Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications.

Purpose: To investigate clinical features, visual prognosis, and ocular complications in patients with ankylosing spondylitis (AS)-associated anterior uveitis (AU). Methods: Data of 211 eyes of 145 patients with AU associated with AS were reviewed retrospectively. Results: Mean follow-up time was 6.31 ± 6.33 years. Men were younger than women at AS diagnosis (p = 0.035). The mean number of uveitis flares was highest during the first quarter of the year and lowest during the third quarter (p = 0.017). Immunosuppressive agent use was higher in women than men (p = 0.052). Ocular complications developed in 120 eyes (56.9%), and the complication rate was 0.146/eye year. Males developed cystoid macular edema more frequently than females (p = 0.05). Glaucoma was observed more often in early-onset disease (age at AS onset <45 years) than late-onset disease (p = 0.028). Conclusions: Visual prognosis of AU in patients with AS was good, although more than half of the eyes developed ocular complications (56.9%).

The Profile and Management of Glaucoma in Adult Aphakic Patients Following Complicated Cataract Surgery.

OBJECTIVES: To determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery. MATERIALS AND METHODS: Retrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma. RESULTS: Mean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed. CONCLUSION: Prevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.

Long-term results of cataract surgery in patients with anterior uveitis.

PURPOSE: This study was aimed to assess the long-term results of phacoemulsification and posterior chamber intraocular lens implantation in patients with anterior uveitis. METHODS: Patients with complicated cataract secondary to anterior uveitis who underwent phacoemulsification and posterior chamber intraocular lens implantation were included in this study. Long-term results and all complications were evaluated throughout the postoperative 4 years. RESULTS: A total of 55 eyes of 48 patients were identified in this study. Cases with anterior uveitis were categorised into four aetiologic groups. Of the 55 eyes, 22 (19 patients) had idiopathic anterior uveitis, 10 (9 patients) had viral anterior uveitis, 10 (9 patients) had Fuchs' anterior uveitis and 13 (11 patients) had anterior uveitis associated with collagen vascular diseases. Preoperative macular oedema was more frequent (63.6%) in the idiopathic group than in the other groups (p < 0.001). The success rates of the best corrected visual acuity of 20/40 or better ranged from 80.0 to 100.0% in the groups. While postoperative increased intraocular pressure rate was statistically significantly higher in the Fuchs' group (p = 0.047), there was no statistically significant difference in other complication rates between the groups. CONCLUSIONS: The long-term outcomes of phacoemulsification with intraocular lens implantation in patients with uveitic cataract were satisfactory with excellent visual acuity and relatively low complication rates.

Short- to long-term results of Ahmed glaucoma valve in the management of elevated intraocular pressure in patients with pediatric uveitis.

OBJECTIVE: The aim of this study was to evaluate the long-term outcome of Ahmed glaucoma valve (AGV) implant for elevated intraocular pressure (IOP) in pediatric patients with uveitis. DESIGN: This was a retrospective chart review. PARTICIPANTS: The study included 16 eyes (11 children) with uveitis. METHODS: Success was defined as having IOP between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucoma medications and without the need for further glaucoma or tube extraction surgery. RESULTS: Mean age of patients at the time of AGV implantation was 14.19 ± 3.25 years. AGV implantation was the first glaucoma surgical procedure in 12 eyes (75%). Average postoperative follow-up period was 64.46 ± 33.56 months. Mean preoperative IOP was 33.50 ± 7.30 mm Hg versus 12.69 ± 3.20 mm Hg at the last follow-up visit (p < 0.001). Three eyes (18.7%) were determined as cases of "failure" because of tube removal in 2 eyes and a second AGV implantation in 1 eye. The cumulative probability of complete success was 68.8% at 6 months, 56.3% at 12 months, 49.2% at 36 months, 42.2% at 48 months, and 35.2% at 84 months, and the cumulative probability of eyes without complication was 75.0% at 6 months, 66.7% at 24 months, 58.3% at 36 months, 48.6% at 48 months and 24.3% at 108 months based on Kaplan-Meier survival analysis. CONCLUSIONS: Although AGV implant is an effective choice in the management of elevated IOP in pediatric uveitis, antiglaucoma medications are frequently needed for control of IOP. Tube exposure is an important complication in the long term. Differential diagnosis between relapse of uveitis and endophthalmitis is important in patients who received AGV implantation.

The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis.

