Evaluation of Anterior Scleral Thickness and Angle Parameters in Eyes with Pseudoexfoliation Syndrome and Glaucoma.

PRCIS: The relationship between anterior scleral thickness and scleral spur length was disrupted in eyes with pseudoexfoliation, and scleral spur length was shorter in eyes with pseudoexfoliative glaucoma. OBJECTIVE: To evaluate anterior scleral thickness (AST) in eyes with pseudoexfoliation (PX) and to examine the relationship between AST and Schlemm's canal (SC), trabecular meshwork (TM), and scleral spur (SS). METHODS: Thirty-eight patients with PX syndrome (PXS), thirty-eight patients with pseudoexfoliative glaucoma (PXG), and thirty-eight healthy subjects were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3 mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated. RESULTS: In all groups, the AST, SC, and TM measurements were similar (P>0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups (P=0.012). There were significant correlations between TM length and AST in the PXG group (P<0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG (P<0.05). There was a significant relationship between AST0 and SS in healthy eyes (P<0.05), but not in other eyes. CONCLUSIONS: The shorter SS length observed in eyes with PXG may be a sign of structural changes. Additionally, disruption of the relationship between AST and SS may be an early sign of pathological processes, especially in eyes with PXS, and may require closer follow-up of these eyes.

Is Keratoconus More Than Just a Corneal Disease?

PURPOSE: The aims of this study were to compare the scleral thickness (ST), lamina cribrosa thickness (LCT), and lamina cribrosa curvature index between patients with keratoconus and healthy controls and to evaluate the relationship between these values and corneal parameters. METHODS: This cross-sectional study included 41 eyes of 41 patients with keratoconus and 30 eyes of 30 age-matched, sex-matched, and axial length-matched controls. Nasal and temporal STs were measured vertically, 4 mm posterior to the scleral spur, using anterior segment optical coherence tomography. The LCT was measured on the radial scans of the optic nerve head. The lamina cribrosa curvature index (lamina cribrosa curvature depth/curvature width × 100) was calculated to determine the degree of posterior bowing of the lamina cribrosa. RESULTS: The nasal ST and temporal ST were significantly lower in the keratoconus group than in the control group ( P = 0.016 and P = 0.023, respectively). The LCT was significantly lower in the keratoconus group compared with the control group ( P < 0.001). There was no significant difference between the groups for the lamina cribrosa curvature index ( P = 0.375). Correlation analysis revealed a significant correlation between the nasal and temporal STs and the central corneal thickness (r = 0.376, P < 0.001 and r = 0.387, P < 0.001, respectively). There was also a significant correlation between the temporal ST and the minimum corneal thickness in the keratoconus group (r = 0.332, P = 0.015). The LCT was significantly correlated with the central corneal thickness (r = 0.445, P < 0.001). CONCLUSIONS: Structural features of the cornea, sclera, and lamina cribrosa with similar collagen content may be similarly affected in patients with keratoconus. Further histologic studies are needed to confirm our results.

The effect of uneventful cataract surgery on Schlemm's canal and the trabecular meshwork in cases with pseudoexfoliation.

PURPOSE: To evaluate the effect of uneventful cataract surgery on Schlemm's canal (SC) and the trabecular meshwork (TM) in cases with pseudoexfoliation (PX). METHODS: In this prospective study, 37 PX and 37 normal eyes, who underwent cataract surgery, were included. The PX group was further divided into two subgroups: PX syndrome (PXS) and PX glaucoma (PXG). Preoperative complete ophthalmologic examination, anterior segment (AS) imaging using a Scheimpflug camera, and measurements of SC length and area and TM thickness and length using AS optical coherence tomography (AS-OCT) were performed in all cases. All measurements were repeated at the first and third months after surgery. RESULTS: Preoperative intraocular pressure (IOP), AS parameters, SC, and TM values showed no significant differences between the groups (p > 0.05). After surgery, there was a significant increase in AS parameter values and a significant decrease in IOP values in both the PX and control groups (p < 0.05). The nasal and temporal SC area showed a significant increase in the PX group after surgery (p = 0.007, p = 0.003, respectively). In the subgroup analysis, the only significant change in the nasal and temporal SC area was in the PXS group (p = 0.006, p = 0.003, respectively). CONCLUSION: Cataract surgery resulted in an increase in the SC area in patients with PXS. This increase may be due to multiple mechanisms including the IOP-lowering effect of cataract removal, change in AS, and removal of intraocular PX material after surgery.

