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    Beyond pelvic pathology: retinal microvascular rarefaction as a systemic marker in endometriosis
    (Bmc, 2025) Keyif, Betul; Sezer, Taha; Colak, Kubra; Gundogdu, Zulfiye Balkan; Meydan, Bayram
    Objective This study aimed to quantitatively assess retinal microvascular alterations in women with pelvic endometriosis using optical coherence tomography angiography (OCTA), and to explore whether these subclinical findings may reflect early signs of systemic microvascular alterations in this population. Methods In this retrospective cross-sectional study, 100 eyes were analyzed-50 from women with laparoscopically or ultrasonographically confirmed pelvic endometriosis and 50 from age-matched healthy female controls. All participants underwent comprehensive ophthalmic examinations and macular OCTA imaging using the Heidelberg Spectralis system. Quantitative parameters, including vessel area density (VAD), foveal avascular zone (FAZ) metrics (area, perimeter, circularity), and FD-300 values, were extracted from the superficial and deep capillary plexuses using the OCTAVA software. Segmental parafoveal VAD values (nasal, temporal, superior, and inferior) were also assessed. Axial length measurements and endometriosis staging were not available in this retrospective dataset. Hormonal therapy use was not systematically documented. Results Compared to healthy controls, women with endometriosis demonstrated significantly lower total and parafoveal VAD and FD-300 values in both retinal plexuses (p < 0.05 for all). FAZ perimeter showed a modest but statistically significant difference, whereas FAZ area and circularity index remained comparable between groups. No participant in either group exhibited clinically visible retinal pathology. These alterations occurred despite preserved visual acuity and in the absence of systemic comorbidities known to affect microcirculation. Conclusion Although causality cannot be inferred from this cross-sectional design, our findings indicate that pelvic endometriosis is associated with region-specific subclinical reductions in retinal capillary perfusion, particularly within the foveal and parafoveal regions. OCTA-derived metrics, especially FD-300 and parafoveal VAD, may offer insight into microvascular integrity in this patient group. These results support further investigation into the systemic vascular aspects of endometriosis and highlight the potential utility of retinal imaging in exploring such associations.
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    Evaluation of pain scores during intravitreal injection in systemic conditions and in conjunction with medications
    (Sage Publications Ltd, 2025) Sezer, Taha; Altikardesler, Emir; Erdogan, Kubra; Arslan, Betul; Colak, Kubra
    Background: Intravitreal injection (IVI) is a common practice in today's ophthalmology clinics. The pain that patients will experience after the application may be important in compliance with the treatment. Objectives: This study aimed to investigate the correlation between various clinical characteristics of patients receiving IVI and corresponding visual analogue scale (VAS) scores (0: no pain to 10: severe pain). Design: Single-centre, Prospective study. Methods: A total of 313 participants (168 females, 145 males) with a mean age of 66.91 +/- 9.67 years underwent IVI for diabetic retinopathy (DRP), retinal vein occlusion (RVO), or age-related macular degeneration (AMD). Eye examinations, including visual acuity and intraocular pressure measurements, were also conducted, and injection indications were determined based on dilated fundus examinations and spectral domain optical coherence tomography images. Following the injections, the researchers solicited VAS scores ranging from 0 to 10 (no pain to severe pain). The study explored the relationships between clinical characteristics, headache frequency, joint and muscle pain, analgesic use, surgical history, antidepressant use, vasovagal syncope, previous injections, and VAS score. Results: The mean VAS score was 4.77 +/- 2.90. While DRP and RVO had similar VAS scores (4.95 +/- 2.98 and 5.22 +/- 2.70, respectively), the AMD group had significantly lower scores (4.09 +/- 2.64). Compared with nonusers, antidepressant users had significantly greater VAS scores (5.79 +/- 3.43) (4.52 +/- 2.70) (p < 0.05). Patients with a history of syncope had significantly greater VAS scores (p < 0.05). In patients reporting monthly headaches, a positive correlation was found between headache frequency and VAS score (r = 0.23, p < 0.01). Conclusion: For individuals experiencing daily headaches, inquiries about vasovagal syncope and antidepressant use may be beneficial, considering the potential association of these symptoms with higher VAS scores after IVIs.