PURPOSE:: To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. METHODS:: A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. RESULTS:: There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. CONCLUSIONS:: Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.

Pattern Visual Evoked Potential Changes in Diabetic Patients without Retinopathy.

Purpose. To assess the different check sizes of pattern visual evoked potential (PVEP) in diabetic patients without retinopathy according to HbA1c levels and diabetes duration. Methods. Fifty-eight eligible patients with type 2 diabetes mellitus and 26 age- and sex-matched healthy controls were included in the study. Only the right eye of each patient was analyzed. All of the patients underwent a comprehensive ophthalmic examination, and the PVEPs were recorded. Results. There was a statistically significant difference in P100 latency in 1-degree check size and in N135 latency in 2-degree check size between controls and patient groups which have different HbA1c levels. There were statistically significant, positive, and weak correlations with diabetes duration and P100 latency in 7-minute and 15-minute check sizes and N135 latency in 15-minute check size. Conclusions. It was showed that there were prolongations in P100 latency only in 1-degree check size and in N135 only in 2-degree check size in diabetic patients without retinopathy. There was statistically significant correlation between diabetes duration and P100 and N135 latencies in different check sizes.

The outcome of penetrating keratoplasty for corneal scarring due to herpes simplex keratitis / O resultado da ceratoplastia penetrante para cicatriz de córnea consequente à ceratite por herpes simplex

ABSTRACT Purpose: To determine the outcomes of penetrating keratoplasty (PK) for treatment of corneal scarring caused by Herpes simplex virus (HSV) keratitis, and whether the corneal scar type affects treatment outcome. Methods: A retrospective analysis of patients who underwent PK for HSV-related corneal scarring between January 2008 and July 2011 was performed. The patients were categorized into two groups. Group 1 consisted of patients with a quiescent herpetic corneal scar and group 2 consisted of patients who developed a corneal descemetocele or perforation secondary to persistent epithelial defects with no active stromal inflammation. The mean follow-up was 21.30 ± 14.59 months. The main parameters evaluated were recurrence of herpetic keratitis, graft rejection, graft failure, visual acuity, and graft survival rate. Results: There were 42 patients in group 1 and 13 in group 2. Preoperative BCVA varied from hand movements to 0.7 logMAR. Postoperatively, 34 patients (61.8%) achieved visual acuity of 0.6 logMAR or more. Recurrence of HSV keratitis was noted in 12 (28.57%) eyes in group 1 and 4 (30.76%) eyes in group 2 (p=0.40). Graft rejection occurred in 4 eyes (9.52%) in group 1 and in 3 (23.07%) eyes in group 2 (p=0.58). The 1-, 2-, and 3-year graft survival rates were 91.9%, 76.0%, and 65.1% in group 1, and 89.5%, 76.0%, and 63.6% in group 2 (p=0.91), respectively. Conclusions: Although there were different recurrence and graft rejection rates for two groups, the graft survival rates at 3 years were similar. According to our results, without inflammation, corneal herpetic scarring with a descemetocele or perforation achieved similar graft survival rates with quiescent herpetic corneal scars.

RESUMO Objetivo: Determinar os resultados da ceratoplastia penetrante (PK) para o tratamento da cicatriz da córnea consequente à ceratite por Herpes simplex vírus (HSV), e se o tipo de cicatriz na córnea afeta o resultado cirúrgico. Métodos: Foi realizada análise retrospectiva dos pacientes, submetidos à PK para a cicatriz da córnea relacionados com o HSV entre janeiro de 2008 e julho de 2011. Os pacientes foram divididos em dois grupos. Grupo 1 consistiu de pacientes que tiveram cicatriz corneana herpética quiescente e grupo 2 consistiu de pacientes que desenvolveram descemetocele ou perfuração córnea secundária a defeitos epiteliais persistentes sem inflamação estromal ativa. O seguimento médio foi de 21,30 ± 14,59 meses. Os principais parâmetros avaliados foram recorrência de ceratite herpética, rejeição de enxerto, falência do enxerto, acuidade visual e taxa de sobrevida do enxerto. Resultados: Foram avaliados 42 pacientes do grupo 1 e 13 doentes do grupo 2. Acuidade visual pré-operatória variou de movimentos das mãos (HM) para 0,7 logMAR. No pós-operatório, 34 pacientes (61,8%) atingiram acuidade visual de 0,6 logMAR ou melhor. Doze olhos (28,57%) tiveram recorrência de HSV ceratite no grupo 1, e quatro olhos (30,76%) tiveram recorrência no grupo 2 (p=0,40). A rejeição do enxerto ocorreu em 4 olhos (9,52%) no grupo 1, e em 3 olhos do grupo 2 (23,07%; p=0,58), taxa de sobrevivência do enxerto foi de 91,9% a 1 ano, 76,0% aos 2 anos e 65,1% aos 3 anos no grupo 1, e 89,5% a 1 ano, 76,0% aos 2 anos e 63,6% aos 3 anos no grupo 2 (p=0,91). Conclusões: Embora diferentes taxas de recorrência e de rejeição do enxerto foram encontradas nos dois grupos, a taxa de sobrevida do enxerto em 3 anos foi semelhantes nos dois grupos. De acordo com nossos resultados, em casos sem inflamação, a cicatriz herpética da córnea com descemetocele ou perfuração demonstra as taxas de sobrevivência do enxerto semelhantes às da cicatriz corneana herpética quiescente.