Evaluation of the effect of sodium-glucose cotransporter-2 inhibitor treatment on choroidal vascular parameters in patients with type 2 diabetes mellitus.

BACKGROUND: To evaluate the effect of sodium-glucose cotransporter-2 inhibitor treatment on choroidal vascular parameters in patients with type 2 diabetes mellitus (T2DM). METHODS: Twenty eyes of 20 patients with T2DM without diabetic retinopathy and 20 eyes of 20 age- and sex-matched patients as the control group were included in the study. The patients were evaluated using enhanced depth imaging optic coherence tomography before treatment and at the third month of treatment. The choroidal images were binarized into luminal areas (LAs) and stromal areas (SAs). The choroidal vascularity index (CVI) was defined as the ratio of the LA to the total circumscribed choroid area (TCA). RESULTS: The mean age of the patients was 56.65±8.41 years. The patients' mean disease duration was 6.65±5.72 years, the mean HbA1c level was 8.89±1.62%, and the mean body mass index was 33.13±4.84 kg/m2. The subfoveal TCA, subfoveal LA, subfoveal SA, total TCA, total LA, and total SA values ​​of the patient group were found to be significantly lower than those of the control group (p = 0.006, p = 0.003, p = 0.028, p = 0.001, p = 0.001, and p = 0.006, respectively). There was a significant increase in the subfoveal TCA, subfoveal LA, subfoveal SA, subfoveal CVI, total TCA, total LA, and total SA values ​​after empagliflozin treatment compared to before empagliflozin treatment (p = 0.005, p = 0.003, p = 0.021, p = 0.032, p < 0.001, p < 0.001, and p = 0.001 respectively). CONCLUSIONS: Empagliflozin provides an improvement in diabetic choroidal changes through its effect on choroidal vascularity parameters.

Evaluation of Schlemm Canal Parameters Using Swept-Source Optical Coherence Tomography in Eyes That Underwent Keratoplasty.

OBJECTIVES: In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups. METHODS: The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal. RESULTS: There was no statistically significant difference between the groups for age and gender ( P ˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141µm 2 and 160.77±65.08 µm, respectively, in the nasal quadrant and 2.623±1.277 µm 2 and 158.81±68.05 µm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups ( P <0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters. CONCLUSION: This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.

Simultaneous posterior eyelid ptosis repair and strabismus surgery: a single-stage approach / Cirurgia reparadora simultânea de blefaroptose posterior e de estrabismo: abordagem de estágio único

ABSTRACT Purpose: Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus. Methods: Patients with ptosis and coexisting strabismus who underwent simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller's muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia. Results: The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller's muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients. Conclusion: Müller's muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.

RESUMO Objetivo: Blefaroptose e estrabismo podem ser coexistentes em adultos e ambos afetam a aparência estética e o domínio psicossocial. Ambos também geralmente requerem cirurgia, realizada tradicionalmente em uma abordagem sequencial. O objetivo do presente estudo foi avaliar a eficácia da execução simultânea da ressecção musculoconjuntival de Müller, com ou sem cirurgia de tarsectomia, e da cirurgia de estrabismo em pacientes adultos com ptose e estrabismo coexistentes. Métodos: Foram retrospectivamente avaliados pacientes com ptose e estrabismo coexistentes submetidos simultaneamente à ressecção musculoconjuntival de Müller, com ou sem tarsectomia, e à cirurgia de estrabismo horizontal. A análise incluiu a mensuração do ângulo de desvio das dioptrias de prisma, a distância do reflexo à margem, a assimetria da altura palpebral e quaisquer complicações após a cirurgia. A ressecção musculoconjuntival de Müller, com ou sem sucesso na tarsectomia, foi considerada bem-sucedida com uma distância reflexo-margem medindo entre 3,5 e 5 mm, e uma diferença entre as duas pálpebras superiores menor que 1 mm. O sucesso da cirurgia de estrabismo foi definido como um alinhamento com ± 10 dioptrias prismáticas de ortotropia. Resultados: Os pacientes foram 3 mulheres e 5 homens, com média de idade de 37,12 anos (faixa de 22 a 62 anos). A parte de estrabismo da cirurgia foi realizada primeiro em todos os pacientes. Os resultados da simetria palpebral superior foram avaliados como perfeitos (<0,5 mm) em 4 pacientes, bons (≥0,5 mm, <1 mm) em 4 pacientes e regulares (≥1 mm) em nenhum. A ressecção musculoconjuntival de Müller, com ou sem sucesso na tarsectomia, teve sucesso em 6 dos 8 pacientes (75%) e a intervenção para o estrabismo foi bem-sucedida em todos os pacientes. Não foi necessária cirurgia de revisão da pálpebra ou do estrabismo após a cirurgia simultânea em nenhum paciente. Conclusão: A ressecção musculoconjuntival de Müller, com ou sem tarsectomia, pode ser combinada com a cirurgia de estrabismo em uma abordagem alternativa para pacientes com ptose e estrabismo coexistentes.

