- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate tear osmolarity (TO) in patients with epiphora caused by primary-acquired nasolacrimal-duct obstruction (PANDO), before and after an external dacryocystorhinostomy (DCR) and to compare with healthy control subjects. Materials and methods: Twenty eyes of 20 patients (15 women, 5 men) who suffered from epiphora for at least one year due to PANDO, and 20 eyes of 20 healthy subjects (13 women, 7 men), were included in this study. External DCR was applied to all patients with PANDO, and TO measurements were repeated during the first month follow-up visit after surgery. Results: The mean period for complaints of epiphora was 1.7 ± 0.6 years (1-3). Patients had a mean TO of 282.6 ± 10 mOsm/l (range: 269-302) prior to DCR, and this increased to 297.7 ± 7.7 mOsm/l (range: 284-310) one month after DCR (p = 0.0001). Preoperative TO values were significantly lower when compared with the healthy control subjects' (301.7 ± 10.6 mOsm/l (range: 280-316) (p = 0.0001). No significant differences were detected between postoperative and control group TO values (p = 0.18). Conclusions: Epiphora due to PANDO causes lower TO values. One month after DCR, TO came to similar TO levels when compared to healthy subjects.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). Methods: A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear ﬁlm break-up time (BUT), Schirmer's test, and Ocular Surface Disease Index (OSDI). Results: The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer's test score and the BUT value (r = -0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = -0.182 p = 0.183). Conclusions: This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To investigate the alterations in the ocular surface and tear film parameters 3 months after accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients. Methods: Twenty-six patients (33 eyes total) with progressive KC were enrolled in this study. All patients were subjected to ophthalmic surface examination, such as OSDI (ocular surface disease index) scoring, the osmolarity tear test, Schirmer test, tear film breakup time (TBUT) analysis, rose bengal (RB) and fluorescein (Fl) ocular surface staining, and conjunctival impression cytology (IC) analysis, respectively. These tests were performed at baseline and 3 months after A-CXL. Nelson's grading system was used to evaluate the cell morphology and goblet cell density. Results: No statistically significant differences in the levels of tear osmolarity, TBUT, Schirmer test, OSDI scoring, and Fl and RB staining between pretreatment and 3 months postoperatively were observed (all P values >0.05). A statistically significant increase in superior (P=0.005) and temporal (P=0.006) IC grading was seen at the postoperative third month compared to pretreatment. Conclusions: Only metaplastic changes and a reduction in the density of the goblet cells were seen in conjunctival IC, which is probably because of the toxicity of ultraviolet-A 3 months after A-CXL. However, these results do not lead to deterioration in TBUT. In this study, A-CXL has no adverse effect on ocular surface and tear function, which are important for visual quality.
- [Show abstract] [Hide abstract] ABSTRACT: The purpose of the study was to evaluate the outcomes and possible complications of CXL performed with customized epithelial debridement technique to keratoconic corneas with the thinnest pachymetry values less than 400 µm. Nineteen eyes of 19 patients were included. The uncorrected (UCVA) and best corrected visual acuity (BCVA), flattest and steepest keratometric (K) readings, central corneal thickness at the thinnest point (t-CCT), endothelial cell density (ECD) were assessed before and 12 months after CXL. The mean UCVA was increased (p = 0.001), while the mean BCVA did not show any difference (p > 0.05). The mean flattest and steepest K readings were decreased (p = 0.001). No change was observed in the mean t-CCT (p > 0.05). The mean ECD was decreased (p = 0.001). The mean pre-CXL and post-CXL percentages of polymegathism and pleomorphism did not show any significant difference (p > 0.05). CXL performed with customized epithelial debridement technique is successful in halting the progression of keratoconus in corneas thinner than 400 µm after 12 months of treatment. However, significant endothelial cell loss can occur after this procedure.