Evaluation of the effect of unilateral late blindness on the retina, optic nerve and choroid parameters in the sighted eye.

BACKGROUND: To investigate whether unilateral late blindness alters the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), central macular thickness (CMT) and choroidal thickness (CT). METHODS: The 17 healthy eyes of 17 monocular patients with late blindness due to isolated eye trauma in one eye and the 19 eyes of 19 healthy individuals were evaluated in this retrospective study. Patients with at least 10 years of monocular blindness, a refractive error between + 1.5 and -1.5 D in the sighted eye, a best-corrected visual acuity of at least 20/20 and an axial length (AL) < 25 mm were included in the study. Following ophthalmologic examination, the RNFL, GCC, CMT and CT values were measured with spectral domain optic tomography (SD-OCT). Those with ocular, systemic or neurological disease that could influence the measured parameters were excluded from the study. RESULTS: A total of 17 (14 males, 3 females) monocular patients [mean age 41.00 ± 11.95 (24-64)] and 19 (16 males, 3 females) healthy individuals [mean age 39.79 ± 6.74 (30-56)], similar in age and gender (p = 0.949 and p = 0.881), were included in the study. The mean duration of being monocular was 22.76 ± 11.76 (10-49) years. No difference was present between the RNFL, GCC, CMT and CT measurements of the monocular patients and the healthy individuals (p = 0.692, p = 0.294, p = 0.113, p = 0.623, respectively). No significant correlation was found between the duration of monocularity and the retinal and optic nerve parameters. CONCLUSION: The results of our study indicate no difference in the optic nerve, retina and choroid OCT findings in the sighted eyes of subjects with long-term monocular blindness compared to subjects with bilateral normal eyes. Although functional and volumetric neuroimaging studies suggest the possibility of compensation in these patients, our findings indicate that this is not at the ocular level.

Vitamin D Levels in Young Adult Cataract Patients: A Case-Control Study.

OBJECTIVE: We aimed to investigate whether a relationship is present between early cataract formation and vitamin D in young adults. METHODS: A total of 37 cataract patients (18 males and 19 females) and 53 healthy participants (27 males and 26 females) under the age of 60 years were included in this study. The 25-OH vitamin D values were measured in all subjects and the mean vitamin D levels compared between the 2 groups. Additionally, the differences between the vitamin D levels of the genders in both groups were investigated. RESULTS: The mean age of the study group was 48.1 ± 8.5 (range 33-59) years, and the mean age of the control group was 49.3 ± 7.8 (range 31-59) years (p = 0.48 and p = 0.83). The mean vitamin D level was 15.6 ± 8.4 ng/mL in the study group and 20.8 ± 7.1 ng/mL in the healthy subjects (p = 0.002). Among the females, the vitamin D level was 10.6 ± 4.7 ng/mL in the study group and 18.1 ± 6.4 ng/mL in the control group (p = 0.0001). No significant difference was found between the groups among the males (p = 0.24). CONCLUSION: We found vitamin D deficiency to be associated with early age-related cataract in a statistically significant manner. We believe it is worth investigating the reason for this concurrence with large longitudinal studies.

Does Pseudoexfoliation Syndrome Affect the Choroidal Response After Uneventful Phacoemulsification.

Purpose: To examine subfoveal and peripapillary choroidal thickness changes after successful phacoemulsification in cataract cases with nonglaucomatous pseudoexfoliation syndrome (PXS). Materials and Methods: Nineteen cataract patients with PXS and 19 without PXS were included in this prospective and interventional controlled study. Subfoveal and peripapillary choroidal thicknesses were measured before surgery and on the postoperative first day (D1), first week (W1), first month (M1), second month (M2), and third month (M3). Subfoveal choroidal thickness measurement included total subfoveal choroidal thickness (tSFCT), the small choroidal vessel layer (SF-SCVL) thickness, and the large choroidal vessel layer (SF-LCVL) thickness. Results: The greatest increase in mean tSFCT compared to baseline was observed between W1 and M1 with values of 23.33 ± 2.96 µm and 31.84 ± 2.88 µm, respectively, for the PXS and non-PXS groups (P = 0.014). The greatest increase in SF-SCVL thickness compared with baseline occurred at M1 with values of 6.66 ± 1.97 µm and 26.52 ± 1.92 µm, respectively, for the PXS and non-PXS groups (P < 0.001). The peripapillary choroidal thickness only showed a significant difference between the groups at the inferior measurement point with values of 117.94 ± 14.15 µm and 137.52 ± 34.53 µm, respectively, for the PXS and non-PXS groups (P = 0.032). Conclusions: Cataract cases with PXS exhibited a different choroidal thickness response compared to non-PXS eyes after successful phacoemulsification. The increased choroidal thickness was particularly observed in Haller's layer in the eyes with PXS and in the choriocapillaris and Sattler's layer in the eyes without PXS.

