Acar, Atakan; Özdal, Pınar Çakar; Başarır, Berna; Özdemir Yalçınsoy, Kübra; Altan, Çiğdem; Budakoğlu, Özlem

Objectives: To present the clinical and demographic characteristics, imaging findings, diagnosis and treatment approach in cases of cat scratch disease (CSD) with ocular involvement. Materials and Methods: The records of 19 patients followed-up and treated between 2010 and 2020, including detailed ophthalmological examinations, imaging findings, and treatment approach, were evaluated retrospectively. Results: Twenty-three eyes of 19 patients, 7 female (37%) and 12 male (63%), were included in the study. The mean age was 34.1±13.3 (range: 11-56) years, and the mean follow-up duration was 12.6±18.0 (range: 1-81) months. Unilateral involvement was observed in 15 cases (79%). Cat contact was reported in 14 cases (74%). In 6 cases (32%), flu-like symptoms were present before the ocular complaints. The mean visual acuity (VA) at presentation was 0.42±0.36 (range: 0.001-1.0). Anterior uveitis was observed in 3 eyes (13%). Posterior segment findings included neuroretinitis in 14 (61%), superficial retinal infiltrate(s) in 8 (35%), papillitis in 3 (13%), branch retinal artery occlusion in 2 (8%), and cilioretinal artery occlusion in 1 (4%) of the eyes. All cases were positive for Bartonella henselae immunglobulin (Ig)M and/or IgG. Systemic antibiotic therapy was administered to all patients. Intravenous pulse or oral corticosteroids were given, especially in cases with optic disc involvement. The mean final VA was 0.80±0.25 (range: 0.01-1.0). Conclusion: CSD may present with different ocular involvement patterns. Apart from the classical neuroretinitis and macular star appearance, patients may present with isolated optic disc edema, branch retinal artery occlusion, and retinal infiltrations. In such patients, cat contact history and Bartonella serology should be evaluated to differentiate CSD.

İçel, Erel; Yılmaz, Hayati; Uçak, Turgay; Taşlı, Nurdan Gamze; Uğurlu, Adem; Karakurt, Yücel

Objectives: To perform the measurements of the optic disc and macula in healthy children using optical coherence tomography angiography (OCTA) in order to determine the normative data values and compare these by age, gender, spherical equivalent (SE), and axial length (AL). Materials and Methods: A total of 146 eyes belonging to 146 healthy children (74 girls, 72 boys) aged 6 to 16 years were included in this prospective study. Refraction and biometry measurements were performed. Retinal nerve fiber layer thickness (RNFLT), central macular volume, and central macular thickness (CMT) were measured by optical coherence tomography (OCT) after dilatation. Using the OCTA device, foveal avascular zone (FAZ) area, vascular density (VD) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) of the macula, and the VD of the radial peripapillary capillary plexus (RPCP) of the optic disc were recorded. Results: The mean age of the study group was 11.27±3 years, the mean AL was 23.39±1.18 mm and the mean SE was-1.31±1.61 diopters. The mean FAZ area was 0.3±0.09 mm2, the mean SCP-VD was 43.88±3.4%, the mean DCP-VD was 39.6±3.55%, and the mean RPCP-VD was 52.47±3.42%. When the relationship between the OCTA measurements and the SE and AL values were analyzed, there was no statistical significance (p>0.05). When age and OCTA measurements were compared, only DCP-VD values were found to significantly decrease with increasing age (p=0.015). There was no significant difference in OCTA measurements based on gender (p>0.05). Similarly, no statistical age-based differences were observed in RNFLT, CMV and CMT values (p>0.05). Conclusion: With its short procedure time and no dye requirement, OCTA can be safely used in the evaluation of the optic disc and macular perfusion in children. Determination of normative values in children will be useful in detecting pathologic changes in tissue in patients with retinal diseases.

