Aslı Vural

Background/Objectives: Mild autonomous cortisol secretion (MACS) is associated with increased cardiometabolic morbidity, but its relationship with the retinal microcirculation is unknown. We compared retinal and peripapillary microvascular parameters between MACS and nonfunctioning adrenal adenoma (NFA) and, secondarily, examined their associations with continuously modeled post-dexamethasone cortisol. Methods: In this single-center, retrospective, cross-sectional study, 98 patients (45 NFA, 53 MACS) were included, and optical coherence tomography angiography (OCTA) and structural OCT data from one eye per patient were analyzed. The primary outcome was whole-image deep capillary plexus (DCP) vessel density. Multivariable models were adjusted for age, sex, body mass index, and cardiometabolic comorbidities; secondary analyses were corrected using the Benjamini–Hochberg false discovery rate (q values). Results: OCTA was evaluable in 89 patients. The primary outcome did not differ significantly between groups in the main analysis (NFA vs. MACS, 48.64 ± 5.71% vs. 47.31 ± 5.77%; adjusted difference −1.29 percentage points, 95% CI −3.97 to 1.38; p = 0.339) or in any sensitivity analysis. In secondary analyses, superior retinal nerve fiber layer (RNFL) thickness was greater in MACS (β = 17.38 µm; q < 0.001) and increased with ln(post-dexamethasone cortisol) (β = 13.74 µm; q = 0.010). Higher ln(post-dexamethasone cortisol) was also associated with lower parafoveal DCP (β = −2.72 percentage points; p = 0.013) and inside-disc radial peripapillary capillary vessel density (β = −3.13 percentage points; p = 0.026), which did not survive multiplicity correction; no superficial capillary plexus sector was associated with either exposure (all p ≥ 0.37). Conclusions: MACS was not significantly associated with whole-image DCP vessel density. The secondary associations with continuous cortisol are cross-sectional and hypothesis-generating and require prospective confirmation.

Purpose: To quantitatively assess the early postoperative effects of cardiopulmonary bypass (CPB) surgery on optic nerve head (ONH) morphology, peripapillary retinal nerve fiber layer (PRNFL) thickness, and radial peripapillary capillary density (RPCD) utilizing optical coherence tomography angiography (OCT-A). Methods: A prospective observational study was conducted involving 40 eyes of 40 patients undergoing CPB surgery. Baseline (preoperative) measurements of ONH parameters, PRNFL thickness, and RPCD were acquired using OCT-A. Postoperative evaluations were performed at postoperative week 1, week 2, and month 1. Statistical analyses were performed using repeated measures analysis, with paired t-tests or Wilcoxon signed-rank tests applied for post hoc pairwise comparisons depending on data distribution. Results: A statistically significant but transient increase in PRNFL thickness was observed at postoperative week 1 and week 2 ( p < 0.05), which returned to baseline by the first month. No significant differences were detected between preoperative and postoperative measurements concerning RPCD, cup-to-disc ratio, rim area, disc area, or cup volume. Conclusion: CPB surgery was associated with early but reversible changes in the ONH and peripapillary retinal structures in this study. OCT-A may serve as a useful non-invasive tool in the assessment of these transient changes. Longer-term follow-up studies are necessary to determine the sustained and permanent ocular effects of CPB surgery.

Objective: To evaluate changes in retrobulbar ocular blood flow parameters by using Colour Doppler Imaging (CDI) and changes in foveal microvasculature by using Optical Coherence Tomography Angiography (OCTA) in pediatric obese patients and to compare them with a group of healthy children. Methods: Children diagnosed with obesity without hypertension and diabetes (39 subjects, obese group) and age-matched healthy controls (26 subjects, control group) underwent CDI and OCTA imaging. Peak systolic velocity, end-diastolic velocity and resistivity index from ophthalmic, central retinal and posterior ciliary arteries on CDI; superficial and deep capillary plexus vascular density and foveal avascular zone area on OCTA imaging were obtained in each group. Central foveal and subfoveal choroidal thicknesses were also measured. CDI and OCTA parameters were compared between two groups. Results: Peak systolic and end-diastolic velocities were found to be significantly lower in obese children than in controls in all three examined arteries (p < 0.05). Resistivity index values were similar between the groups. OCTA imaging did not reveal significant changes in superficial and deep capillary plexus vascular densities and foveal avascular zone area across analysed retinal regions between the groups. Subfoveal choroid was thicker in obese group than in control group (325.89 ± 52.77 µm vs. 304.52 ± 21.76 µm, p = 0.04). Conclusion: An apparent decrease was present in retrobulbar hemodynamics in obese children. This arises the possibility of early ocular macrovascular compromise rather than retinal microvascular impairment in childhood obesity.