Effect of trabeculectomy and Ahmed glaucoma valve implantation surgery on corneal biomechanical changes.

PURPOSE: To evaluate alterations in corneal biomechanical properties before and 6 months after conventional trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation. METHODS: Thirty-nine eyes of 39 patients were evaluated retrospectively. Complete ophthalmological examinations including evaluation of corneal biomechanical properties using the Ocular Response Analyzer were performed before and after 6 months postoperatively. A mean of four measurements for corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) was recorded. The participants had undergone trabeculectomy or shunt surgery as the first surgical procedure for glaucoma treatment of uncontrolled IOP with maximum antiglaucoma eyedrops. RESULTS: There were 20 eyes of 20 patients in trabeculectomy group and 19 eyes of 19 patients in AGV implantation group. There was no significant difference between two groups in terms of sex, age, eye laterality, lens status, antiglaucoma drug usage, preoperatively measured Mean Deviation of Humphrey Visual Field Analyzer, CH, CRF, IOPcc, and IOPg (p > 0.05). CH and CRF increased significantly after shunt surgery (p < 0.001). CH increased in trabeculectomy group postoperatively (p < 0.001); however, CRF showed a small amount of decrease, but this reduction was not statistically significant (p > 0.05). CH and CRF showed higher increase after AGV surgery than trabeculectomy surgery (p < 0.05). There was no significant correlation between IOP changes and CH-CRF changes in both TRAB and AGV groups (p > 0.05). CONCLUSION: According to our results, surgical technique differences may have an impact on postoperative corneal biomechanical outcomes. AGV surgery offers better corneal biomechanical results than standard trabeculectomy in 6-month follow-up.

Can subfoveal choroidal thickness replace subjective tests in patients using tadalafil to treat erectile dysfunction?

We aimed to determine the effect on choroidal thickness of daily 5 mg tadalafil use in patients with erectile dysfunction (ED) and to evaluate agreement between short form of International Index of Erectile Function (IIEF 1-5, 15) scores and choroidal thickness during follow-up. Enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) was used to measure full choroidal thickness in the subfoveal area, choroidal thickness (CT) and small-choroidal-vessel-layer (SCVL) thickness. Thirty of the 45 patients included complete their follow-ups and exhibited medication continuity. Patients were divided into two groups, five (16.7%) with ED at any level at third-month follow-up, and 25 (83.3%) with no ED, and subgroup analysis was then performed. Median changes in SCVL thickness at first- and sixth-month follow-ups were 20.5 µm versus 9.0 µm (p = .001) and 23.5 µm versus 12.5 µm (p = .005) in patients without and with ED respectively. The SCVL thickness increased by 20 µm compared with the baseline level, indicating an improvement in the patient's complaints of erectile dysfunction. The level of increase in SCVL thickness can be a useful and objective guide to clinicians if they cannot be present when the IIEF questionnaire is administered.

Outcomes of Ahmed glaucoma valve implantation for steroid-induced elevated intraocular pressure in patients with retinitis pigmentosa.

