Optical Coherence Tomography Findings in Primary Headache Disorders: Is pain duration a clinical correlate?

Objective: Ganglion cell layer thickness (GCLT) may be used as a potential marker for central neural changes. We compared GCLT by using spectral domain optical coherence tomography (SD-OCT) in patients with primary headache disorders and healthy controls. We seeked whether there was any difference between the headache groups and whether any clinical parameters correlated to GCLT.Methods: Fifty three primary headache patients, 11 age and sex-matched healthy subjects were included in this cross-sectional study after power analysis. All subjects underwent SD-OCT. The duration of disorder, headache frequency, severity, duration of pain, presence of ocular pain, and accompanying symptoms have been collected.Results: Mean GCLT of the headache group was 15.7 ± 3.8 µm (mean ± standard deviation) and the control group was 17.5 ± 2.4. The difference was not statistically significant. When we compared the controls, migraine and tension-type headache patients' GCLT values, we found a significant difference (ANOVA, p= 0.001). Migraine patients had thinner GCLT compared to all non-migraine headache patients (p = 0.01). Intraocular pressure values of migraine patients and non-migraine patients were not statistically significantly different (p = 0.13). The only clinical parameter that correlated with GCLT was pain duration (r = -0.43 and p = 0.01). The patients with white matter lesions had thinner GCLT (p = 0.046).Conclusion: Our results suggest that not long-term sufferring from pain but migraine pathophysiology itself seems to affect neuroretinal tissue. Pain duration was moderately and inversely correlated to GCLT, meaning that the longer the headache, the thinner the ganglion cell layer is.

Effects on Wavefront Aberration after Short-term Wear of Senofilcon A Photochromic Contact Lens.

BACKGROUND: To assess the variability in wavefront aberrations with short-term wear of photochromic senofilcon A contact lenses in both its activated and inactive states. METHODS AND MATERIAL: In this cross-sectional study, 20 participants who had previously used soft contact lenses were enrolled. Corneal aberrometry measurements were performed on each subject, without contact lenses, using Sirius Scheimpflug-Placido topography. The photochromic lenses were illuminated using a blue-violet light (λ max = 420 nm) so as to provoke an activated state, and measurements were taken with the lenses inserted, in both states. The root mean square (RMS) of the aberrations was calculated, and the higher- and lower-order aberrations, astigmatism, coma, spherical aberration, and trefoil measurements were evaluated using a 5.0-mm pupil diameter. RESULTS: The average contact lens sphere power was - 2.33 ± 1.07 D. The mean refractive errors with contact lens wear were 0.07 ± 0.18 D for the sphere and - 0.26 ± 0.15 D for the cylinder. The mean RMS values for all the corneal aberrations showed no statistically significant differences with and without contact lenses (p > 0.05). In a bivariate correlation analysis, there was a positive correlation between contact lens sphere power and coma (vertical and horizontal) in the activated state (r = 0.455, p = 0.44 and r = 0.495, p = 0.27, respectively). CONCLUSION: The photochromic contact lenses did not influence ocular aberration during short-term wear, even when the photochromatic additive was activated. This property may help to provide more comfortable vision with lens wear. This finding needs to be verified by further studies.

Headache and cognitive disturbance correlate with ganglion cell layer thickness in patients who recovered from COVID-19.