Agreement between Corneal Thickness Measurements Using Pentacam Scheimpflug Camera, Noncontact Specular Microscopy, and Ultrasonographic Pachymetry in Diabetic Patients.

PURPOSE: To evaluate the agreement of corneal thickness (CT) measurements obtained by the Pentacam Scheimpflug camera, noncontact specular microscopy (SM), and ultrasonographic pachymetry (UP) in diabetic (DM) patients; and whether duration of diabetes and level of Hb A1c affect the agreement. MATERIALS AND METHODS: The CT was measured in 127 patients with DM, and 137 age and sex-matched healthy controls sequentially by Pentacam, SM, and UP. Also diabetic subjects were subdivided according to duration of diabetes and Hb A1c levels. Pearson correlation analysis, linear regression analysis, and Bland-Altman plots were used for examination of agreement. RESULTS: We found an excellent and statistically significant correlation of CT measurements between Pentacam-SM (R2 = 0.768; R2 = 0.855), Pentacam-UP (R2 = 0.546; R2 = 0.652), and SM-UP (R2 = 0.759; R2 = 0.797) in diabetic and control groups, respectively. We performed further comparisons of the pair of instruments using the Bland-Altman analysis, and the mean difference between pair of methods was much smaller for SM-UP pair (-4.20 ± 9.79 in diabetic, and -4.58 ± 8.08 in control group). The group having Hb A1c level less than 7.5% showed the best agreement between SM-UP pair as in the control group. Whereas Pentacam-UP showed the best agreement in the group having Hb A1c level ≥7.5%. The best agreement was between Pentacam-UP in 0-4 year group, and between Pentacam-SM in 5-9 year and ≥10 year groups. CONCLUSION: SM-UP pair showed a higher agreement in diabetic patients. According to subgroup analyses, Hb A1c level, rather than the duration of diabetes, may determine the agreement of these pachymetry devices. But the difference in CT measurements between devices can still influence clinical diagnosis and treatment. Therefore, these methods are not completely interchangeable.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients' complaints and ocular diagnoses.

PURPOSE: This study aimed to assess the consistency between patients' complaints and their eye diseases. DESIGN: Cross-sectional study. METHODS: RESULTS: The frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively). CONCLUSIONS: Visually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.

RETRACTED: Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment.

The online-ahead-of-print published article, "Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment," by Altay Yesim, Demirok Gulizar, Balta Ozgur, and Bolu Hulya (DOI: 10.1089/jop.2015.0099) is being officially retracted from Journal of Ocular Pharmacology and Therapeutics (JOPT) due to post-publication authorship disputes and the discovery of simultaneous submission to both JOPT and the International Journal of Ophthalmology, which is a violation of the proper protocols of peer review. Journal of Ocular Pharmacology and Therapeutics and its editorial leadership are committed to maintaining the highest levels of scientific reporting and publishing, and therefore officially retracts the article based on the infringements listed herein.

Intraoperative application of 5-fluorouracil and mitomycin C aschemoadjuvants in primary pterygium surgery.