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: To report revision external dacryocystorhinostomy (rE-DCR) results following failed dacryocystorhinostomy (DCR) surgery. Methods: A retrospective review of patients who underwent rE-DCR between June 2006 and June 2015 at Yıldırım Beyazıt University Ankara Ataturk Training and Research Hospital Department of Ophthalmology. Data were collected on the primary surgery technique and patient demographics. Results: Forty-one rE-DCRs were performed on 40 patients after various failed DCR techniques. Two patients had failed DCR twice, and 38 patients had failed DCR once. Six of these previous failed DCRs were multidiode laser DCR, two of them were endoscopic DCR, and 33 were external dacryocystorhinostomy (E-DCR). In all rE-DCR procedures, silicone tube intubation was performed, and the tube was removed at least 6 months after surgery. We used mitomycin C on 16 patients (40%). At the last examination, six patients still had epiphora (15%), and their nasolacrimal passage was obstructed. Thirty-four patients had no complaints, and their passages were open (85%). Conclusion: The rE-DCR procedure has high success rates for failed DCR surgeries, whichever procedure was performed.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To investigate possible changes in anterior segment parameters with the Pentacam in patients taking tamsulosin or doxazosin for benign prostatic hyperplasia. Methods: This prospective, cross-sectional study was conducted at Necip Fazil City Hospital, Kahramanmaras, Turkey. Patients included in the study were grouped as follows: 29 patients treated with tamsulosin (group 1), 27 patients treated with doxazosin (group 2), and 40 untreated controls (group 3). Right eyes of each patient were included in the study. All patients underwent examination with the Pentacam under standard dim light conditions and with undilated pupils. Anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), corneal volume (CV), and pupil diameter (PD) were recorded. Results: Mean duration of treatments was 2.7 ± 1.2 (1-5) and 2.4 ± 0.9 (1-5) years in groups 1 and 2 (p = 0.276). The ACD, ACV, ACA width, and PD were statistically significantly decreased in groups 1 and 2 when compared to group 3 (p<0.05). There were no statistically significant differences among the groups in mean values of CCT and CV. Conclusions: In this study, decreased ACD, ACV, ACA width, and PD values were detected in tamsulosin and doxazosin groups when compared to controls. These findings should be considered during anterior segment examinations and surgeries.
Article: A Surprise in the Lacrimal Sac[Show abstract] [Hide abstract] ABSTRACT: To present a case with recurrent dacryocystitis as an unusual complication of medial orbital wall fracture repair with cartilage tissue graft. A 20-year-old male had facial trauma and underwent surgery to reconstruct right medial orbital wall fracture. During follow-up, he presented with continuous epiphora, mucopurulent discharge from the right eye. A thorough history taking indicated that medial orbital fracture was reconstructed with postauricular cartilage. We planned a standard external dacryocystorhinostomy (DCR). During the creation of lacrimal sac flaps, hard tissue was noted in the lacrimal sac. This tissue was excised and sent for pathological examination. The pathological examination revealed cartilage tissue. There were no further ipsilateral symptoms or complications after DCR. In patients with lacrimal system injury related to orbital wall fracture, iatrogenic foreign bodies in the lacrimal sac should be considered in patients with recurrent dacryocystitis who had reconstructive surgery for facial and orbital trauma.
- [Show abstract] [Hide abstract] ABSTRACT: Objective: The objective was to identify the clinical properties and visual outcome of patients with bilateral amblyopia. Materials and Methods: Patients with bilateral amblyopia who did not have ≥1.5 D anisometropia were included in this study. Stereopsis was assessed by the TNO test. The first and final best corrected visual acuities and stereopsis ratios of the patients after starting treatment were compared with paired t test and chi-square tests, respectively, in the SPSS software program. Results: Among 53 patients with bilateral amblyopia, the mean age was 7.04±2.30 (min: 3, max: 13) years, and the mean followup period was 2.93±1.59 (min:6 months, max: 7 years) years. The rates of 0–4 D, 4–7 D, >7 D of hypermetropia, and >4 D myopia were 32.1% (n=17), 37.7% (n=21), 22.6% (n=12), and 5.7% (n=3), respectively. The cylindrical refractive error was <2 D in 77.4% (n=41) of the patients, and it was 2–4 D and >4 D in 5.7% (n=3) and 17% (n=9) of the patients, respectively. After the correction of refractive error using glasses, there was a significant increase in visual acuities and ratios of stereopsis (p=0.001 for both). Conclusion: Bilateral refractive amblyopia is mostly unremarkable with the absence of visible signs such as squint. While it is possible to encounter refractive amblyopia with <4 D hypermetropia and <2 D astigmatism, the response of these patients to optical correction is good.
