Age-Related Differences in the Clinical Patterns of Ocular Graft-Versus-Host Disease.

Objectives: To evaluate age-related differences in clinical patterns of ocular graft-versus-host disease (GVHD). Materials and Methods: In this cross-sectional study, patients diagnosed with ocular GVHD were evaluated in two groups: Group I included those aged 18 years or younger and Group II included those over 18 years of age. Demographic and clinical information were recorded and compared between the groups. Results: Forty eyes of 20 patients were included (11 patients were in Group I and 9 patients were in Group II). Follow-up was at least 6 months. All patients had burning, dryness, and foreign body sensation. Conjunctival hyperemia, cicatricial conjunctivitis, and limbal stem cell disease (LSCD) was observed more frequently in Group II. In addition to non-preserved artificial tears, cyclosporine A 0.05% (65%) and autologous/allogeneic serum eye drops (80%) were given and silicone plugs were inserted (28%). In Group I, an improvement in GVHD scoring and best corrected visual acuity was observed after 6 months of treatment (p<0.0005). Conclusion: In ocular GVHD, conjunctival cicatrization and limbal stem cell deficiency might be observed more often in adults. Topical cyclosporine, autologous/allogenic serum drops, and punctal plugs are helpful in moderate or more severe cases. With early diagnosis and treatment, an improvement in clinical signs and visual acuity might be observed, particularly in younger patients.

The Impact of Learning Curve on Flap Thickness Outcome in Femtosecond Laser-assisted Laser In Situ Keratomileusis Performed with New LenSx Dual Platform.

PURPOSE: To evaluate the effect of learning curve on flap thickness (FT) outcome in femtosecond (FS) laser-assisted laser in situ keratomileusis (LASIK) operation for myopia performed with recently introduced LenSx dual platform using curved applanation cone. METHODS: Seventy eyes of 36 patients with myopia or myopic astigmatism operated with FS laser-assisted LASIK with recently introduced LenSx dual platform were evaluated in this retrospective study. Operations were divided into two groups: first 20 operations (20 eyes of 10 patients) and next 50 operations (50 eyes of 26 patients). Data on patient demographics, preoperative and postoperative keratometric and aberrometric parameters, and FT related outcome, including mean central FT, mean total FT, intra-FT range, and FT homogeneity were compared in study groups. RESULTS: Except for significantly lower preoperative steepest keratometry values in the next 50 operations versus first 20 operations (p = 0.033), no significant difference was noted between study groups in terms of preoperative and postoperative parameters. When compared to first 20 operations, next 50 operations were associated with significantly higher values for mean central FT (median, 123 µm vs. 114 µm; p = 0.007) and mean total FT (median, 123 µm vs. 113 µm; p = 0.015), whereas significantly lower intra-FT range (median, 4.0 µm vs. 4.5 µm; p = 0.003). CONCLUSIONS: In conclusion, our findings related to FS laser-assisted LASIK surgery for myopia with new LenSx dual platform using curved applanation cone revealed significant impact of learning curve on the corneal FT outcome in terms of closer FT to the intended value and lower intra-flap range.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery.

PURPOSE: To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). METHODS: This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. RESULTS: The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. CONCLUSIONS: This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Evaluation of the Effects of Silicone Oil on the Macula with Optical Coherence Tomography in Patients with Rhegmatogenous Retinal Detachment

Objectives: The effects of silicone endotamponade duration on the macula were evaluated in patients with rhegmatogenous retinal detachment. Materials and Methods: Sixty-five eyes of 65 cases with rhegmatogenous retinal detachment that underwent pars plana vitrectomy and silicone endotamponade were included in the study. All cases were classified in three groups according to duration of silicone tamponade: ≤3 months, 3-6 months, and ≥6 months. All cases were evaluated at 1 week, 1 month, and 3 months after silicone injection, just before and at 1 month after silicone removal in terms of intraretinal pathologies in the macula by using spectral-domain optical coherence tomography (SD-OCT). Results: Sixteen (26.6%) of the patients were female and 49 (75.4%) were male. The mean age of the patients was 58.1±12.1 years (18-82); the mean follow-up time was 12.4±4 months (6-20). The mean duration of silicone tamponade was 6.7±2.3 months (2-12). In 26.6% of patients with ellipsoid zone/outer limiting membrane defect, a statistically significant improvement in reflectivity was detected after silicone oil removal (p=0.016). There was a significant increase in central foveal thickness after silicone removal in eyes with duration of silicone more than 3 months (p=0.003 for 3-6 months, p=0.006 for ≥6 months). The prevalence of cystoid macular edema before and after silicone removal was also significantly higher in the eyes with silicone duration of 6 months or longer (p<0.001). Conclusion: In eyes with silicone endotamponade, structural changes in the macula may differ according to the duration of silicone oil in the eye.