BACKGROUND: Retinal abnormalities are being increasingly reported in COVID-19, in addition to the well-known symptoms of this disease accounting for the neurological involvement. In this study, we aimed to investigate whether ganglion cell layer thickness (GCLT) was different in recovered COVID-19 patients compared to controls in the subacute stage and to determine whether it correlated with COVID-19-related neurological symptoms or pneumonia. METHODS: This study involved 40 patients who had recovered from COVID-19 and 40 age- and sex-matched healthy controls. All the participants underwent ophthalmological examination, spectral domain optical coherence tomography and neurological examination. The clinical and biochemical properties of the patients were noted and their correlations with GCLT were sought. RESULTS: The duration after COVID-19 infection was 113 ± 62 (mean ± SD) days. At this subacute stage, there was no significant difference between the GCLT measurements of the COVID-19 patients and the controls (14 ± 4.0 µm [median ± IQR] vs 16 ± 4.8 µm, respectively). When we analyzed the relationships with neurological symptoms in the patient group, we found that patients with cognitive symptoms had lower GCLT values compared to those without (13 ± 3 µm vs. 16 ± 4 µm, respectively; p = 0.002). Patients who suffered headache during the acute infection also had lower GCLT values compared to those without (14 ± 4 µm vs. 18 ± 5 µm, respectively; p = 0.015). The GCLT values did not differ significantly with respect to anosmia, ageusia, sleep disturbances, having had COVID-19 pneumonia, or smoking status. Age, duration after COVID-19, and blood levels of thyroid stimulating hormone, glucose, vitamin D and vitamin B12 were not in correlation with GCLT in our study. CONCLUSION: Our findings highlight an association between GCLT values and neurological symptoms such as cognitive disturbance (brain fog) and headache in patients who had recovered after non-severe COVID-19 infection. Neuroretinal involvement by SARS-CoV2 might be linked to central neurological symptoms. The patients with lower GCLT values may benefit from close monitoring for neurological problems.

Subacute neurological sequelae in mild COVID-19 outpatients.

Introduction: Neurological aspect of COVID-19 is less understood compared to its respiratory and systemic effects. We aimed to define subacute neurological sequelae in patients who recovered from mild COVID-19. Materials and Methods: This study enrolled long COVID patients who had mild infection, were non-hospitalized, and admitted to our hospital with neurological complaints occurring after COVID-19. The evaluation included detailed history of the symptoms, neurological examination, blood tests and necessary investigations relevant to their personal medical situation, and also a retrospective inquiry about their respiratory and neurological status during the acute phase of infection. Descriptive statistical measures, Chi-square and Student's t-test were utilized. Result: We identified 50 patients (29F/21M) with a mean age of 36.9 ± 1.6 (mean ± SEM). The average time from COVID-19 to admission was 99 days(min-max= 15-247). Most frequent neurological complaints were headache (42%) and cognitive dysfunction (42%). Sleep disturbance (36%), prolonged anosmia (30%), prolonged ageusia (22%), fatigue (22%), and dizziness (8%) followed. Most patients with headache experienced headache also as an acute manifestation of COVID-19 (p= 0.02). Acute-stage sleep disorders were found to be more associated with subacute cognitive symptoms than other central symptoms (p= 0.008). The most common neurological symptom in the acute phase was headache (74%). Six patients, despite the absence of any acute-stage neurological symptoms, presented with emergence of subacute neurological sequela. There were only five patients with pulmonary involvement during the acute stage, who were not different from the rest of the cohort in terms of neurological sequelae. There was no increase of inflammatory markers in the blood tests at the subacute stage, or no association of the symptoms to biochemical parameters. Conclusions: This study gives a description of neurological sequelae of mild COVID-19 at the subacute stage, in a relatively young group, and reveals that cognitive disturbances, as well as headache, are quite frequent.

Acute clouding of a trifocal intraocular lens during implantation: A case report.

PURPOSE: In this paper, we present a case of acute clouding of a trifocal intraocular lens (IOL) that resolved spontaneously by the day after surgery. OBSERVATIONS: A 68-year-old woman with a nuclear cataract in the right eye was scheduled for cataract surgery with +21.00 diopter trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec AG, Germany) implantation. Phacoemulsification was uneventful until the implantation of the IOL. Although the IOL was initially transparent, we observed acute clouding of the IOL optic immediately upon implantation into the eye, and the IOL remained cloudy at the end of the surgery. On the day after surgery, we observed that the clouding was completely resolved. CONCLUSIONS AND IMPORTANCE: We think that the sudden temperature change of the IOL upon implantation into the anterior chamber may have caused acute clouding. If a similar situation is encountered, clinicians should avoid explantation or replacement of the Zeiss AT LISA trifocal IOL, as the clouding resolves spontaneously.

Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome.

PURPOSE: To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). METHOD: This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. RESULTS: Schirmer's test 1 scores were 2.7 ± 0.5 mm at baseline and 3.5 ± 0.7 mm at 12th month in DE-SS, 2.9 ± 0.7 mm at baseline and 9.5 ± 0.7 mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). CONCLUSION: Topical CsA seems to be more effective in the treatment of the DE-NSS.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange.