- [Show abstract] [Hide abstract] ABSTRACT: This study aims to investigate the corneal biomechanical properties of steroid sensitive refractive surgery patients and to compare these with those patients that did not have steroid induced ocular hypertension after refractive surgery. This retrospective study in a tertiary care center involved 48 eyes with steroid induced ocular hypertension (Group I) and 61 eyes of age and sex matched refractive patients who used topical steroids for the same duration as group I without developing ocular hypertension (group II). All patients had preoperative ophthalmological examination, pachymetry and postoperative corneal hysteresis (CH) and resistance factor (CRF) measurements by ocular response analyser. The preoperative CH and CRF measurements of the two groups were compared. The mean CH was statistically lower in group I (6.89±1.62) as compared to group II (7.80±1.30) (p=0.001). The CRF was higher in group I (7.68±2.26) as compared to group II (7.66±1.72) but the difference was not statistically significant (p=0.96). The preoperative spherical refractive error (r=0.43, p=0.00) and postoperative corneal thickness (r=0.58, p=0.001) were moderately correlated with CH. A statistically significant decrease in CH in subjects with steroid induced ocular hypertension is found. Previous studies have revealed an association of low CH with risk of glaucomatous damage of optic nerve. This may imply risk of optic disc damage in this ocular hypertension group if not recognized and treated properly. However the results should be confirmed with larger sample sizes. Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
- [Show abstract] [Hide abstract] ABSTRACT: To determine the effect of refractive error on temperament and character properties using Cloninger's psychobiological model of personality. Using the Temperament and Character Inventory (TCI), the temperament and character profiles of 41 participants with refractive errors (17 with myopia, 12 with hyperopia, and 12 with myopic astigmatism) were compared to those of 30 healthy control participants. Here, temperament comprised the traits of novelty seeking, harm-avoidance, and reward dependence, while character comprised traits of self-directedness, cooperativeness, and self-transcendence. Participants with refractive error showed significantly lower scores on purposefulness, cooperativeness, empathy, helpfulness, and compassion (P<0.05, P<0.01, P<0.05, P<0.05, and P<0.01, respectively). Refractive error might have a negative influence on some character traits, and different types of refractive error might have different temperament and character properties. These personality traits may be implicated in the onset and/or perpetuation of refractive errors and may be a productive focus for psychotherapy.
- [Show abstract] [Hide abstract] ABSTRACT: Abstract Context: It is well known that oral isotretinoin treatment causes numerous ocular side-effects. Objective: To investigate the effect of systemic isotretinoin treatment on central corneal thickness (CCT) values due to meibomian gland disease (MGD). Participants: In this prospective study, 47 patients (27 men, 20 women) with nodulocystic acne vulgaris treated with oral isotretinoin (0.8 mg/kg daily) were included. Methods: All patients were analyzed with the Pentacam Scheimpflug topography at baseline, on the 3rd and 6th month of treatment. Main outcome measures were MGD scores and CCT. Results: The mean age of patients was 25.1 ± 4.4 years. The mean MGD scores were significantly higher at 3rd month (1.3 ± 0.9) and 6th month (1.5 ± 1.0) of treatment compared with baseline (1.1 ± 0.9) (p < 0.001). The mean CCT value at baseline was 540.5 ± 22.1 µm; 536.9 ± 20.5 µm at 3rd month and 531.4 ± 22.2 µm at 6th month. The differences between baseline and 6th month CCT measurements were statistically significant (p < 0.001). There was negative correlation between mean MGD scores and CCT values at the 6th month of treatment which was statistically significant (p = 0.038, r = -0.221). Conclusion: Isotretinoin treatment causes higher MGD scores. A statistically significant decrease in CCT due to MGD was detected at 6th month of treatment.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: The aim of this study was to compare topographic and biomechanical properties of corneas in patients with acromegaly with those of healthy individuals. Methods: Thirty-five patients with acromegaly (study group) and 35 healthy individuals (control group) were enrolled in this prospective study. Topographic measurements, including central corneal thickness (CCT), mean keratometry (K) value, K1, K2, surface asymmetry index, corneal volume (CV), and anterior chamber depth in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius; Costruzione Strumenti Oftalmici). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-corelated intraocular pressure (IOPg) were measured using Reichert Ocular Response Analyzer (Reichert Ophthalmic Instruments). Results: Mean CCT, CV, CH, CRF, and IOPg values were higher in acromegalic eyes (549.3 ± 30.2 μm, 59.1 ± 3.1 μm, 11.3 ± 1.2 mm Hg, 11.3 ± 1.2 mm Hg, and 17.5 ± 2.9 mm Hg, respectively) than in healthy eyes (531.4 ± 33.6 μm, 57.4 ± 2.7 μm, 10.4 ± 1.2 mm Hg, 10.2 ± 1.6 mm Hg, and 14.8 ± 3.1 mm Hg, respectively; CCT, P = 0.042; CV, P = 0.032; CH, P = 0.044; CRF, P = 0.035; IOPg, P < 0.001). Conclusions: CCT, CV, CH, CRF, IOPg, and IOP with Goldmann applanation tonometry were significantly higher in acromegalic eyes. These corneal topographic and biomechanical properties, disease duration, and disease status should be considered when planning corneal refractive surgery and determining accurate intraocular pressure in patients with acromegaly.
