The effect of prematurity on tear production.

PURPOSE: To evaluate the effect of the birth weight and the postconceptional age on the tear production of preterm and term newborn infants and to evaluate the changes in tear production during the first two months of life. SUBJECTS--METHODS: Both eyes of medically stable term and preterm infants were included in the study. Based on postconceptional age and birth weight, we divided preterm infants into three groups. Then, we measured the basal and reflex tear secretions of both eyes by Schirmer tests before and after instillation of topical anesthetic agent. We performed initial tear measurements on the second day of life (between first 24 hours to first 48 hours after birth): and at 2 weeks, 4 weeks and 8 weeks after birth. RESULTS: We tested a total of 138 infants (63 preterm and 75 term), 72 males and 66 females. Schirmer-1-test of preterm and terms on the 2nd day of life revealed a mean basal tear secretion (BTS) of 4.8 +/- 4.1 and 8.8 +/- 3.2 mm, respectively (p < 0.0001). The mean reflex tear secretion (RTS) within 48 hours of life was 6.1 +/- 3.9 mm and 10.3 +/- 4.4 mm in preterm and term infants, respectively (p < 0.0001). The mean values of both basal and reflex tear secretion were significantly lower in the preterm than the term infants during the first two months of the life. In preterm infants, both basal and reflex tear secretions were found to be highly correlated with postconceptional age (r: 0.79 and 0.74, respectively, both p values: 0.001); however, there was a weak correlation with birth weight (r: 0.16 and 0.19, respectively, both p values: 0.01). Statistically significant differences for both BTS and RTS existed among the three postconceptional age groups: there were no such difference among the three different birth weight groups. We found no gender or laterality dependent (side of the eyes) differences in the tear production (both p values >0.05). CONCLUSIONS: Preterm infants have significantly reduced tear secretion compared with term infants. Postconceptional age, rather than birth weight, seems to be more correlated with the tear secretion. Sex and laterality does not appear to have an effect on tear production in infants. Tear production of preterm infants is significantly reduced than that of term infants during the first two months of life. Term infants increased their tear production significantly in each examination during the neonatal period while the preterms increase tear production significantly only at mean postconceptional age of eight and a half (8.5) months.

Keratoconus presenting with bilateral simultaneous acute corneal hydrops.

PURPOSE: To report a case of unknown keratoconus presenting with bilateral simultaneous acute corneal hydrops. METHODS: Case report. RESULTS: A case of a 12-year-old male patient with Leber congenital amaurosis (LCA) presented with sudden whitening and lacrimation for 2 days in both eyes simultaneously. At the initial examination, there were bilateral acute corneal hydrops, enophthalmic eyes and roving nystagmus. Ultrasonography revealed clear crystalline lenses and attached retina. Initial management consisted of topical hypertonic solutions, steroids and artificial tears. CONCLUSION: Bilateral simultaneous acute corneal hydrops has not been reported before in the literature. It may be the presenting sign of keratoconus.

The relationship between plasma leptin levels and chronic complication in patients with type 2 diabetes mellitus.

OBJECTIVE: The aim of this study was to investigate the relationship between plasma leptin levels and the chronic complications in type 2 diabetic (T2DM) patients. PATIENTS AND METHODS: There were 157 T2DM patients (age, 56.7 ± 11.4 years; mean diabetes duration, 8.9 ± 3.6 years; mean body mass index, 28.1 ± 4.3 kg/m(2)) included to the study. Microvascular and macrovascular complications of diabetes were evaluated in all patients. There were 46 healthy subjects as control group. Plasma leptin levels were measured in both diabetic and healthy subjects. RESULTS: Plasma leptin levels of the diabetic patients were not significantly different from the healthy subjects (26.4 ± 18.2 vs. 29.1 ± 13.1 ng/mL, P > 0.05). Plasma leptin levels in obese diabetic patients were higher than in nonobese (37.6 ± 20.9 vs. 20.0 ± 17.2 ng/mL, P = 0.001); in hypertensive diabetic patients than normotensive (35.2 ± 19.3 vs. 19.4 ± 13.9 ng/mL, P < 0.001); dyslipidemic diabetic patients than normolipidemic diabetic subjects (38.5 ± 18.3 vs. 31.3 ± 19.5 ng/mL, P = 0.038); diabetic patients with metabolic syndrome than diabetic patients without metabolic syndrome (37.9 ± 20.1 vs. 23.2 ± 15.3 ng/mL, P = 0.001). Plasma leptin levels were lower in diabetic patients who were smokers than nonsmokers (20.0 ± 15.5 vs. 24.7 ± 17.4 ng/mL, P = 0.023). There was no significant difference between patients with and without diabetic nephropathy, retinopathy, neuropathy, coronary artery disease or peripheral vascular disease (P > 0.05). CONCLUSIONS: Our data suggest that obesity, hypertension, dyslipidemia, and metabolic syndrome in T2DM were associated with increased plasma leptin levels. We conclude that plasma leptin levels may not be strongly associated with microangiopathy and macroangiopathy in T2DM individuals.