Pediatric Ocular Acne Rosacea: Clinical Features and Long Term Follow-Up of Sixteen Cases.

Purpose: To report the clinical characteristics, treatment modalities and long term follow-up of 16 pediatric ocular acne rosacea patients.Methods: The medical records of pediatric ocular acne rosacea patients were reviewed.Results: There were 16 patients with a mean age of 7.7 ± 5 (1-16) years. The mean follow-up period was 52.8 ± 52 (3-150) months. Eight patients had skin involvement. The mean duration of delay for diagnosis was 16.2 ± 5.1 (4-48) months. Nine patients had a delayed diagnosis. Meibomitis, blepharitis, lid telangiectasia, and conjunctival hyperemia were present in all cases. Systemic antibiotics were prescribed in 12 patients. The mean delay in diagnosis was longer in patients with conjunctival/corneal involvement (p = .001) and these patients required longer systemic treatment (p = .001). Complete remission was achieved in 87.5% of cases.Conclusion: Children presenting with a long history of ocular irritation, meibomian gland disease, recurrent chalazia and peripheral corneal infiltrates should alert ophthalmologists to consider the diagnosis of ocular acne rosacea even in the absence of skin changes.

Patients satisfaction and clinical outcomes of binocular implantation of a new trifocal intraocular lens.

PURPOSE: To evaluate the clinical outcomes following bilateral implantation of PanOptix intraocular lens (IOL). METHODS: This study included consecutive patients scheduled to undergo cataract or refractive lens exchange surgery between October 2017 and June 2018 at two centers. Manifest refraction, uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA, 60 cm) and uncorrected near visual acuity (UNVA, 40 cm), defocus curves, presence of dysphotopsia, need for spectacles, presence of posterior capsule opacification and visual function were evaluated at 6 months after surgery. RESULTS: The IOL was implanted in 138 eyes of 69 patients. The mean binocular UDVA was 0.02 ± 0.05 logMAR, UIVA 0.06 ± 0.07 logMAR and UNVA 0.05 ± 0.07 logMAR. Defocus curve showed two peaks at 0.00 D and - 1.50 D. Complete spectacle independence was reported in 94.2% of the patients. The mean VF-14 test result was 97.7 ± 2.2 (93.2-100). Only one patient (1.4%) reported seeing bothersome halos. The presence of posterior capsule opacification was noted in seven eyes (10%), whereas Nd:Yag capsulotomy was required only in one eye. CONCLUSIONS: This trifocal IOL provided excellent visual outcomes at all distances with high spectacle independence and patient's satisfaction.

Comparison of Mix-and-Match Implanted Bifocal IOLs and Bilateral Implanted Trifocal IOLs After Femtosecond Laser-Assisted Cataract Surgery.

PURPOSE: To compare the visual performance of mix-and-match implanted bifocal intraocular lenses (IOLs) and bilateral implanted trifocal IOLs from the same manufacturer with the same IOL platform after femtosecond laser-assisted cataract surgery (FLACS). METHODS: This prospective, comparative, non-randomized study included patients who underwent FLACS (LenSx; Alcon Laboratories, Inc., Fort Worth, Texas) with bilateral implantation of bifocal IOLs (ReSTOR +2.50 D/+3.00 D; Alcon Laboratories, Inc.) or trifocal IOLs (PanOptix; Alcon Laboratories, Inc.). Visual acuities, manifest refraction, defocus curve, contrast sensitivity, quality of life measured by the Visual Function Index (VF-14), and spectacle independence were assessed at 6 months after surgery. RESULTS: A total of 70 eyes of 35 patients were included in this study. There was no difference in patient demographics and preoperative measurements between groups (P > .05). There was no difference in uncorrected distance visual acuity and corrected distance visual acuity outcomes between groups (P > .05), but uncorrected intermediate visual acuity and uncorrected near visual acuity outcomes were significantly better in the PanOptix group (P < .01). Correspondingly, the binocular defocus curve of the PanOptix IOLs showed significantly better visual acuity between -1.00 and -3.00 diopters compared to the ReSTOR IOLs (P < .05). The PanOptix group showed higher contrast sensitivity scores than the ReSTOR group for 12 and 18 spatial frequencies in photopic conditions and for 18 spatial frequencies in mesopic conditions (P < .05). The average VF-14 score was similar between groups (P = .78). None of the patients required spectacles. CONCLUSIONS: Bilateral implanted PanOptix IOLs seem to provide better intermediate and near vision, defocus curve, and contrast sensitivity compared to mix-and-match implanted ReSTOR IOLs. However, similar vision-related quality of life and spectacle independence were achieved with both IOLs. [J Refract Surg. 2019;35(9):559-564.].

The efficacy of systemic and intravitreal infliximab treatments in an endotoxin-induced uveitis model.