Article: Preseptal and orbital cellulitis[Show abstract] [Hide abstract] ABSTRACT: Preseptal cellulitis (PC) is defined as an inflammation of the eyelid and surrounding skin, whereas orbital cellulitis (OC) is an inflammation of the posterior septum of the eyelid affecting the orbit and its contents. Periorbital tissues may become infected as a result of trauma (including insect bites) or primary bacteremia. Orbital cellulitis generally occurs as a complication of sinusitis. The most commonly isolated organisms are Staphylococcus aureus, Streptococcus pneumoniae, S. epidermidis, Haempphilus influenzae, Moraxella catarrhalis and S. pyogenes. The method for the diagnosis of OS and PS is computed tomography. Using effective antibiotics is a mainstay for the treatment of PC and OC. There is an agreement that surgical drainage should be performed in cases of complete ophthalmoplegia or significant visual impairment or large abscesses formation. This infections are also at a greater risk of acute visual loss, cavernous sinus thrombosis, meningitis, cerebritis, endophthalmitis, and brain abscess in children. Early diagnosis and appropriate treatment are crucial to control the infection. Diagnosis, treatment, management and complications of PC and OC are summarized in this manuscript. J MicrobiolInfect Dis 2014; 4(3): 123-127
- [Show abstract] [Hide abstract] ABSTRACT: Abstract Context: There is a generalization that "antihypertensive (antiHT) therapy causes Dry Eye Syndrome", which has been claimed for years however most of the publications are epidemiological studies. We performed a clinical study to investigate the effects of antiHT agents on tear function. Objective: The aim of this article is to evaluate the effects of different classes of antiHT medications on tear osmolarity, ocular surface problems and dry eye symptoms. Materials and methods: Prospective, non-randomized a clinical study. A total of 71 patients who would be initiated antiHT medication due to elevated systemic blood pressure were included in the study. Thirty of these patients were given antiHT drugs containing diuretic (diuretic +), and 41 of them were given diuretic-free drugs (diuretic -). While the number of the patients medicated in the group that received Angiotensin Converting Enzyme inhibitors (ACE inh)/Angiotensin receptor blockers (ARB) (ACE/ARB +) was 29, the number of those medicated in the ACE/ARB-free group (ACE/ARB -) was 42. Ocular surface disease index scores, tear osmolarity, Schirmer I test, tear film break-up time (TBUT), fluorescein (FL) and rose bengal corneal staining patterns of the patients were analyzed. The patients were examined through the repetition of all the tests in the 1st and the 3rd month. Results: The participants (n = 71) comprised 38 males and 33 females with a mean age of 51.8 ± 10.4. When the first (0-1st month) and the third month (0-3rd months) control measurements between diuretics (+) and diuretics (-) groups before and after antiHT therapies were compared, a statistically significant difference was not found in any of the tests applied. When the 0-1st month measurements of ACE/ARB (+) and ACE/ARB (-) groups were compared, it was observed that staining with FL in ACE/ARB (+) group decreased in a statistically significant manner (p = 0.035) and there was a significant increase in TBUT values (p = 0.022). Discussion and conclusion: The use of antiHT drugs containing diuretic had no adverse effect on the tear function tests, but using drugs that contain ACE/ARB could have a positive impact.