The Prevalence of Positive Donor Corneoscleral Rim Culture and its Association with Ocular Infection After Transplantation.

Objectives: The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty. Methods: Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study. Results: A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor corneoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures. Conclusion: Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

Anterior Corneal High-order Aberrations in Fuchs' Endothelial Corneal Dystrophy Classified by Scheimpflug Tomography.

SIGNIFICANCE: Visual acuity may be limited after endothelial keratoplasty in Fuchs' endothelial corneal dystrophy. This may be due to increased anterior high-order aberrations that persist after endothelial keratoplasty. It is not clear at what stage these aberrations begin. We aimed to evaluate how subclinical corneal edema affects anterior corneal high-order aberrations. PURPOSE: We aimed to evaluate anterior corneal high-order aberrations according to the presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy using Scheimpflug topography. METHODS: All the patients underwent corneal topography (Sirius Scheimpflug-Placido disc camera; CSO Ophthalmic, Scandicci, Italy). Fifty-two eyes of 31 patients with Fuchs' endothelial corneal dystrophy and 52 eyes of 35 patients without corneal problems were included. In addition, patients with Fuchs' endothelial corneal dystrophy were divided into two groups according to subclinical corneal edema as with Fuchs' endothelial corneal dystrophy-edema and Fuchs' endothelial corneal dystrophy-nonedema. Subclinical corneal edema was defined based on the presence of at least two of three findings of the loss of regular isopachs, displacement of the thinnest point of the cornea, and posterior depression. High-order aberrations were expressed as Zernike polynomials in the 4- and 6-mm optical zone. RESULTS: We found that subclinical corneal edema in Fuchs' endothelial corneal dystrophy caused a larger 4-mm trefoil II and a smaller 6-mm spherical aberration II measurements than the nonedema group. The 6-mm total high-order aberrations, 6-mm coma aberration, and 4- and 6-mm trefoil II aberration measurements were larger, and the 6-mm spherical aberration II was smaller in Fuchs' endothelial corneal dystrophy patients with edema compared with the healthy eyes. CONCLUSIONS: The presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy results in larger 4-mm trefoil II and smaller 6-mm spherical aberration II measurements. More patients with intermediate values are needed to evaluate the effect of these aberrations on visual acuity.

Evaluation of Pupillometric Parameters in Patients with COVID-19.

PURPOSE: To investigate the pupillary diameter and pupillary light response in patients who have recovered from the COVID-19. METHODS: Thirty two eyes of 32 patients with a history of COVID-19 in the last two months and 32 eyes of 32 age and sex-matched healthy controls were included in this prospective study. All patients had neurological symptoms. Dynamic and static pupillometry measurements were performed with the Sirius (CSO, Italy) corneal topography device. RESULTS: Patients with COVID-19 had higher mean scotopic, mesopic, and photopic pupil diameters compared to the controls (p = .01, p = .04, p = .02, respectively). In dynamic pupillometry analysis, 0th, 2th, 8th and 16th second pupil diameter measurements were higher in COVID-19 patients (p = .02, p = .04, p = .04, p = .04, respectively). There were no differences in the average speed of pupillary dilatation (p > .05). CONCLUSION: Our findings suggest that the pupillary response, an indicator of autonomic nervous system activity, may be affected in COVID-19 patients with neurological symptoms.

Simultaneous posterior eyelid ptosis repair and strabismus surgery: a single-stage approach.

PURPOSE: Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus. METHODS: Patients with ptosis and coexisting strabismus who underwent simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller's muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia. RESULTS: The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller's muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients. CONCLUSION: Müller's muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.

Effect of Diabetes Mellitus and Systemic Hypertension on Macular Hole Surgery.