Purpose: To compare the efficacy of systemic and intravitreal infliximab treatments in an experimental endotoxin-induced uveitis (EIU) model. Methods: Twenty-eight white New Zealand rabbits were equally divided into 4 groups. Group 1 received an intravitreal injection of 0.1 cc saline, group 2 received an intravitreal injection of 2 µg/0.1 cc lipopolysaccharide (LPS), group 3 received an intravitreal injection of 2 µg/0.1 cc LPS and 2 mg/0.1 cc infliximab, and group 4 received intravitreal injection of 2 µg/0.1 cc LPS and intravenous injection of 5 mg/kg infliximab. Clinical, biochemical (aqueous and vitreous humour protein levels and TNF-α concentrations), and histopathological evaluations were performed. Results: The clinical examination score was lower in group 4 than in group 2 (p = 0.006); but there was no significant difference between groups 2 and 3 (Bonferroni correction, p = 0.016). No statistically significant difference was found among groups 2, 3, and 4 for aqueous humour protein levels (p > 0.05). Significantly higher aqueous humour concentrations of TNF-α was measured in group 3 comparing to both group 1 and 4 (p = 0.003 and p = 0.002, respectively). No significant difference was found in vitreous protein levels or TNF-α concentrations among all study groups (Bonferroni correction, p = 0.026 and p = 0.101, respectively). Histopathological evaluation of the uveal tissue and anterior chamber reaction revealed the highest inflammation in group 3 (p < 0.001). In group 4, histopathological evaluation of uveal tissue was lower than in groups 2 and 3 (p < 0.001 and p = 0.001, respectively); whereas there was no difference in anterior chamber inflammation between groups 2 and 4 (p = 1.00). Conclusion: Intravitreal 2 mg/0.1 cc infliximab injection exacerbated inflammation in an EIU model; whereas systemic infliximab treatment at a dose of 5 mg/kg suppressed inflammation effectively and rapidly.

Macular Evaluation with Spectral Domain Type Optic Coherence Tomography in Eyes with Acute Nonarteritic Ischemic Optic Neuropathy at the Presentation Visit.

PURPOSE: To evaluate the macula with spectral domain type optic coherence tomography (OCT) in eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION) at the presentation visit. METHODS: Medical charts of the 133 patients who received the diagnosis of acute NAION between January 2008 and July 2014 at the Neuro-ophthalmology unit of Dokuz Eylul University were reviewed retrospectively. Sixtythree patients within 30 days of symptom onset with available baseline spectral domain type macular OCT were included in this study. Clinical and macular characteristics of the affected eye were assessed and compared to the fellow eyes. RESULTS: Sixty-three eyes of 63 patients comprised the study group. Twenty one study eyes (33.3%) had normal posterior pole, 22 (34.9%) some evidence of subretinal fluid, 10 (15.8%) vitreomacular adhesion, five (7%) age-related macular degeneration related changes, four (6%) epiretinal membrane and one (1%) previous grid laser scars. On the other hand, 41 of 63 the fellow eyes (65%) had normal posterior pole, ten (15.8%), vitreomacular adhesion, seven (10.7%), age-related macular degeneration related changes, three (4%) epiretinal membrane and two (3%) other type of changes. OCT scan passing through the fovea exhibited 10 or more hyperreflective dots in 10 (15%) of the study eyes whereas two of the fellow eyes (3.2%) had 10 or more hyperreflective dots. CONCLUSION: Macular OCT can be a part of the routine neuroophthalmologic examination in patients with acute NAION not only to show the NAION related changes such as the subretinal fluid accumulation but also to identify the other coexistent macular abnormalities.

Bilateral Choroidal Detachment Induced by Unilateral Application of a Fixed Combination of Topical Timolol Maleate and Brinzolamide.

We describe a 66-year-old man who developed bilateral choroidal detachment that was induced by unilateral topical administration of a fixed combination of 1% brinzolamide and 0.5% timolol maleate the day after an uneventful phacoemulsification surgery and intraocular lens implantation involving his right eye. We believe that the reaction was an idiosyncratic reaction, most likely against brinzolamide. The condition improved rapidly after the cessation of the fixed combination of brinzolamide and timolol maleate and treatment with 1% topical prednisolone acetate every hour and 1% cyclopentolate twice a day bilaterally. Although there are several similar cases involving choroidal detachment after oral acetazolamide and topical dorzolamide treatment mentioned in the literature, the present case is the first case report involving bilateral choroidal detachment after topical treatment with brinzolamide.

Splitting of a Dexamethasone Implant (Ozurdex) following the Injection.

In this brief report, we share our observations on a splitted Dexamethasone implant (Ozurdex) which we discovered a week after the injection. It is likely that implant splitting neither changes the efficacy of the implant nor creates a mishap for the patient.