Purpose: To define late-stage fluorescein angiography (FA) findings in patients who received anti-vascular endothelial growth factor (VEGF) agents (intravitreal bevacizumab or aflibercept) as a treatment for stage 3 retinopathy of prematurity (ROP) in zone II. We also compared the findings of untreated eyes. Method: Infants with a history of ROP who underwent fluorescein angiography were evaluated retrospectively. The patients were divided into 2 groups: those who received anti-VEGF treatment and those who regressed spontaneously without treatment. Vascular abnormalities, such as vascular leakage, shunts at the vascular-avascular junction, periarteriolar areas with hypoperfusion, fine branching and blunt termination of the vessels and, were recorded. Results: Angiography evaluations revealed leakage in the eyes of 27.69% of the infants in the anti-VEGF–treated group and in 21.7% of the untreated group ( p = .638). Among the abnormal vascular findings in the peripheral retina, the ratios of fine branching and blunt termination, numbers of shunts along the vascular-avascular junction, and sizes of periarteriolar areas of hypoperfusion were significantly larger in the untreated group than in the treated group ( p < .05; p < .01). The gestational ages and birth weights were significantly lower ( p ≤ .05) in infants with vascular findings in both groups. Conclusion: Vascular abnormalities in the peripheral retina are likely due to the ROP itself. Although these abnormalities were detected by FA imaging in both treated and untreated infants with ROP, they were significantly less frequent in patients treated with anti-VEGF, indicating that anti-VEGF treatments have a partially positive effect on the retinal vascularization process.

Revista oficial de la Sociedad Española de Nutrición Parenteral y de la Sociedad Española de Nutrición. Está dedicada al estudio y divulgación de temas relacionados con la nutrición.

To assess clinical characteristics of torpedo maculopathy (TM) lesions in an infant population with age ≤1.5 years and to investigate the role of NEXMIF mutation in the development of TM. Retrospective analysis of medical records of 17 consecutive infants with the diagnosis of TM between 2016 January and 2019 December were done. Fundus images and a hand-held spectral-domain optical coherence tomography (Envisu 2300, Bioptigen, Morrisville, NC, USA) were used to identify clinical characteristics of TM lesions. Additional molecular testing for mutation screening for NEXMIF gene was also carried out. Totally 55334 infants were screened during the study period and 17 (0.03%) were identified as having TM. The mean age at the time of diagnosis was 3.94±5.08 months. All TM lesions showed variable degrees of hypopigmentation. Satellite lesion in one infant was nasally located to the main TM lesion. Absence, disruption, loss, degeneration and/or irregularity of the ellipsoid zone were common findings on OCT examination. No pathogenic or likely pathogenic variant of NEXMIF gene was detected. Fundoscopic appearance and OCT findings of lesions show similarities to those already reported previously. Contrary to popular belief, a nasally located satellite lesion was observed in one of our case.