PURPOSE: To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients. MATERIALS AND METHODS: This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV­IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire). RESULTS: A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit. CONCLUSIONS: The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Evaluation of Retinal Ganglion Cell Layer Thickness in the Early Period After Femtosecond LASIK Surgery

Objectives: To evaluate the early effects of femtosecond laser-assisted in situ keratomileusis (LASIK) surgery on retinal ganglion cell thickness (GCT), peripapillary retinal nerve fiber thickness (NFT), and central macular thickness (CMT) obtained by spectral domain optical coherence tomography (SD-OCT) in a healthy population. Materials and Methods: This case-control study included data from the right eye of 40 subjects without any disease other than refractive error and who had undergone femtosecond LASIK surgery. The preoperative, postoperative 1-hour, and postoperative 3-week GCT, NFT, and CMT values obtained by SD-OCT were compared. Results: The mean age was 27.54±5.99 years (18-45 years). GCT, NFT, and CMT were 18.43±6.03 µm, 107.90±9.01, and 234.3±21.2 µm preoperatively; 18.05±5.93 µm, 108.08±8.92 µm, and 230.1±22.6 µm at postoperative 1 hour; and 17.86±5.27 µm, 107.98±10.13, and 236.3±25.1 µm at postoperative 3 weeks (p=0.159, 0.85, and 0.254, respectively). Conclusion: There were no changes in GCT, NFT, and CMT values evaluated with SD-OCT in the early period after femtosecond LASIK surgery.

Comparison of Higher-Order Aberrations After Single-Step Transepithelial and Conventional Alcohol-Assisted Photorefractive Keratectomy

Objectives: To compare the asphericity and higher-order aberration (HOA) outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and conventional alcohol-assisted PRK (aaPRK) in patients with myopia and myopic astigmatism. Materials and Methods: Of the 108 eyes of 54 patients enrolled in the study, tPRK was performed on 54 (50%) eyes and aaPRK was performed on 54 (50%) eyes. The following parameters were compared: corrected distance visual acuity (CDVA), spherical equivalent (SE), flat and steep keratometry, intraocular pressure, central corneal thickness, asphericity, and HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, second-order vertical coma, and aberration coefficient. Results: The demographic and baseline characteristics were similar between the two groups (p>0.05, for all). The aberration coefficient value was significantly lower in patients treated with aaPRK compared to patients treated with tPRK at postoperative 3 months, 6 months, and 1 year (p=0.022, p=0.019, and p=0.017, respectively). Differences in the other variables were statistically insignificant (p>0.05 for all). Conclusion: Both tPRK and aaPRK procedures obtain similar postoperative CDVA, SE, asphericity, and HOA outcomes, except the aberration coefficient value.

Preliminary effects of treating the half of high latent hyperopia on refractive and visual results of femtosecond laser-assisted in situ keratomileusis in subjects with hyperopia.

BACKGROUND: To evaluate the preliminary effects of treating the half of high latent hyperopia on refractive and visual outcomes of femtosecond laser-assisted in situ keratomileusis (LASIK) in young subjects with hyperopia. METHODS: This non-randomized comparative study includes 120 eyes of 60 subjects who underwent femtosecond LASIK to correct hyperopia. Group 1 (n = 60) includes subjects with ≤ 1D algebraic difference (DRSE) between cycloplegic (CRSE) and manifest (MRSE) refraction spherical equivalents and was treated by entering manifest refraction values. Group 2 includes subjects with > 1D DRSE and was treated by entering the mean manifest and cycloplegic refraction values. Refractive and subjective outcomes obtained at the 1-, 3-, and 6-month postoperative visits were compared. RESULTS: The mean age of the subjects was 26.2 ± 3.5 and 26.2 ± 5.2 years for Group 1 and Group 2, respectively. The male-to-female ratios were 10/10 in both groups. Demographic values of the groups were similar (p > 0.05). Preoperative MRSE values were similar (p = 0.924), while CRSE and DRSE values were significantly higher in Group 2 (p < 0.001). At the 1- and 3-month postoperative visits, MRSE was higher and uncorrected distance visual acuity (UDVA) was lower in Group 2 (p < 0.001). Subjective visual parameters and quality of vision scores were also worse in Group 2 during these visits (p < 0.001); however, at the 6-month visit, all outcomes for Group 2 improved, and MRSE, UDVA, some subjective visual parameters, and quality of vision scores became similar between groups (p > 0.05). CONCLUSION: At the 6-month visit after treating the half of > 1D latent hyperopia with femtosecond LASIK, refractive and visual outcomes like MRSE, UDVA, subjective visual parameters, and quality of vision scores become similar to those obtained in ≤ 1D latent hyperopia.