- [Show abstract] [Hide abstract] ABSTRACT: Objective. To investigate the biomechanical characteristics of the cornea in patients with mitral valve prolapse (MVP) and the prevalence of keratoconus (KC) in MVP. Materials and Methods. Fifty-two patients with MVP, 39 patients with KC, and 45 control individuals were recruited in this study. All the participants underwent ophthalmologic examination, corneal analysis with the Sirius system (CSO), and the corneal biomechanical evaluation with Reichert ocular response analyzer (ORA). Results. KC was found in six eyes of four patients (5.7%) and suspect KC in eight eyes of five patients (7.7%) in the MVP group. KC was found in one eye of one patient (1.1%) in the control group (P = 0.035). A significant difference occurred in the mean CH and CRF between the MVP and control groups (P = 0.006 and P = 0.009, resp.). All corneal biomechanical and topographical parameters except IOPcc were significantly different between the KC-MVP groups (P < 0.05). Conclusions. KC prevalence is higher than control individuals in MVP patients and the biomechanical properties of the cornea are altered in patients with MVP. These findings should be considered when the MVP patients are evaluated before refractive surgery.
- [Show abstract] [Hide abstract] ABSTRACT: Abstract Objective: To investigate the effects of corneal epithelium on corneal curvature in patients with keratoconus. Design: This is a prospective, nonrandomized study. Participants: Fifty-nine eyes of 47 patients diagnosed as keratoconus and for whom corneal collagen crosslinking (CXL) was recruited in this study. Methods: This study is a single-center clinical trial. Pregnancy, lactation, connective tissue disease, corneal thickness below 350 μm, severe dry eyes, or scar of corneal surgery were exclusion criteria. Before and during CXL procedure after removing the corneal epithelium, maximum values of corneal apical curvature, simulated keratometry 1 (Sim-K1), simulated keratometry 2 (Sim-K2), temporal and inferior curvature values, all of which are 1.5 mm from the corneal center, were calculated. These values before and after removal of epithelium were compared statistically. Results: Mean age of patients was 23.30 ± 5.5 (12-38) years. Twenty-eight (59%) were male while 19 (41%) were female. Mean values measured before and after removing the corneal epithelium were: apical curvature; 59.19 ± 7.2 (47.06-82.40) diopter (D) and 61.70 ± 8.8 (49.19-92.66) D (p = 0.001), SimK1; 47.57 ± 4.3 (39.14-64.57) D and 48.23 ± 4.3 (41.89-66.70) D (p = 0.001), SimK2; 52.04 ± 5.3 (43.56-69.34) D and 53.34 ± 5.6 (43.73-70.89) D (p = 0.001), inferior curvature; 53,85 ± 5.2 (43.47-76.56) D and 55.05 ± 5.8 (44.56-81.93) D (p = 0.002), temporal curvature 49.49 ± 5.1 (41.50-71.03) D and 51.53 ± 5.4 (41.58-73.34) D (p = 0.001), respectively. Conclusions: In keratoconus patients during CXL treatment, after removing the corneal epithelium, more steepness is detected in the curvature of the steeper area of the cornea. When evaluating patients with keratoconus, the masking effect of corneal epithelium on values of curvature should be taken into consideration.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To evaluate the efficacy and safety of orthokeratology in patients with low and medium myopia. Material and Method: Twenty six eyes of 6 male and 7 female patients were evaluated prospectively. The mean spherical equivalent was -3.87±1.35 D (-7 - -2.25) in 26 eyes. Individual semi-rigid, gas-permeable night Gelflex lenses (Australia) were performed based on keratometry values, ambient pupil, mesopic pupil, and autorefractometry values providing best-corrected visual acuity (BCVA). In all cases, uncorrected and best-corrected visual acuity, refraction, keratometry, corneal topography, slit lamp and intraocular pressure measurements were evaluated on first day, at first week, and at first, third and sixth months. Results: While the mean uncorrected visual acuity (UCVA) before orthokeratology (Ortho-K) was 1.08±0.24 (0.4-1.3) logMAR, first week after Ortho-K, it was 0.24±0.27 (0-1) logMAR. The BCVA was 0.01±0.07 (0-0.4) logMAR prior and first week after Ortho-K. First week after Ortho-K, it was 0.22 logMAR at right and 1 logMAR at left. While the average UCVA of our cases at first month was 0.11±0.19 (0-0.8) logMAR, the average BCVA at first month was 0.018±0.08 (0-0.4) logMAR. No ophthalmological complications were noted. Discussion: Ortho-K is a safe and effective method for correction of low and moderate myopia in patients who do not prefer surgery and do not wish to wear glasses or contact lenses during the day.