Purpose: To evaluate the refractive precision of three‐piece versus one‐piece intraocular lenses (IOLs) in eyes with pseudoexfoliation (PXF) and changes in anterior chamber depth (ACD) following cataract surgery.Methods: This prospective, nonrandomized, interventional, comparative case series included PXF eyes, which were implanted with one‐piece acrylic IOL or three‐piece acrylic IOLs (Group A; n = 31, Group B; n = 30). Non‐PXF control eyes were implanted with one‐piece acrylic IOL (Group C; n = 30). Postoperative refractive error (RE) and absolute RE, as well as pre‐ to postoperative ACD changes, were statistically analysed. A p value < 0.05 was considered statistically significant.Results: Changes in ACD (mean ± standard deviation) in Groups A, B and C were 0.9 ± 0.4, 1.0 ± 0.3 and 0.7 ± 0.4 mm, respectively. Significant differences were found between Groups A and C (p = 0.043) and between Groups B and C (p = 0.008). In Groups A, B and C, the median and interquartile (Q1 to Q3) values were 0.3 (−0.8 to 1.0), −0.5 (−0.8 to −0.3) and 0.1 (−0.4 to 0.3) for RE and 1.0 (0.4 to 1.3), 0.5 (0.3 to 0.8) and 0.3 (0.3 to 0.5) for absolute RE, respectively. The RE differences between Group A and B (p = 0.009) and Group B and C (p < 0.001) were statistically significant. For absolute RE, the differences were significant for all comparisons (p < 0.05).Conclusion: Refractive precision in PXF eyes may be better with three‐piece than with one‐piece IOL implantation, but worse than with one‐piece IOL implantation in non‐PXF eyes. Significant changes in ACD in PXF eyes may be related to RE.

Purpose Our aim is to compare foveal microvascular structure, foveal retinal thickness, and best-corrected visual acuity (BCVA) in children with a history of premature retinopathy (ROP) and healthy children. It is also evaluated whether microvascular structural changes in the course of ROP had resulted from treatment modalities of ROP or the disease itself. Methods This is a cross-sectional observational comparative study. Seventy-one children were analyzed in four different groups: children treated with bevacizumab (18), or laser (19) for ROP; or spontaneously regressed disease (18) and non-premature healthy children (16). We analyzed foveal avascular zone (FAZ) and vessel densities (VDs) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) at foveal and parafoveal region with optical coherence tomography angiography (OCT-A). Foveal thickness was measured by cross-sectional OCT. Correlations between FAZ area, foveal VD, central foveal thickness (CFT), BCVA, gestational age (GA), and birth weight (BW) were evaluated. Results After comparing of OCT-A parameters between all premature children (groups 1–3) and non-premature children (group 4), significant differences were found in VD-SCP (whole), VD-SCP (foveal), VD-SCP (parafoveal), CFT, and VD-DCP (foveal) (all p < 0.001). Significantly smaller FAZ area was also noted in ROP children. Higher foveal VD of SCP, DCP, and smaller FAZ area were significantly associated with lower GA and BW. Conclusion By using OCT-A, significant foveal microvascular anomalies were identified in children with ROP irrespective of the treatment option or spontaneous regression. There has been a correlation between microvascular anomalies, CFT, and a lower BCVA.

To evaluate foveal thickness, foveal microvasculature, and refractive error in children with asymmetric involvement of retinopathy of prematurity who had laser treatment in one eye and spontaneously regressed retinopathy of prematurity in the fellow eye. Totally, 17 children (34 eyes) with a history of asymmetric course of acute Zone II retinopathy of prematurity were assessed. Data on best-corrected visual acuity, refractive status, axial length, anterior chamber depth, and optical coherence tomography angiography findings were analyzed between treated and non-treated fellow eyes. Treated eyes were more myopic than non-treated eyes (mean, –0.09 ± 1.86 diopters vs mean, 0.07 ± 0.98 diopters, p = 0.026). Compared to non-treated eyes, treated eyes had shallower anterior chamber depth (mean, 3.27 ± 0.24 mm vs mean, 3.55 ± 0.19 mm, p = 0.02). No significant difference was observed regarding optical coherence tomography angiography parameters between two eyes of the children. The mean central foveal thickness was found to be higher in treated eyes than in non-treated eyes (297.46 ± 22.03 vs 275.55 ± 18.45, p = 0.009). Higher number of laser spots were associated with decreased parafoveal superficial capillary plexus vessel density (r = –0.56, p = 0.02) and increased central foveal thickness (r = 0.62, p = 0.008). Our results revealed no difference in optical coherence tomography angiography parameters between laser-treated and non-treated eyes in children with asymmetric involvement of Zone II retinopathy of prematurity except for a higher central foveal thickness in laser-treated eyes. Treated eyes were more myopic than the non-treated eyes. Number of laser applications during treatment had an impact on parafoveal superficial capillary plexus vessel density.