Correlation of Non-invasive Tear Break-Up Time with Tear Osmolarity and Other Invasive Tear Function Tests.

Aim: To compare the outcomes of non-invasive break-up time (NI-BUT) test and the other conventional dry eye tests.Methods: The right eyes of 170 subjects were included in the study. In order to evaluate the tear quality of the patients, NI-BUT levels were measured by the Scheimplug-Placido disk system (Sirius topography). Tear osmolarity test was performed with TearLab Osmolarity System. Topical anesthesia-assisted type I Schirmer test and topical anesthesia-assisted BUT were lastly applied to all patients in order not to affect other measurements.Results: The mean NI-BUT value was 9.59 ± 4.37 sec, tear osmolarity was 292.93 ± 9.30 mOsm/L, Schirmer test was 15.32 ± 6.05 mm/5 min, and biomicroscopic BUT value was 8.98 ± 3.79 sec. The Schirmer test results were statistically significantly correlated with biomicroscopic BUT and NI-BUT values (p = .019, r = 0.180 and p = .030, r = 0.166; respectively). It was also found that tear osmolarity was strongly and inversely correlated with biomicroscopic BUT and topographic NI-BUT values (p < .001, r = -0.554 and p < .001, r = -0.528; respectively). There was no significant correlation between Schirmer test and tear osmolarity.Conclusion: It is important to use a sensitive, reproducible and non-invasive method in the evaluation of tear functions. We think that the objective and noninvasive topographic NI-BUT measurements and the minimally invasive osmolarity measurements should be used more frequently in practice because they are correlated with the measurements obtained by invasive methods and should be widespread in clinics.

Topometric and Tomographic Evaluation of Subclinical Keratoconus.

PURPOSE: To investigate the corneal topometric and tomographic findings that can be used in the diagnosis of subclinical keratoconus. METHODS: A retrospective cohort study. The study group was selected from patients with clinically evident keratoconus in one eye and subclinical keratoconus without evident topographic findings in fellow eye. The age-matched control group was selected from patients who were candidates for laser in situ keratomileusis (LASIK) and did not develop ectasia after LASIK surgery at least 1-year follow-up. All subjects underwent topographic, topometric and tomographic (Belin-Ambrósio Enhanced Ectasia Display III) analyses via a Pentacam HR rotating Scheimpflug camera (Oculus, Germany, version 1.20r.98) before LASIK surgery. RESULTS: The study group consisted of 151 patients (69 male and 82 female, mean age of 24.8 ± 7.2 years) and the control group also consisted of 150 patients (70 male and 80 female, mean age of 26.0 ± 6.3 years). There were statistically significant differences in all measured topometric (p˂.05) and tomographic (p˂.001) parameters between the eyes with subclinical keratoconus and those of the control group. In discriminating eyes with subclinical keratoconus from normal eyes, final D showed the highest area under curve value (0.858, sensitivity 85.2%, specificity 66.7%), followed by maximum pachymetric progression index (0.809, sensitivity 81.9%, specificity 69.4%) and average pachymetric progression index (0.796, sensitivity 81.9%, specificity 68.1%) in receiver operating characteristic analysis. CONCLUSION: Topometric and tomographic parameters might be useful for early detection of keratoconus, but the sensitivity and specificity of any parameter are not high enough to be used alone.

