Remodeling of Cornea With Isotretinoin Treatment.

OBJECTIVES: To evaluate the change of corneal epithelial thickness (ET) in subjects using isotretinoin with spectral-domain optical coherence tomography and further to explore reflection of changes on corneal topography. METHODS: Forty eyes of 40 subjects with acne vulgaris scheduled for oral isotretinoin were included in this prospective study. Subjects were examined with RTVue-XR and Pentacam at baseline, 1th, 3rd, and 6th months of treatment, and 3rd month of isotretinoin cessation. RESULTS: A statistically significant increase was detected in each sector of ET map except inferonasal 7 to 9 mm between baseline and following visits (P<0.05, for all visits). The increase in superior (2-7 mm), inferior (2-7 mm), and maximum values in epithelium statistics and the decrease in superior (2-7 mm), inferior (2-7 mm), minimum, and maximum values in stroma statistics at follow-up visits were significant (P<0.05, for all visits). Central corneal thickness, maximum Ambrosio-relational thickness, average pachymetric-progression index at 1th, 3rd, and 6th months, and thinnest pachymetry, index of surface variance (ISV) at 3rd, and 6th months differed significantly (P<0.05, for specified visits). The regression in parameters was observed at 3rd month of isotretinoin cessation. CONCLUSIONS: Isotretinoin treatment induces epithelial thickening and stromal thinning. Remodeling of corneal layers causes statistical differences in ISV and pachymetry-related parameters of Pentacam. The pachymetry changes in cornea return to baseline at the 3rd month of discontinuation of treatment.

Application of autologous serum eye drops after pterygium surgery: a prospective study.

PURPOSE: The study aims to determine the effect of 50% autologous serum drops (ASD) on corneal healing and patient comfort following pterygium surgery. METHODS: Fifty eyes of 50 patients who underwent pterygium excision combined with autologous conjunctival graft were included in this prospective randomized study: in 25 eyes, 50% ASD. In the remaining 25 eyes, conventional artificial tears (CAT) were applied postoperatively until corneal epithelium had completely epithelialized. Corneal epithelium healing speed, visual analog scale (VAS) for postoperative pain assessment, conjunctival inflammation, and recurrences were evaluated. Patients were followed up for 6 months. RESULTS: Mean corneal epithelium closure time was 3.16 ± 0.37 days (range 3 and 4 days) in ASD group and 4.96 ± 0.84 days in CAT group (range 4 and 6 days), and the difference was statistically significant (p < 0.001). VAS scores were significantly lower in ASD group than CAT group in the first 5 days after surgery. In 9 of 50 eyes, moderate conjunctival inflammation continued 1 month: 4 (16%) in ASD group and 5 (20%) in CAT group (p = 0.713). In total, pterygium recurrence was seen in 5 (10%) eyes: 2 eyes (8%) in ASD group and 3 eyes (12%) in CAT group (p = 0.637). CONCLUSION: ASD accelerated corneal epithelial healing following pterygium surgery. ASD group had lesser pain that was seem to be related with accelerated corneal epithelial healing.

Assessment of Corneal Backward Light Scattering in Diabetic Patients.

OBJECTIVES: To analyze corneal backward light scattering differences in patients with type 2 diabetes mellitus. METHODS: We enrolled 43 eyes from 43 diabetic patients and 40 eyes from 40 healthy controls. Corneal backward light scattering was evaluated using densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (PentacamHR). RESULTS: When densitometry values were divided by depth, anterior layer of diabetic corneas displayed significantly higher corneal backward light scattering values than controls (32.05, 95% confidence intervals [CI], 31.02-33.08 vs. 29.18, 95% CI, 27.60-30.76, P=0.024). Corneal densitometry measurements were also significantly higher in diabetic eyes compared with control eyes, when considered by concentric zones of total cornea in the 0 to 2 mm (21.65, 95% CI, 20.28-23.01 vs. 18.87 95% CI, 18.49-19.25, P=0.020), and anterior layer in the 0 to 2 mm (27.3, 95% CI, 25.04-29.56 vs. 22.31, 95% CI, 20.57-24.05, P<0.001), 2 to 6 mm (26.2, 95% CI, 24.99-27.41 vs. 22.4, 95% CI, 20.18-24.62, P<0.001) and 6 to 10 mm (32.19, 95% CI, 29.98-34.40 vs. 27.2, 95% CI, 25.39-29.01, P=0.022). There was excellent positive correlation between anterior total corneal densitometry measurements and duration of diabetes (r=0.802, P<0.001), although no significant correlation was observed with anterior total corneal densitometry measurements and hemoglobin A1c levels (r=0.080, P=0.621) in diabetic eyes. CONCLUSIONS: Backward light scattering values from the anterior layer of the cornea is greater in diabetic eyes than in controls. Anterior total corneal densitometry measurements show positive correlation with the duration of diabetes.

Evaluating relaxed ciliary muscle tone in presbyopic eyes.

