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Objectives: To evaluate the corneal effects of the intravitreal dexamethasone implantation using corneal topography and specular microscopy. Material and methods: 27 eyes of the 27 patients who received a single intravitreal dexamethasone implantation dose for diabetic macular edema were enrolled in this study. Sirius topography and EM-3000 specular microscopic examinations were performed at the initial examination (baseline), and then on the first day, during the first week, and 1 month after IDI. Changes in corneal parameters were investigated. Results: The mean age was 58.66 ± 6.59 years. 15 patients were men, and 12 were women. The mean disease duration was 12.2 ± 2.4 months, and mean glycosylated hemoglobin (HbA1c) was 7.2 ± 1.1. After dexamethasone injection, the mean central corneal thickness, endothelial cell density, and coefficient variation of cell area presented a statistically significant decrease ( p < 0.05). Anterior segment parameters, such as anterior chamber depth, iridocorneal angle, sim K1 and K2 keratometry, pupillary diameter, horizontal visible iris diameter, and corneal astigmatism did not change ( p > 0.05). Conclusion: Intravitreal dexamethasone implantation affects corneal endothelial cell structure but does not appear to affect corneal topography parameters.

Background To evaluate choroidal thickness, ganglion cell complex and photoreceptor outer segment length in patients with breast cancer undergoing tamoxifen therapy using spectral domain optical coherence tomography (SD-OCT) and to compare the results to normal eyes. Methods Fourty four patients with breast cancer undergoing tamoxifen therapy and fourty one healthy controls were included in this prospective, comparative study. All participants underwent a complete ophthalmologic evaluation and SD-OCT. Subfoveal, nasal (nasal distance to fovea 500 μm, 1000 μm, 1500 μm) and temporal (temporal distance to fovea 500 μm, 1000 μm, 1500 μm) choroidal thickness measurements were performed using enhanced depth imaging mode of SD-OCT. Using an Early Treatment Diagnostic Retinopathy Study (ETDRS) circle at the macular level, the automated retinal segmentation software was applied to determine thicknesses of the ganglion cell complex (GCC) by adding the macular retinal nerve fiber layer, macular ganglion cell layer, and macular internal plexiform layer parameters. The photoreceptor outer segment (PROS) length was determined by manually as the distance from inner surface of ellipsoid zone to inner surface of retina pigment epithelium after automatic retinal segmentation. Results The mean choroidal thickness measurements were statistically greater in tamoxifen group than controls in all quadrants (p<0.001 for all quadrants). Of all tamoxifen users (44 eyes of 44 patients), 33 eyes (75%) had uncomplicated pachychoroid (UCP). Pachychoroid pigment epitheliopathy (PPE) was detected in 5 patients (11.3%) in tamoxifen group. Patients with PPE in one eye had UCP in the fellow eye. Central serous chorioretinopathy findings were observed in one patient. Tamoxifen users had statistically lower GCC thicknesses in all inner rings of ETDRS inlay and only in nasal outer ring (p:0.027, p:0.002, p:0.002, p:0.001 and p:0.030; respectively). No statistically significant difference was found between the groups in terms of mean subfoveal PROS length. Conclusions SD-OCT provides valuable information in identifying the structural changes and evaluation of ocular findings in patients receiving tamoxifen therapy. Increasing choroidal thickness, PPE, thinning GCC were detected in tamoxifen users. These OCT findings may be an early indicator of retinal toxicity for patients undergoing tamoxifen therapy in follow-up period.

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This study aimed to compare the short-term efficacy of dexamethasone (Dex) implant with those of three consecutive ranibizumab (Rzb) injections in the treatment-naive diabetic macular edema patients. Methods: In this retrospective study, 30 eyes of 30 diabetic macular edema (DME) patients were enrolled in the intravitreal Rzb (IVR) group; 29 eyes of 29 patients were enrolled in the Dex implant (DI) group. The IVR group was treated with three consecutive monthly Rzb injections; the DI group was injected one single DI. Both groups underwent ophthalmological examinations and optical coherence tomography exams at baseline and 1 st , 2 nd , and 3 rd month visits. Data were analyzed with SPSS 22.0, statistically. Results: Mean age, duration of diabetes, baseline best-corrected visual acuity, and central macular thickness (CMT) of both arms were statistically indifferent. The intraocular pressure (IOP) changes were within and between groups insignificant. The comparison of visual gain at the final visit showed no difference (p>0.05). The final CMT reduction in both groups was statistically insignificant (145 µm vs 110.5 µm p>0.05). In the DI group, two eyes (7%) had to be treated with topical anti-glaucomatous agents in the follow-up. Conclusion: Both monthly Rzb injections and DI are equally effective in the initial treatment of DME. Although the treatment effect of the DI was seen earlier in the follow-up, the IOP elevations may be a clinical concern in some cases.