Comparison of Two Different Accelerated Corneal Cross-linking Procedure Outcomes in Patients with Keratoconus

Background: Corneal cross-linking treatment is the unique treatment method that can cease the progression of keratoconus disease. Because of the long duration of conventional treatment, accelerated cross-linking treatment methods are being developed. Aims: To compare two different accelerated corneal cross-linking protocols in terms of postoperative visual acuity and topographic findings (higher-order aberrations and keratometry values). Study Design: Retrospective comparative study. Methods: Sixty-five eyes of 43 patients (30 men and 13 women) who underwent two different accelerated corneal cross-linking protocols (10 min, 9 mW/cm2 and 5 min, 18 mW/cm2) for progressive keratoconus were retrospectively analyzed. Patients were divided into two groups according to the accelerated corneal cross-linking treatment protocol: group 1 (10 min, 9 mW/cm2, 32 eyes of 21 patients) and group 2 (5 min, 18 mW/cm2, 33 eyes of 22 patients). Uncorrected visual acuity and best-corrected visual acuity values and topographic findings (central corneal thickness and flat and steep keratometry values) were recorded preoperatively and 6 months after corneal cross-linking treatment. High-order aberration values measured with Pentacam preoperatively and 6 months after corneal cross-linking were also recorded. Results: In both groups, a significant improvement was detected in the uncorrected visual acuity and best-corrected visual acuity levels preoperatively and 6 months postoperatively (group 1: p=0.001, p=0.001 and group 2: p=0.001, p=0.001, respectively). In addition, central corneal thickness values decreased significantly in both groups (p=0.006 and 0.001). Trefoil values showed no significant difference preoperatively and 6 months postoperatively in group 1 (p=0.160 and 0.620, respectively). In groups 1 and 2, coma values were found to decrease significantly in the 6th postoperative month compared with preoperative values (p=0.001 and 0.020, respectively). There was no significant difference between preoperative and 6th month postoperative horizontal and vertical trefoil values in both groups (p=0.850 and 0.140, respectively). There was no significant difference between the two groups in terms of preoperative and 6th month postoperative higher-order aberrations, refractive errors, keratometry values, and uncorrected visual acuity and best-corrected visual acuity levels. Conclusion: Both accelerated corneal cross-linking procedures provide similar improvement in topographic findings, coma values and visual acuity.

Evaluation of the effect of optic zone diameter selection on high-order aberrations in photorefractive keratectomy excimer laser treatment.

To evaluate the postoperative higher-order aberration (HOA) differences and visual quality outcomes of wavefront-optimised photorefractive keratectomy (PRK) surgery in 6.5-mm and 7.0-mm optic zones. The study included 136 eyes of 68 patients who underwent wavefront-optimised PRK surgery for myopia or myopia with astigmatism. Q values, third-order coma (Z [3, 1] and Z [3, - 1]), third-order trefoil (Z [3] and Z [3, - 3]), fourth-order spherical aberration (Z [4, 0]) and aberration coefficients were evaluated before surgery and 6 months after surgery. All patients underwent ophthalmic examinations that included visual acuity, central corneal thickness and intraocular pressure. The mean age of participants was 25.5 ± 6.7 (18-50 years). A total of 38 (55.88%) participants were male and 30 (44.12%) were female. In half of the eyes (n = 68), the 6.5-mm optic zone was selected (group 1), while the 7.0-mm optic zone was selected for other half (n = 68; group 2). No statistically significant difference was observed between the two groups in terms of preoperative best corrected visual acuity (BCVA) and postoperative uncorrected visual acuity (UCVA) (p = 0.45 and p = 0.22, respectively). The 7.0-mm optical zone was found to be associated with lower aberration coefficient values and lower Z [4, 0] spherical aberrations of HOAs. Although the 6.5-mm optical zone was associated with an increase in most wavefront aberration variables, measurements were not statistically different between two groups other than aberration coefficients and Z [4, 0] spherical aberrations. Photorefractive keratectomy performed with both the 6.5-mm and 7.0-mm optical zone diameters is very successful in correcting refractive errors. For some HOAs, treatment with the 7.0-mm optical zone seems to be more advantageous.

Additive Effect of Topical Nepafenac on Mydriasis in Patients With Diabetes Mellitus.

