit, 38 eyes (87%) were aphakic, 5 eyes (11%) were phakic, and 1 eye (2%) was pseudophakic. The mean Snellen equivalent VA at the final visit for the 14 (32%) eyes with measurable VA was 20/283. Nine (20%) eyes had final VA of only light perception or no light perception. The remaining 21 (48%) eyes behaved consistently with form vision, but the patients were not able to report VA.

Conclusions: Most of the eyes achieved at least form vision, with acceptable postoperative complication rates. Functional and anatomical outcomes are not strictly dependent on axial length, and microphthalmic eyes with mild posterior segment involvement have the potential for good visual results. Outcomes after surgery for posterior PFV associated with tractional retinal detachment are limited. Anatomical success does not always equate to functional improvement.
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http://dx.doi.org/10.1007/s00417-017-3886-4DOI Listing
March 2018

Anatomical and functional outcomes following vitrectomy for dense vitreous hemorrhage related to Terson syndrome in children.

Graefes Arch Clin Exp Ophthalmol 2018 Mar 29;256(3):503-510. Epub 2017 Dec 29.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7 Fulya - Şişli, 34349, Istanbul, Turkey.

Purpose: Our purpose was to assess anatomical and functional outcomes of vitrectomy in pediatric cases of Terson syndrome.

Methods: A total of 11 eyes of seven children diagnosed with Terson syndrome secondary to traumatic brain injury and 17 eyes of 12 children diagnosed with Terson syndrome secondary to nontraumatic brain hemorrhage who had 20-gauge or 23-gauge pars plana or pars plicata vitrectomy were included in this retrospective study. The primary outcome was the change in visual acuity from the preoperative examination to postoperative final follow-up. Secondary outcomes were anatomic surgical success and postoperative complications.

Results: The mean time between diagnosis and surgery was 62 ± 35 days (range, 30-150), and the average age at the time of the surgery was 4.5 ± 6.4 years (range, 3 months to 17 years). The mean preoperative logarithm of the minimum angle of resolution (logMAR) (Snellen) best corrected visual acuity (BCVA) was 2.6 ± 0.7 (20/7260) (n = 9) and in the remaining 19 eyes it was recorded as noncentral, unsteady, nonmaintained fixation. The mean follow-up period was 50 ± 54 months (range, 12-192 months). At the last follow-up visit, the mean logMAR BCVA was 0.46 ± 0.6 (20/60) (n = 19) and in eight eyes it was recorded as fix-and-follow. One eye developed a retinal detachment 14 months after the first operation, and one eye developed an epiretinal membrane after 2 years. Anatomical success was recorded in all patients at the final visit.

Conclusions: In children with massive vitreous hemorrhage secondary to Terson syndrome, vitrectomy is an effective procedure and offers a rapid visual improvement. Earlier surgical treatment prevents amblyopia and blood-related potential complications.
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http://dx.doi.org/10.1007/s00417-017-3887-3DOI Listing
March 2018

OUTCOMES OF VITRECTOMY WITH SILICONE OIL TAMPONADE FOR MANAGEMENT OF RETINAL DETACHMENT IN EYES WITH CHORIORETINAL COLOBOMA.

Retina 2019 Apr;39(4):736-742

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To estimate the outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy and silicone oil tamponade.

Methods: A retrospective chart review of 10 eyes (10 patients) who underwent pars plana vitrectomy for retinal detachment with chorioretinal coloboma.

Results: The average age at the time of the surgery was 29.8 ± 19.7 years. The mean follow-up period was 28.8 ± 28.4 months. The mean silicone oil tamponade duration was 9.8 ± 3.5 weeks. Of 10 eyes, 4 (40%) had retinal breaks outside the coloboma, 4 (40%) had breaks inside the coloboma, 1 (10%) had breaks inside and outside the coloboma, and in 1 eye (10%); the causative retinal break was not localized. Preoperatively, the mean visual acuity was 20/2,500 (n = 9), and 1 (10%) was recorded as "Not CSM." At the final examination, the mean visual acuity for the patients with measurable visual acuity was 20/200 (P = 0.06), and in the remaining eye was recorded as light perception. The retina was finally reattached in nine eyes (90%). Postoperative complications included cataract in three (30%), persistent elevated intraocular pressure in one (10%), band keratopathy in one (10%), and proliferative vitreoretinopathy in one (10%).

Conclusion: Complete pars plana vitrectomy with or without lensectomy, laser photocoagulation around the peripheral retina, around all the peripheral breaks and around the colobomatous area, and silicone oil tamponade is effective for retinal detachment in eyes with chorioretinal coloboma. Silicone oil removal as early as possible did not increase the risk of redetachment and seems to reduce the incidence of oil-related complications in such cases.
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http://dx.doi.org/10.1097/IAE.0000000000002014DOI Listing
April 2019

Primary vitrectomy with short-term silicone oil tamponade for uncomplicated rhegmatogenous retinal detachment.

Int Ophthalmol 2019 01 18;39(1):117-124. Epub 2017 Dec 18.