PURPOSE: Studies of age-related changes in ciliary muscle (CM) morphology and contractility have variously reported that CM weakens or strengthens with age. In response, the aim of this study was to evaluate relaxed CM tone in vivo in pre-presbyopic and presbyopic patients using a predictor value (PCM). METHODS: Two groups of eyes-40 eyes of 40 healthy volunteers with a mean age of 28.1 ± 5.8 years and 40 eyes of 40 healthy volunteers with a mean age of 56.6 ± 7.3 years-formed the sample for this prospective, observational cross-sectional study. Used to evaluate relaxed CM tone, PCM was calculated as the difference between the change in mean anterior chamber depth (ACD) and lens thickness (LT) before and after cycloplegia, as measured with swept-source optical biometry. RESULTS: The PCM for relaxed CM tone was 0.04 ± 0.04 mm in pre-presbyopic participants, 0.06 ± 0.03 mm in presbyopic ones, and significantly greater in presbyopic patients (p = .018). CONCLUSION: The statistical significance of PCM between pre-presbyopic and presbyopic eyes might not signify clinical significance, since the difference was close to the repeatability limits for swept-source optical biometry. When relaxed, CM tone does not diminish with presbyopia according to changes in anterior chamber parameters due to cycloplegia.

External ophthalmomyiasis: a case series and review of ophthalmomyiasis in Turkey.

Ophthalmomyiasis externa is the infestation of the superficial external ocular structures by fly larvae. This is a particularly rare condition, which has nevertheless been reported in several countries worldwide. It is common in sheep-farming areas, especially in Mediterranean countries. The patients may present with classic conjunctivitis, pseudomembranous conjunctivitis, conjunctival hemorrhages, punctuate keratitis, keratouveitis, and eyelid edema with erythema. Herein, we present three cases of external ophthalmomyiasis caused by Oestrus ovis larvae and review ophthalmomyiasis cases reported from Turkey.

The role of anterior hyaloid face integrity on retinal complications during Nd: YAG laser capsulotomy.

BACKGROUND: This study evaluated anterior hyaloid damage (AHD), AHD-related Nd:YAG laser parameters, and retinal complications in subjects that underwent Nd:YAG laser posterior capsulotomy for cataracts. METHODS: In this prospective, cross-sectional study, 277 pseudophakic eyes of 216 patients treated with Nd:YAG laser capsulotomy for posterior capsule opacification were enrolled. Pulse number, pulse energy, and total energy were noted for each eye. All procedures were performed with a sense of anterior hyaloid protection. Anterior hyaloid faces were assessed during procedure and 1 day after the procedure. Eyes with biomicroscopically invisible anterior hyaloid face were excluded from statistical analysis. Eyes with and without AHD were compared according to Nd:YAG laser parameters. Retinal complications were evaluated at day 1, week 1, month 1, and month 3. RESULTS: In 22 eyes (7.9 % of 277 eyes), the anterior hyaloid face couldn't be assessed biomicroscopically. Anterior hyaloid damage was observed in 49 eyes (19.2 % of 255 eyes). The pulse number, pulse energy, and total energy were observed to be higher in eyes with AHD (P < .001, P = .024, P < .001, respectively). Cystoid macular edema was detected in five eyes (three with AHD) at 1-week examination. Localized retinal detachment occurred in one eye with AHD. Occurrence of retinal complication in the AHD(+) group was 12.7 times higher than in the AHD(-) group, adjusted for total energy used (P < 0.001). CONCLUSION: The risk of AHD may increase with high pulse number, pulse energy, and total energy. Anterior hyaloid face integrity should be considered for YAG laser-related retinal complications.

Autofluorescence patterns as a predictive factor for neovascularization.

PURPOSE: To investigate fundus autofluorescence (FAF) patterns in patients with nonexudative age-related macular degeneration (AMD) and to test if FAF patterns affect the development of choroidal neovascularization (CNV). METHODS: One hundred one patients with early AMD underwent a detailed ophthalmological examination. Fundus autofluorescence imaging was performed with a confocal scanning laser ophthalmoscope following a standard protocol. The classification of the International Fundus Autofluorescence Classification Group was used for the description of the FAF patterns. RESULTS: One hundred seventy-eight eyes of 101 patients (59 women, 42 men) with a mean (±SD) age of 66.4 (±6.1) years were included. The mean (±SD) follow-up was 41.3 (±27) months. One hundred seventy-eight eyes presented various types of drusen with or without hyperpigmentation or hypopigmentation at initial examination. During follow-up, a total of 22 (12.3%) eyes developed CNV. The most frequent pattern for CNV development was the patchy pattern in 30.4%, followed by linear in 25%, and reticular pattern in 20.8% of eyes. CONCLUSIONS: Fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope is a useful technique to identify FAF characteristics in patients with nonexudative AMD. Different patterns of FAF abnormalities can be obtained in these eyes. Our results indicate that patchy, linear, and reticular patterns are the specific patterns associated with CNV development in nonexudative AMD.