BACKGROUND/AIM: To compare the effectiveness of intraoperative 5 fluorouracil (5-FU) and mitomycin C (MMC) application in preventing recurrence following primary pterygium excision. MATERIALS AND METHODS: This was a prospective clinical trial that included 93 patients with primary pterygia assigned to three treatment groups in which 29 patients received an intraoperative application of 25 mg/mL 5-FU for 5 min, 32 patients received an intraoperative application of 0.02% MMC for 5 min, and 32 patients underwent only surgical excision (the control group). Follow-up visits were done on postoperative days 1, 3, 7, 15, and 30, and then every month. RESULTS: After a mean follow-up of 14 months, the surgical excision recurrence rates in the 5-FU, MMC, and control groups were 27.6%, 12.5%, and 43.75%, respectively. There was a statistically significant difference in the 5-FU and MMC groups when compared with the control group (chi-square; P = 0.04); however, the difference between the 5-FU and MMC groups was not significant. No serious complications were seen in the 5-FU and MMC groups. CONCLUSION: Intraoperative application of MMC and 5-FU is effective and safe for the prevention of recurrence. Our findings suggest that MMC is more potent for the prevention of recurrence and it causes less complaints than 5-FU.

Amniotic membrane transplantation in bacterial and herpetic stromal keratitis.

BACKGROUND/AIM: The aim of this study was to describe the results of amniotic membrane transplantation (AMT) in patients with bacterial and herpetic stromal keratitis. MATERIALS AND METHODS: This was a retrospective chart review study including 42 patients with herpetic keratitis (group 1) and 42 patients with bacterial keratitis (group 2). AMT was performed in addition to antimicrobial therapy. Topical steroids were administered after surgery. The outcome parameters evaluated were epithelialization time, decrease of stromal inflammation, and uncorrected visual acuity (UCVA). RESULTS: The average age of our patients was 55.85 ± 19.07 years, and average follow-up was 14.70 ± 11.75 months. The period of epithelialization was 19.23 ± 7.32 days in the herpetic group and 19.31 ± 6.30 days in the bacterial group. Descemetocele developed in 2 patients of the herpetic group. Other patients in both groups completed epithelialization after AMT procedures with varying amounts of corneal scarring. The bacterial group showed an improvement in UCVA, but the herpetic group showed no improvement in UCVA. CONCLUSION: AMT is a convenient approach for the treatment of corneal keratitis resistant to conventional treatment and allows the use of early topical steroid application. It provides patients with corneal scarring an opportunity for subsequent keratoplasty by arresting the inflammatory response.

Review of 306 evisceration surgeries performed between 2005 and 2013.

BACKGROUND/AIM: The purpose of the present study was to evaluate the reasons for eye evisceration surgeries performed from 2005 to 2013 in our clinic. MATERIALS AND METHODS: The medical records of patients who underwent evisceration surgery over the past 9 years were retrospectively evaluated. Detailed data were reviewed, with a focus on the first precipitating factor for evisceration. RESULTS: Of the 306 patients who underwent evisceration surgery in the studied period, 111 (36.27%) were female (with a mean age of 41.56 ± 21.38 years) and 195 (63.73%) were male (with a mean age of 37.76 ± 21.92 years). The most common cause of evisceration was ocular trauma (184 patients; 60.1%). Male patients experienced significantly more trauma, while glaucoma was more common in female patients. CONCLUSIONS: Eye removal is devastating for both patients and their relatives, and its most important and preventable cause is ocular trauma.

Measurements of Pupillary Diameter and Wavefront Aberrations in Pregnant Women.

Purpose. To show whether pregnancy affects the measurements of pupillary diameter and wavefront (WF) aberrations. Methods. This was a case-control study including 34 healthy pregnant women in the third trimester and age-matched 34 nonpregnant women. Only women who had no ocular abnormalities and no refractive error were included. We measured photopic and mesopic pupil diameter and WF aberrations at the third trimester and at the second postpartum month. Measurements of the right eyes were used in this study. The differences between groups were analysed by paired t-test and t-test. Results. Pregnant women's mean photopic pupil size in the third trimester was significantly higher than in postpartum period and in control group (3.74 ± 0.77, 3.45 ± 0.53, and 3.49 ± 0.15 mm, p < 0.05, resp.). Mesopic pupil size in the third trimester was also higher than in postpartum period and in control group (6.77 ± 0.52, 6.42 ± 0.55, and 6.38 ± 0.21 mm, p < 0.05, resp.). RMS-3 and RMS-5 values were higher in pregnancy but these differences were not statistically significant. Conclusion. Pregnancy increased photopic and mesopic pupil size significantly but did not increase wavefront aberrations notably. Increased pupil size may be due to increased sympathetic activity during pregnancy. And this activity can be noninvasively determined by measuring pupil size.