Department of Biostatistics, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Purpose: To compare the outcomes of phakic and pseudophakic uncomplicated rhegmatogenous retinal detachment (RRD) treated with primary pars plana vitrectomy (PPV) and short-term silicone oil (SO) tamponade.

Methods: A retrospective chart review of 201 eyes (185 patients) with uncomplicated RRD treated with primary 23-gauge PPV and short-term SO tamponade. Anatomical success was defined as a reattached retina for at least 6 months after SO removal.

Results: The analysis consisted of 111 phakic eyes and 90 pseudophakic eyes. The mean duration of SO tamponade in phakic eyes was 8.5 ± 1.9 and in pseudophakic eyes was 8.3 ± 1.9 weeks [corrected] (P = 0.39). The primary reattachment rate was 93% in the phakic group and 98% in the pseudophakic group (P = 0.19). The mean Snellen VA equivalent at the final visit was 20/30 in both groups. Final VA ≥ 20/40 was achieved in 81% of phakic and 86% of pseudophakic eyes (P = 0.69). Postoperative complications included cataract in the phakic group (100%), transient elevation of intraocular pressure (IOP) (29%), epiretinal membrane (8%), proliferative vitreoretinopathy (7%), cystoid macular edema (3%), secondary macular hole (2%), persistent elevation of IOP (1.5%), and persistent hypotony (1%).

Conclusions: The success rates and functional outcomes of primary 23-gauge PPV with short-term SO tamponade did not differ significantly between the two groups, suggesting that lens status is not the single most important factor influencing the final results. The use of short-term SO was not associated with keratopathy, visual loss without any apparent reason and high rates of chronic elevation of IOP or redetachment following SO removal.
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http://dx.doi.org/10.1007/s10792-017-0787-9DOI Listing
January 2019

Reply.

Retina 2017 11;37(11):e146-e147

Istanbul Retina Institute, Istanbul, Turkey.

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http://dx.doi.org/10.1097/IAE.0000000000001920DOI Listing
November 2017

Pachychoroid Pigment Epitheliopathy Associated With Tamoxifen.

Ophthalmic Surg Lasers Imaging Retina 2017 10;48(10):838-842

Pachychoroid pigment epitheliopathy (PPE) is considered to be a forme fruste of central serous chorioretinopathy. Tamoxifen (Soltamax; Midatech Pharma, Raleigh, NC) has an anti-estrogenic effect on cytoplasmic estrogen receptors. Serum total testosterone, cortisol, and cortisone levels increase during tamoxifen therapy. Tamoxifen may cause hormone disturbance leading to the development of disorders in the pachychoroid spectrum. The authors present two cases of PPE associated with tamoxifen therapy. A 65-year-old woman (Patient 1) and a 52-year-old woman (Patient 2) had a recent history of tamoxifen therapy. PPE lesions were seen in both eyes of Patient 1 and in the right eye of Patient 2. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:838-842.].
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http://dx.doi.org/10.3928/23258160-20170928-10DOI Listing
October 2017

Pachychoroid pigment epitheliopathy in fellow eyes of patients with unilateral central serous chorioretinopathy.

Br J Ophthalmol 2018 04 4;102(4):473-478. Epub 2017 Aug 4.

Istanbul Retina Institute, Istanbul, Turkey.

Aims: To investigate the prevalence of pachychoroid pigment epitheliopathy (PPE) in fellow eyes of patients with unilateral central serous chorioretinopathy (CSC) and to determine differences between patients with PPE, uncomplicated pachychoroid (UCP) and normal fellow eyes.

Methods: We retrospectively reviewed 536 patients with CSC. Demographic and medical data, spectral domain optical coherence tomography scans with enhanced depth imaging mode, infrared reflectance images and fundus autofluorescence images were obtained from the patients' medical records.

Results: 254 (47.4%) of 536 patients had bilateral CSC. The female to male ratio was 1/2.8 in all patients with CSC. In patients with unilateral CSC (282 patients), 61% of fellow eyes had PPE, 30.8% had UCP and 8.2% were normal. There were no significant differences between patients with PPE, UCP and normal eyes in age, duration of disease, sex, presence of systemic hypertension, steroid use, psychopharmacological medication use, refractive error or central foveal thickness. Eyes with PPE and UCP did not differ regarding subfoveal choroidal thickness. In eyes with PPE (172 eyes), 77.3% had retinal pigment epithelium (RPE) bumps and 43% had pigment epithelium detachment.

Conclusion: PPE is common in fellow eyes of patients with CSC. There is no difference between PPE and UCP regarding demographic characteristics and medical features.
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http://dx.doi.org/10.1136/bjophthalmol-2017-310724DOI Listing
April 2018

INDOCYANINE GREEN ANGIOGRAPHY OF PACHYCHOROID PIGMENT EPITHELIOPATHY.

Retina 2018 Sep;38(9):1668-1674

Istanbul Retina Institute, Istanbul, Turkey.

Purpose: To compare choroidal hyperpermeability and vessel density between eyes with central serous chorioretinopathy (CSC), those with pachychoroid pigment epitheliopathy (PPE) and those with uncomplicated pachychoroid (UCP).