Objectives: This is a retrospective, comparative evaluation of the short-term efficacy and safety of intravitreal ranibizumab (IVR) and IVR combined with posterior subtenon triamcinolone acetonide (STA) in the treatment of diabetic macular oedema (DME). Methods: A total of 79 pseudophakic eyes of 57 patients with DME who underwent IVR injection treatment were examined retrospectively. All of the patients were treatment-naive. In the study group (STA+IVR), consisting of 30 eyes of 39 patients, the STA and IVR were administered in the first treatment session simultaneously, followed by 2 consecutive monthly IVR injections. In the control group (IVR only) comprised 40 eyes of 27 patients, 3 consecutive monthly IVR injections were administered. Patients with serous retinal detachment (SRD) according to optical coherence tomography images were identified in both groups for subgroup analyses. The primary outcome measures were changes in central macular thickness (CMT), best corrected visual acuity (BCVA), and the intraocular pressure (IOP) at 1, 2, and 3 months post-injection. Results: There was no statistically significant difference between the demographic characteristics of the patients' baseline BCVA and CMT measurements (p>0.05). For the IVR group, the mean pre-treatment CMT and BCVA was 421.20±89.10 µm and 0.42±0.24 logMAR, respectively. After the third injection, the mean was 308.12±59.07 µm and 0.20±0.12 logMAR, respectively. The combined treatment group baseline measurements were 454.50±122.52 µm and 0.54±0.29 logMAR, respectively. After the third injection, the mean was 294.22±50.33 µm and 0.27±0.21 logMAR, respectively. The decrease was statistically significant for both groups (p=0.001). Comparison of the CMT within groups revealed a statistically significant difference in favor of the combined group after the second injection (p=0.017). There was no statistically significant difference in the BCVA gains between groups (p>0.05). Patients with SRD were evaluated as a subgroup, and at the first month, the mean gain in CMT was -71.63±57.98 µm in the control group and -123.61±93.46 µm in the study group (p=0.048). The required anti-glaucomatous treatment was statistically significant in the combined group (p=0.008). Conclusion: Both treatments provided improvement in BCVA and CMT and can be considered functional and anatomically effective treatment options for DME.

Background To evaluate choroidal thickness, ganglion cell complex (GCC) and photoreceptor outer segment length were measured in patients with breast cancer undergoing tamoxifen therapy, using spectral-domain optical coherence tomography (SD-OCT); results were compared with those for normal eyes. Methods Forty-four patients with breast cancer, undergoing tamoxifen therapy, and 41 healthy controls were included in this prospective, comparative study. All participants underwent a complete ophthalmologic evaluation and SD-OCT. Subfoveal, nasal (nasal distance to fovea 500, 1000, 1500 μm), and temporal (temporal distance to fovea 500, 1000, 1500 μm) choroidal thickness measurements were performed using the enhanced depth imaging mode of SD-OCT. Using an Early Treatment Diagnostic Retinopathy Study (ETDRS) circle at the macular level, the automated retinal segmentation software was applied to determine the thickness of the GCC. The photoreceptor outer segment (PROS) length was determined manually, as the distance from the inner surface of the ellipsoid zone to the inner surface of retina pigment epithelium. Results The mean choroidal thickness was statistically greater in the tamoxifen group than controls in all quadrants ( p < 0.001 for all quadrants). Of all tamoxifen users (44 eyes of 44 patients), 33 eyes (75%) had UCP. Pachychoroid pigment epitheliopathy (PPE) was detected in five tamoxifen-group patients (11.3%). Patients with PPE in one eye had UCP in the fellow eye. Central serous chorioretinopathy findings were observed in one patient. Tamoxifen users had statistically lower GCC thickness in all inner rings of the ETDRS inlay and in the nasal outer ring only ( p = 0.027, 0.002, 0.002, 0.001, and 0.030, respectively). No statistically significant difference in mean subfoveal PROS length was found between the groups. Conclusions SD-OCT provides valuable information for identifying structural changes and evaluating ocular findings in patients receiving tamoxifen therapy. Increased choroidal thickness, PPE and thinning GCC were detected in tamoxifen users. These OCT findings may be an early indicator of retinal toxicity for patients undergoing tamoxifen therapy in the follow-up period. Keywords tamoxifen retinopathy, choroidal thickness, ganglion cell complex, PROS, spectral-domain optical coherence tomography