Analyses of surgically induced astigmatism and axis deviation in microcoaxial phacoemulsification.

To evaluate surgically induced astigmatism (SIA) and axis deviation after coaxial microincision superotemporal clear corneal phacoemulsification incision in eyes with differently located steep axis. This prospective, comparative study included four groups of 45 eyes with age-related cataracts; each group underwent 2.2-mm superotemporal clear corneal incision (CCI) cataract surgery. The four groups of patients were divided by location of the steep axis. Groups were matched according to symmetry of the steep axis for both right and left eyes as follows--0°-45° of steep axis for right eyes, and 136°-180° for left eyes (group 1); 46°-90° for right eyes and 91°-135° for left eyes (group 2); 91°-135° for right eyes and 46°-90° for left eyes (group 3); and 136°-180° for right eyes and 0°-45° for left eyes (group 4). Outcome measures included changes in mean total astigmatism, SIA, and axis deviation. Astigmatism was measured by manual keratometry readings before surgery and week 1, week 4, week 8, and week 12 postoperatively. SIA was calculated by the vector analysis (Holladay-Cravy-Koch method). The magnitude of mean total astigmatism was lowest in group 3 and highest in group 1 at week 12. SIA was 0.39 diopters (D), 0.22 D, 0.17 D, and 0.28 D in group 1, group 2, group 3, and group 4, respectively. The change in astigmatic axis deviation was highest in group 3 (23.6 ± 16.6) (P < 0.05). Axis deviation and SIA were stable after week 4. Planning of CCI on or near the steep axis can help decrease corneal astigmatism.

Evaluation of vessel density in healthy subjects with family history of glaucoma.

OBJECTIVES: To investigate whether any microvascular changes are present in optic disc, peripapillary or maculary regions in healthy subjects with a family history of glaucoma. METHODS: A total of 82 healthy subjects including 42 first-degree relatives of primary open-angle glaucoma (POAG) and 40 controls were enroled in this cross-sectional study. Global and sectoral vessel density (VD) measurements excluding large vessels, retina nerve fibre layer (RNFL) and macula ganglion cell (mGCC) thicknesses were obtained from a combined optical coherence tomography-angiography (OCT-A) and spectral-domain OCT system. Effect size (ES) was used for evaluating the magnitude of the statistically significant difference. Area under receiver operating characteristic curves (AUCs) were used to examine the ability of parameters to differentiate first-degree relatives to controls. RESULTS: There was no significant difference in RNFL and mGCC thicknesses between groups. Although lower VD measurements in optic disc, peripapillary region, and macula were observed in the first-degree relatives, statistically significant mean difference (3.13 ± 0.87, p = 0.001) and large ES (0.80) were in only lower nasal sector of peripapillary region. Inter-eye asymmetry of supero-nasal VD was also statistically higher (3.74 ± 2.55 vs 1.89 ± 1.64) with a large ES in the first-degree relatives (p < 0.001, ES = 0.86). AUC for differentiating first-degree relatives from controls was highest for inter-eye asymmetry of supero-nasal sector VD (0.74, p < 0.001), followed by lower nasal sector VD (0.72, p < 0.001). CONCLUSION: Compared to controls, first-degree relatives of patients with POAG were found to have significantly greater inter-eye asymmetry in supero-nasal peripapillary VD and less VD in the lower nasal peripapillary region.

The Use of Prostaglandin Analogues and Cystoid Macular Edema after Uneventful Cataract Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: To evaluate whether using prostaglandin analogues (PGAs) perioperatively is associated with an increased rate of the development of clinical or subclinical cystoid macular edema (CME) after uneventful cataract surgery. METHODS: The PubMed, Scopus, and ScienceDirect databases were searched to June 2022 for this systematic review and meta-analysis. Two authors independently screened search results. Random-effects meta-analyses were performed to calculate the overall incidence rate and odds ratio (OR). Quality of studies was assessed using the modified Newcastle-Ottawa scale. The incidences of CME for continued vs discontinued use of PGAs perioperatively, continued use of PGAs, discontinued use of PGAs, and PGA users vs non-PGA antiglaucomatous users were main outcomes. RESULTS: Out of 544-articles, 9 studies that met the inclusion criteria were analyzed. The continued use of PGAs was not associated with an increased risk of the development of subclinical macular edema compared with discontinued use (OR = 1.32 [95% Confidence Interval (CI) = 0.49-3.51], p = .582). The overall incidence of CME was 34% (95% CI = 0.17-0.52) for continued use of PGAs and 7% (95% CI = 0.02-0.13) for discontinued use of PGAs. Using PGAs did not increase the risk of CME's development compared with non-PGA antiglaucomatous usage (OR = 2.29 [95% CI = 0.84-6.23], p = .103). CONCLUSIONS: Discontinuing treatment with PGAs during the perioperative period in eyes without any known risk factors for CME has no clinically significant effect on reducing the development of postoperative CME based on the existing studies. Further, well-designed randomized controlled trials need to be performed.