Methods: We retrospectively reviewed indocyanine green angiography images of 60 patients with unilateral active CSC who had PPE (36 eyes) or UCP (24 eyes) in their fellow eyes. We used color thresholding of indocyanine green angiography images to determine choroidal vessel density.

Results: The mean choroidal thickness of eyes with CSC was greater than that of eyes with PPE or UCP, but this difference was not statistically significant (P = 0.46). There was no significant difference between the PPE (92%) and CSC (93%) groups regarding choroidal hyperpermeability (P = 0.76), but both of these groups had higher choroidal permeability than the UCP group (50%) (both P < 0.001). In 30 (90%) of 33 eyes with PPE who had choroidal hyperpermeability, retinal pigment epithelium alterations were in the region of hyperpermeability. Choroidal vessel density did not differ between the PPE and UCP groups (P = 0.57).

Conclusion: Pachychoroid pigment epitheliopathy is forme fruste of CSC. There is no difference between complicated and UCP regarding subfoveal choroidal thickness and choroidal vessel density. The main difference between these groups is choroidal hyperpermeability.
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http://dx.doi.org/10.1097/IAE.0000000000001773DOI Listing
September 2018

Correlation between morphological changes and functional outcomes of recent-onset macula-off rhegmatogenous retinal detachment: prognostic factors in rhegmatogenous retinal detachment.

Int Ophthalmol 2018 Jun 10;38(3):1275-1283. Epub 2017 Jun 10.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7, Fulya - Şişli, 34349, Istanbul, Turkey.

Purpose: To assess correlation between preoperative and postoperative findings and surgical factors, and postoperative functional outcomes after successful repair of acute macula-off rhegmatogenous retinal detachment (RRD).

Methods: Forty-four eyes of 44 patients with recent-onset macula-off RRD who had primary pars plana vitrectomy were included in this retrospective study. Best-corrected visual acuity (BCVA) and retinal and choroidal changes on spectral-domain optical coherence tomography (SD-OCT) were evaluated before and after surgery. Correlation between preoperative and postoperative variables such as demographic and clinical data, SD-OCT findings and surgical factors, and postoperative functional outcomes were assessed.

Results: Eighteen women and 26 men, whose mean age at the onset of RRD was 51.7 ± 14.4 years, were evaluated. The mean preoperative and postoperative logMAR BCVA were 1.1 ± 0.5 (20/250) and 0.14 ± 0.1 (20/30), respectively, after a mean of 16.7 ± 7.2 months. Although all factors were evaluated as prognostic factors for functional outcome after surgical treatment of recent-onset macula-off RRD, epiretinal membrane formation was found as the only factor affecting postoperative visual acuity.

Conclusion: Satisfactory visual recovery can be achieved after a successful surgery in patients with acute RRD without any association with morphological changes such as increased subretinal fluid, central foveal thickness, subfoveal choroidal thickness, cystic spaces in the inner nuclear layer and/or outer nuclear layer, undulation of separated outer retina, and disruption of the photoreceptor layer. Epiretinal membrane formation may affect visual outcome in these patients.
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http://dx.doi.org/10.1007/s10792-017-0591-6DOI Listing
June 2018

Choroidal thickness in chronic rhegmatogenous retinal detachment before and after surgery, and comparison with acute cases.

Int Ophthalmol 2018 Jun 19;38(3):1035-1042. Epub 2017 May 19.

Istanbul Retina Institute, Hakkı Yeten Cad. Unimed Center No: 19/7 Fulya-Şişli, 34349, Istanbul, Turkey.

Purpose: To evaluate subfoveal choroidal thickness (SCT) in cases with chronic rhegmatogenous retinal detachment (RRD), before and after pars plana vitrectomy, and cases with acute RRD using optical coherence tomography.

Methods: This retrospective study included 24 eyes with chronic RRD and 26 eyes with recent-onset RRD. Best corrected visual acuity, intraocular pressure, and SCT were measured and compared between the two groups. Of 24 eyes with chronic RRD, 11 had primary pars plana vitrectomy. Measurements of operated and fellow eyes were also compared before surgery and 1 week, 1 and 3 months after surgery.

Results: The preoperative mean SCT in eyes with chronic RRD was 342.6 ± 111.7 µm and in fellow eyes 342.4 ± 116.7 µm (P = 0.83) and in eyes with acute RRD was 346.2 ± 51 µm and in fellow eyes 262.7 ± 46.8 µm (P < 0.001). There was also no significant change in SCT between baseline before surgery and 3 months after surgery in eyes with chronic RRD (P = 0.20).

Conclusion: No significant difference was found in the mean SCT between affected and fellow eyes in chronic RRD. This may be related to intraocular inflammation, which is more limited in chronic than in acute RRD. There was also no significant difference in the SCT in eyes with chronic RRD between the operated and fellow eyes after surgery. It may be concluded that vitrectomy does not affect choroidal thickness.
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http://dx.doi.org/10.1007/s10792-017-0556-9DOI Listing
June 2018