PURPOSE: To evaluate the outcomes of Ahmed glaucoma valve (AGV) in the management of elevated intraocular pressure (IOP) secondary to steroid use for macular edema in patients with retinitis pigmentosa (RP). METHODS: A total of nine eyes of five patients were evaluated retrospectively. Complete success was defined as IOP ≤ 21 mmHg without glaucoma medications, while qualified success was defined as IOP ≤ 21 mmHg with glaucoma medications. RESULTS: Mean age at surgery was 25.0 ± 8.3 years, and mean follow-up time was 38.4 ± 13.2 months. Mean IOP was 41.0 ± 8.3 mmHg preoperatively, 9.4 ± 3.5 mmHg at first week (p = 0.008), 13.1 ± 3.6 mmHg at first month (p = 0.008), 14.8 ± 4.1 mmHg at 6th month (p = 0.008), 11.7 ± 2.6 mmHg at 12th month (p = 0.008), 12.4 ± 2.9 mmHg at 24th month (p = 0.008), 12.6 ± 3.6 mmHg at 36th month (p = 0.043) and 12.8 ± 4.2 mmHg at 48th month (p = 0.068) postoperatively. The mean number of topical anti-glaucomatous medications decreased from 2.8 ± 0.4 preoperatively to 0.4 ± 0.9 postoperatively (p = 0.007). Complete success was obtained in 7 (77%) eyes, and qualified success in 2 (23%) eyes. No failure was detected. CONCLUSIONS: AGV implantation can be considered as an alternative and safe option in the management of resistant, elevated IOP secondary to steroid treatment for macular edema in patients with RP.

Choroidal thickness in psoriasis.

Our aim was to compare the choroidal thickness in psoriasis patients and age- and gender-matched healthy volunteers. A total of 38 psoriasis cases and 38 age- and gender-matched controls were evaluated. The left eye was evaluated in all subjects. The choroidal thicknesses were measured at the subfovea and horizontally across the fovea at 500-µm intervals using enhanced depth imaging spectral domain optical coherence tomography. The points of measurement were 1500 µm temporal and nasal to the fovea. Choroidal thicknesses in psoriasis patients were thicker than those in the controls, but these differences were not statistically significant (P > 0.05). A positive correlation was present between the duration of disease and choroidal thickness at certain measurement points, but there was no significant correlation between the Psoriasis Area and Severity Index score and choroidal thickness. There was no significant difference between psoriasis patients and healthy controls in terms of choroidal thickness. However, choroidal thickness was associated with disease duration.

Necessity of Periodic Ophthalmological Examinations in Binocular B Class Driving Licence Holders Over 50 Years of Age.

OBJECTIVE: To determine whether binocular B class driving licence (BBCDL) holders over 50 years old are in compliance with the BBCDL criteria for visual acuity, to determine the age-based prevalence of ophthalmological disorders reducing visual acuity in this group, and to investigate whether periodic ophthalmological examinations are needed in licence holders over 50 years of age. MATERIALS AND METHODS: This prospective study enrolled 451 adults over 50 years old having a BBCDL. The study subjects were categorized into 3 age groups as group 1 (51-60 years), group 2 (61-70 years), and group 3 (over 71 years). RESULTS: The mean age of the subjects was 60.02±7.27 years; 338 (74.9%) were male and 113 (25.1%) were female. The BBCDL criteria were met by 353 (78.3%) subjects whereas 98 (21.7%) subjects did not meet them. Eighty-four (85.7%) of 98 patients not meeting BBCDL criteria still drove. The mean age of the subjects meeting BBCDL criteria (58.82±6.77 years) was significantly lower than the subjects not meeting them (64.34±7.40 years) (p<0.001). The most common pathologies in the individuals still driving despite not meeting BBCDL criteria were senile cataract (38.5%) and diabetic retinopathy (23.1%) in group 1, senile cataract (55.3%) and diabetic retinopathy (14.9%) in group 2, and senile cataract (63.6%) and senile macular degeneration+senile cataract (18.2%) in group 3. CONCLUSION: More than a fifth of individuals over 50 years old did not meet the BBCDL criteria, due predominantly to senile cataract, and the majority of these individuals continue to drive. Therefore, we believe that individuals over 50 years old who have a BBCDL should undergo periodic ophthalmological examinations.

Suramin, Genistein and Collagen Matrix (DuraGen) for Delayed Adjustment after Strabismus Surgery: Which One is Best?