OBJECTIVES: To evaluate the additive effect of topical nepafenac on pupil diameter (PD) in patients with diabetes mellitus (DM) and cataract. METHODS: This prospective comparative study included the patients having cataract surgery with and without DM. Two consecutive PD measurements were taken using an automatic quantitative pupillometry system (MonPack One, Metrovision). A baseline measurement was taken, then one drop of nepafenac % 0.1 (Nevanac; Alcon, Fort Worth, TX) was instilled only to the eye that will be operated on (study eye). Cyclopentolate 1.0% (Sikloplejin; Abdi Ibrahim, Istanbul, Turkey) was instilled to both eyes (study eye/fellow eye) 5 minutes later. The second measurement was taken at 1 hour after this application. RESULTS: The DM group consisted of 43 patients, and the control group consisted of 39 participants. The baseline PDs of both eyes were similar in the DM group (P=0.070) and the control group (P=0.345). The change in pupil size from baseline to mydriasis was statistically significantly greater in the study eyes (2.69±0.53) than fellow eyes (2.54±0.61) in the DM group (P=0.009), but there was no statistically significant difference in the control group (2.94±0.63 vs. 2.86±0.58). When the groups were compared, the PD changes were similar in the study eyes between groups (P=0.065), while the PD changes in the fellow eyes were lower in the DM group (P=0.017). CONCLUSIONS: Nepafenac has been shown additive effect on pupil dilation in diabetic patients before cataract surgery.

The effect of different optical zone diameters on the results of high-order aberrations in femto-laser-assisted in situ keratomileusis.

PURPOSE: To evaluate the postoperative high-order aberration differences of femto-LASIK surgery in 6.5 and 7 mm optic zones. PATIENTS AND METHODS: We retrospectively reviewed 80 eyes of 40 patients with myopia or myopia with astigmatism who underwent femtosecond LASIK surgery. Q values, z3, 3 (h. trefoil), z3, -3 (v. trefoil), z3, 1 (h. coma), z3, -1 (vertical coma), z4, 0 (spherical aberration), z5, -1 (second other v. coma), aberration coefficients were evaluated 3 months after surgery. Central corneal thicknesses, intraocular pressures, patient ages and genders, optical zone diameters and ablation depths are collected from patients' medical records. RESULTS: The mean age was 28.4 ± 0.69 years (range, 20-47 years). Lower z4, 0 spherical aberrations and aberration coefficient values were associated with larger optical zones (7 mm) (z4, 0 spherical aberrations = 1.25, p = 0.01; coefficient value = -1.21, p < 0.01). Although a smaller optical zone (6.5 mm) was associated with an increase in most of the wave-front aberration variables, measurements were not statistically different between the two groups other than z4, 0 spherical aberrations and aberration coefficients. DISCUSSION: LASIK treatment with 6.5 and 7 mm optical zones is safe and effective for correcting myopia and myopic astigmatism and has statistically similar visual outcomes. Moreover, larger optical zone (7 mm) was found to be associated with lower spherical aberration induction and smaller aberration coefficient values compared to 6.5 mm optical zone. This can be important for decision-making in femto-LASIK surgery for better postoperative results.

Effect of topical pilocarpine on refractive surgery outcomes.

PURPOSE: To investigate the effect of topical pilocarpine on topical cycloplegia and on the results of refractive surgery. METHODS: The study included 100 eyes of 100 patients who underwent laser-assisted in situ keratomileusis. Group 1 comprised patients who wanted to undergo surgery on the same day after cycloplegic examination and were applied with 2% pilocarpine hydrochloride; group 2 comprised patients whose pupils spontaneously went into the natural position. Corneal thickness, mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), pupil diameter, pupil center shift and high-order aberrations (HOAs) were compared between the two groups. RESULTS: There were no statistically significant differences between the groups in respect of preoperative age, gender, corneal thickness, MRSE, UDVA and CDVA. The pupil diameter was not statistically significant between the groups. Pupil diameter after pilocarpine was not statistically significant when compared with the natural pupil diameter. There were no statistically significant differences in postoperative HOA between the two groups. CONCLUSIONS: The pupillary dilatation and the associated pupillary shift were reduced with pilocarpine. Postoperative refractive values and aberrations showed no difference between the groups.

Comparison of 9.0 and 9.2 mm Flap Diameter Options of Femtosecond Laser In-Situ Keratomileusis for Hypermetropia and Hypermetropic Astigmatism.