OBJECTIVE: To evaluate the anatomical and functional results of macular hole surgery in patients with diabetes mellitus (DM) and hypertension (HT) without retinopathy. STUDY DESIGN: Descriptive comparative study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Turkey between January 2016 and December 2020. METHODOLOGY: This study included 141 eyes of 139 patients who underwent pars plana vitrectomy for macular holes. The patients were divided into two groups according to the anatomic closure after surgery. Group 1 (cases) were patients with macular hole closure, and group 2 (controls) were patients whose macular hole was not closed. The patients with and without diabetes mellitus (DM) or hypertension (HT) were compared. All patients did not have retinopathy. After surgery, the anatomical closure rate of the macular hole and the amount of increase in visual acuity were measured. Significance of the difference between the groups was evaluated using chi-square test. RESULTS: The best-corrected visual acuity (BCVA) was 1.30 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). While BCVA was 1.3 logMAR before surgery in the group with DM, it was 0.7 logMAR after surgery (p<0.001). In the group with HT, BCVA was 1.3 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). The anatomic success rate after surgery in patients with DM was similar to the group without DM (p=0.93). The anatomic success rate after surgery in patients with HT was similar to the group without HT (p=0.46). CONCLUSIONS: In the absence of retinopathy there is no difference between the success rates of the macular hole surgery in patients with or without DM and HT. KEY WORDS: Diabetes mellitus, Hypertension, Vitrectomy, Macular hole.

Assessment of the Quality and Reliability of YouTube Videos on Fuchs Endothelial Corneal Dystrophy.

Objectives: The aim of the study was to assess the quality and reliability of videos on Fuchs endothelial corneal dystrophy (FECD) on YouTube. Methods: A search of YouTube was performed for the term "FECD" without any changes to the website's standard search preferences. The first 100 videos were recorded. A total of 71 videos were evaluated regarding the DISCERN score (min-max: 16-75), Journal of the American Medical Association (JAMA) score (min-max: 0-4), and Global Quality Scale (GQS) score (min-max: 0-5). Results: The mean DISCERN score was 40.1±15.6 (moderate), the mean JAMA score was 2.01±0.7 (poor), the mean GQS score was 2.5±1.3 (moderate), and the mean video power index score was 106.8±135.7. Twenty-three of the videos (32.4%) were uploaded by physicians, 25 (35.2%) by universities/private hospitals, and 21 (29.6%) by health channels. Thirty-six videos (50.7%) contained information about the disease, 24 (33.8%) discussed surgical techniques, and 11 (15.5%) were about patient experience. Conclusion: YouTube provides only moderate-quality health information on FECD. Physicians and professional organizations should be aware of and embrace this evolving technology to raise awareness about FECD.

Pupilloplasty in a patient with true polycoria: a case report / Pupiloplastia em um caso de policoria verdadeira

ABSTRACT Here we report a case of surgical pupilloplasty in an adult with true polycoria. A 44-year old man was referred to our clinic with a best-corrected visual acuity (BCVA) of 0.5 diopters (D) in his left eye. Biomicroscopy revealed two pupils within a 2.5-mm central zone, with diameters of 1.2 and 1.1 mm. Both pupils had real iris sphincters and responded to light and chemical stimulation. Therefore, we surgically cut the bridge between the two pupils without any intraoperative or postoperative complications. One month after the surgery, BCVA had improved to 0.9 D, and the final pupil was almost round, measuring 2.7 mm in diameter.

RESUMO Relatamos um caso de pupiloplastia cirúrgica em um paciente adulto com policoria verdadeira. Um homem de 44 anos de idade foi encaminhado ao nosso serviço com acuidade visual melhor corrigida (BCVA) de 0,5 em seu olho esquerdo. Biomicroscopia revelou 2 pupilas, dentro de uma zona central de 2,5 milímetros com dimensões de 1,2 mm e 1,1 mm de diâmetro. Ambas as pupilas apresentavam esfíncteres irianos reais que respondiam à luz e a drogas. A ponte entre as 2 pupilas foi cortada cirurgicamente. Não houve complicações transoperatórias ou pós-operatórias. A BCVA melhorou para 0,9, e a pupila ficou quase circunferencial com 2,7 mm de diâmetro, um mês após a cirurgia.

Pupilloplasty in a patient with true polycoria: a case report.

Here we report a case of surgical pupilloplasty in an adult with true polycoria. A 44-year old man was referred to our clinic with a best-corrected visual acuity (BCVA) of 0.5 diopters (D) in his left eye. Biomicroscopy revealed two pupils within a 2.5-mm central zone, with diameters of 1.2 and 1.1 mm. Both pupils had real iris sphincters and responded to light and chemical stimulation. Therefore, we surgically cut the bridge between the two pupils without any intraoperative or postoperative complications. One month after the surgery, BCVA had improved to 0.9 D, and the final pupil was almost round, measuring 2.7 mm in diameter.