Conversion to deep anterior lamellar keratoplasty (DALK): learning curve with big-bubble technique.

BACKGROUND AND OBJECTIVE: To report the perioperative complications and clinical outcomes of 50 deep anterior lamellar keratoplasty (DALK) cases. PATIENTS AND METHODS: Fifty eyes of 50 patients with pathologies involving the corneal stroma and sparing the Descemet's membrane and endothelium were included consecutively in this prospective, noncomparative interventional case series study. DALK was performed using the big-bubble technique. RESULTS: The most frequent indication for DALK surgery was keratoconus (26 eyes), followed by corneal dystrophy (10 eyes) and superficial corneal scar (14 eyes). The average follow-up period was 12.0 ± 3.9 months. DALK was completed in 41 cases (82%). A big bubble was achieved successfully in 37 cases (74%). Descemet's membrane perforations occurred in 14 (28%) eyes, 8 of which were macroperforation and necessitated conversion to penetrating keratoplasty. Complications tended to decrease throughout the study. Postoperative best-corrected visual acuity of 0.5 or better was present in 30 of 41 (73.2%) eyes that underwent DALK. There was no episode of graft rejection. CONCLUSION: DALK big-bubble technique may be a valuable procedure during transition from penetrating keratoplasty to anterior lamellar keratoplasty. It provided acceptable visual and refractive outcome even during the learning period in a variety of corneal lesions.

Demographic and clinical features of uveitis in tertiary centers in Turkey.

PURPOSE: To analyze the referral patterns and clinical features of uveitis in tertiary eye care centers in Turkey. METHODS: Uveitis services of eight university clinics collected data on uveitis patients who presented during 2004. Data were collected on a form including a questionnaire on socio-demographic and clinical features which were documented at presentation. RESULTS: A total of 761 patients (1187 eyes) with a mean age of 35.5 years were included in the study. Male to female ratio was 1.04:1. The majority of patients (89.6%) were from an urban population, 53% were referrals and 43% had had uveitis for more than one year. The most common type of uveitis was anterior uveitis (52.5%) followed by panuveitis (28.1%), posterior uveitis (12.7%) and intermediate uveitis (6.7%). In 56.8% of patients an etiological classification was established. The most common etiology was Behcet's disease (32.1%), followed by Fuchs' heterochromic iridocyclitis (5.1%) and ocular toxoplasmosis (4.7%). Among 48 pediatric patients uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis both having equal frequencies (12.5%) were the most common diagnosis. These were followed by Behcet's disease with juvenile-onset (10.4%). At the time of presentation, 6.25% of the patients were legally blind (having visual acuity less than 0.1 in the better seeing eye). CONCLUSION: Compared to the uveitis series reported from other countries, Behcet uveitis was the leading cause of uveitis in this series. Uveitis associated with juvenile idiopathic arthritis and ocular toxoplasmosis were the most common cause of uveitis in childhood. On the other hand, entities like acquired immunodeficiency syndrome-related uveitis, presumed ocular histoplasmosis and Birdshot retinochoroidopathy were rare.

Review of the chronology of clinical manifestations in 60 patients with Behçet's disease.

BACKGROUND: The natural course of Behçet's disease is not fully known. OBJECTIVE: The aim of the present study was to determine the occurrence of the symptoms retrospectively in chronologic order in patients with Behçet's disease, diagnosed according to the criteria of the International Study Group for Behçet's Disease. METHODS: A total of 60 consecutive patients (29 male and 31 female; aged 35.87 +/- 9.84 years) were involved in the study. The symptoms of the disease were retrospectively recorded in the time order of the manifestations per patient. RESULTS: Oral ulcer was the most commonly observed onset manifestation (51 of 60 patients: 85%), followed by genital ulcer (13 of 60 patients: 21.7%) and articular symptoms (10 of 60 patients: 16.7%). The duration between the oral ulcer and the fulfillment of diagnostic criteria was calculated to be 3.77 +/- 4.43 years. The same duration was 2.50 +/- 4.74 and 2.11 +/- 3.44 years for genital ulcer and articular symptoms, respectively. The duration between the time point of fulfillment of diagnostic criteria and the diagnosis (2.83 +/- 2.3 years) was found to be longer in female patients (3.2 +/- 2.5 years). The duration was also longer in patients having only mucocutaneous lesions (3.18 +/- 2.5 years) than in patients having serious organ involvement such as eye disease (1.63 +/- 0.7 years; p < 0.05). CONCLUSION: Our study indicates that oral ulcer is the onset manifestation in the majority of the patients and the disease is often diagnosed with a delay of several years after the appearance of the onset sign.