AIM: To compare the postoperative one-year outcomes of asphericity (Q) and high order aberration (HOA) values of 9.0 and 9.2 mm diameter flap groups in hypermetropia and hypermetropic astigmatism subjects who underwent femtosecond laser in-situ keratomileusis (LASIK). MATERIALS AND METHODS: The study included 68 eyes of 34 patients. A femtosecond laser platform (Allegrato Wave, Wavelight AG, Erlangen, Germany) was used for flap cutting. Corneal stroma was ablated using Wavelight EX500 with wavefront-optimized profile (WaveLight GmbH, Erlangen, Germany). 9.0 mm flap diameter was randomly chosen for one eye, and 9.2 mm flap diameter was chosen for the fellow eye. Two eyes of the patients who used two different flap diameters were enrolled into two different groups. Corneal stroma was ablated using Wavelight EX500 with wavefront-optimized profile (WaveLight GmbH, Erlangen, Germany). Postoperative one-year outcomes of Q and HOA values of 9.0 and 9.2 mm diameter flap groups were compared statistically. RESULTS: The preoperative manifest refraction spherical equivalents of the 9.0 and 9.2 mm diameter flap groups were 1.86 ± 1.81 D and 1.69 ± 1.99 D (p=0.754). No intraoperative or postoperative complications were observed. At postoperative one-year, Q values were 0.98 ± 0.13 D and 0.91 ± 0.15 D (p=0.029). HOAs including horizontal and vertical coma, horizontal and vertical trefoil, spherical aberration, and second order vertical coma were not significantly different (p > 0.05 for all). Total HOA values were 1.62 ± 0.14 and 1.40 ± 0.16, in the 9.0 and 9.2 mm diameter flap groups, respectively (p < 0.001). CONCLUSION: Both the 9.0 and 9.2 mm diameter flap options in femtosecond LASIK are equally safe and effective. Many of the HOA values are similar in both options, and better results were provided in terms of total HOA and Q values with the 9.2 mm diameter flap option. This study was registered with trial registration number 118-011.

Effects of Cyclotorsion Orientation and Magnitude in Eyes with Compound Myopic Astigmatism on the Compensation Capacity of WaveLight EX500 Photorefractive Keratectomy.

PURPOSE: To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform. METHODS: This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees). RESULTS: The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was -0.32 ± 0.3 diopters (D, -1.25 to 0.00 D) in group 1, -0.47 ± 0.2 D (-2.00 to 0.00 D) in group 2, -0.62 ± 0.2 D (-1.00 to -0.25 D) in group 3, and -0.91 ± 0.2 D (-1.50 to -0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001). CONCLUSIONS: Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.

Comparison of Samfilcon A and Lotrafilcon B silicone hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy.

PURPOSE: To compare the efficacy of Samfilcon A and Lotrafilcon B bandage contact lenses after photorefractive keratectomy (PRK). METHODS: In this study, patients with bilateral PRK were assigned for the fitting of Lotrafilcon B lens and Samfilcon A lens. The patients were examined on the day of surgery and on postoperative days 1, 2 and 3. Slit biomicroscopy was performed to assess epithelial defect size in the postoperative examinations. The subjective evaluation of pain and visual symptoms was recorded on postoperative days 1, 2 and 3. RESULTS: Analysis was made of 68 eyes of 34 patients who fulfilled the criteria and had PRK for correction of low to moderate myopia/astigmatism. On postoperative days 1 and 2, pain and epiphora scores were significantly lower in eyes with Samfilcon A lens (p < 0.001 for all), and on postoperative day 3, the differences were not significant (p = 0.414 and p = 0.180, respectively). There was no significant difference between the two lenses in respect of the levels of photophobia. The difference in epithelial defect size was statistically lower in eyes with Samfilcon A lens compared to Lotrafilcon B on day 1 (16.89 mm2 vs. 21.07 mm2; p = 0.003) and day 2 (1.49 mm2 vs. 2.46 mm2; p < 0.001). The difference was not significant on day 3. (0.05 mm2 vs. 0.05 mm2; p = 1.000). CONCLUSIONS: The Samfilcon A lens is superior to the Lotrafilcon B lens in reducing postoperative pain and accelerating re-epithelialization.