AIM: To evaluate the efficacy and safety of suramin, genistein and collagen matrix for the prevention of inflammation, the reduction of fibrosis and the delay in adjustment after strabismus surgery on a rabbit model. METHODS: By using an adjustable suture technique, a recession of the superior rectus muscle (SRM) was made in 36 eyes of 18 rabbits. Three study groups were created using genistein, suramin and collagen matrix (n = 6 per group). Two control groups utilized dimethyl sulphoxide (DMSO) (n = 6) and balanced salt solution (n = 12). The adjustments and measurements were made on days 2, 7, 14. After enucleation was done on day 21, the degree of inflammation was evaluated quantitatively in histopathological sections and immunohistochemical investigations were performed for tissue expression of cytoplasmic vascular endothelial growth factor (VEGF), MAC 387, TGF-ß and bFGF. RESULTS: The adhesions between conjunctiva and SRM were significantly less in the collagen matrix and suramin groups (p = 0.002) and adhesions between the sclera and SRM were considerably reduced in the genistein and DMSO groups (p = 0.006) on day 7. Force exerted for adjustment was significantly less in the collagen matrix and suramin groups on day 14 (p = 0.006). Expression of b-FGF was significantly lower in the conjunctival epithelium in the suramin and genistein groups (p = 0.0001 for both). TGF-ß was significantly lower (p = 0.001) in the suramin group and VEGF expression was totally absent. MAC 387 expression was lower in the genistein and suramin groups (p = 0.0001). CONCLUSION: Suramin, genistein and collagen matrix successfully reduce adhesions, and facilitate adjustment following recession surgery. Both suramin and genistein effectively suppress growth factor expression, while collagen matrix offers the longest time interval for adjustability after strabismus surgery.

The relationship between the degree of cognitive impairment and retinal nerve fiber layer thickness.

The goal of the present study is to investigate the relationship between the degree of cognitive impairment and retinal nerve fiber layer (RNFL) thickness which is measured by the optical coherence tomography (OCT). Thirty-five patients with Alzheimer's disease (AD), 35 patients with mild cognitive impairment (MCI), and 35 healthy volunteers, between the ages of 60-87, who were examined in the neurology outpatient clinic among 2012-2013 were prospectively involved in our study. Mini mental state examination (MMSE) test, montreal cognitive assessment (MOCA), and also neuropsychological test batteries were used for the neurocognitive evaluation. RNFL thickness was measured by the OCT technique and the differences among groups were studied. The relationship between RNFL thickness and MMSE scores with demographic characteristics was investigated. RNFL thickness was significantly lower in AD and MCI groups compared with the control group (p < 0.01). No significant differences of RNFL were found between the MCI and the AD groups (p > 0.05). Significant correlation was found between MMSE scores and the RNFL values (p < 0.05). Significant thinning in RNFL along with age was detected (p < 0.05). In our study, it is thought that retinal nerve fiber degeneration and central nervous system degeneration may be concurrent according to the thinning of RNFL measured by OCT in AD and MCI groups. RNFL measurement may also be useful for early diagnosis and evaluation of the disease progression. Further studies are needed to optimize the utility of this method as an ocular biomarker in AD.

Effect on astigmatism of the location of clear corneal incision in phacoemulsification of cataract.

PURPOSE: To investigate the refractive results of clear corneal incision performed at the steepest meridian of pre-existing corneal astigmatism. METHODS: One hundred eighty-two patients with astigmatism > 0.75 diopters (D) were evaluated. Superior, temporal, nasal, superotemporal, or superonasal clear corneal incisions were performed at the steep meridian. Refraction, visual acuity, and topography values were evaluated, and changes in surgically induced astigmatism were calculated by vector analysis using the Fourier formula. Paired t test was used to compare mean values. RESULTS: Postoperative cylinder values showed minor changes in all groups, except the nasal group. Nasal incision increased preoperative cylinder from 1.13 D to 1.83 D 6 months after surgery. Temporal and superotemporal incisions resulted only in small astigmatic changes. Conversely, superior, superonasal, and nasal incisions induced more pronounced astigmatism. CONCLUSIONS: Performing clear corneal incision for phacoemulsification of cataract at the steep meridian resulted in small changes with temporal incisions, whereas nasal incisions resulted in higher surgically induced astigmatism.