Uğurlu, Adem; Aslanova, Maisa; Cebeci, Zafer; Mercül, Nur Kır

Objectives: To determine length of hydroxychloroquine use and cumulative dose and evaluate the ocular effects by 10-2 central visual field test, microperimetry (MP), color fundus photography, optical coherence tomography (OCT), and fundus autofluorescence (FAF) in hydroxychloroquine users. Materials and Methods: Patients who used hydroxychloroquine continuously for at least 2 years for various connective tissue diseases were included in the study. A total of 300 eyes of 150 patients aged 19-78 years who were followed due to risk of developing hydroxychloroquine maculopathy in the İstanbul University İstanbul Faculty of Medicine Ophthalmology Department between the years 1995-2017 were evaluated. Best corrected visual acuity (BCVA), biomicroscopic, and fundoscopic examination were performed at all visits. MP, FAF, OCT, fundus photography, and central 10-2 visual field examinations were performed 3 times at 6-month intervals. Results: The mean age of patients was 48.9±10.8 years; 141 (94%) patients were female and 9 (6%) were male. The mean duration of hydroxychloroquine use was 10.5±6.4 (2-30) years. Fifty-six patients had been using the drug for 5 years or less. The mean cumulative drug dose was 754.7±447.2 (146-1825) g. Mean BCVA was 0.02±0.08 LogMAR at all follow-up visits (p=0.999). Mean MP values at the first, second, and third examinations were 14.07±3.24 dB, 14.18±3.35 dB, and 14.54±2.79 dB, respectively (p>0.05). Mean central macular thickness was 221.9±19.8 µm at initial examination, 221.8±19.9 µm at the second visit, and 221.8±19.8 µm at the final visit (p=0.113). There was a weak negative correlation between age and MP values at all three visits (visit 1: p=0.003, r=-0.170; visit 2: p=0.001, r=-0.185, visit 3: p=0.011, r=-0.146). There was statistically significant relationship between MP values and hydroxychloroquine length of use and cumulative dose (p=0.027 and p=0.049, respectively). Duration of use was not associated with changes in 10/2 visual field (p=0.124). There were significant relationships between alterations in FAF and hydroxychloroquine length of use and cumulative dose (p=0.027 and p=0.049, respectively). Conclusion: FAF alterations were significantly associated with duration of hydroxychloroquine use and cumulative dose. As objective methods are more reliable, examinations such as FAF can be recommended as auxiliary methods in the follow-up and early detection of toxic maculopathy.

Yeter, Volkan; Aritürk, Nursen

Purpose: To investigate the relationships between the birth parameters such as birth weight, gestational age, and birth type and the parameters of macula, optic nerve and retinal nerve fiber layer (RNFL) in preschoolers. Material and Method: After a broad ophthalmologic examination was performed for every healthy child at age between 3 and 6, the children were scanned by optical coherence tomography (OCT) for the evaluation of macula, optic disc, and RNFL parameters. The relationships between the birth parameters and OCT parameters were analyzed by Spearman correlation test and Mann Whitney U test. Results: One hundred and seventy-two eyes of 111 healthy children were evaluated in the study. The mean age of the children was 57.48 +/- 11.87 months (range: 30-80 months). Forty-eight percent of the children were delivered vaginally and the rest of them-by cesarean section. The negative correlations between gestational age and thicknesses of superior inner and temporal inner macula, and temporal and inferior RNFL were statistically significant(r=-0.204, p=0.019; r=-0.203, p=0.020; r=-0.230, p=0.009; r=0.175, p=0.047; respectively). While the parameters that showed negative correlations with birth weight were superior outer macular thickness, temporal, inferior, and average RNFL thicknesses and disc area, the parameters that demonstrated positive correlations with birth weight were cup/disc-area and horizontal cup/disc ratios (r=-0.196, p=0.025; r=-0.317, p<0.001; r=-0.269, p=0.002; r=-0.228, p=0.009; r=-0.189, p=0.032; r=0.181, p=0.04; r=0.197, p=0.025, respectively). Optic disc area of the children who were delivered vaginally was larger than that of the children who were delivered by cesarean section and this difference between these two groups was statistically significant (p=0.034). Discussion: There significant effects of the birth parameters such as birth weight and gestational age on some parameters of macula and optic disc obtained by OCT. It may be thought that the impairment of intrauterine growth could possibly influence optic nerve head and macula.