Corneal endothelial changes in long-term cannabinoid users.

PURPOSE: The aim of this study was at evaluating the effects of long-term cannabis use on the corneal endothelial cells with the specular microscopy. METHODS: The study enrolled 28 eyes of 28 patients diagnosed with cannabinoid use disorder. The cannabinoid group was selected among patients who had been using the substance for three days or more per week over the past one year. Thirty-two eyes of 32 age- and sex-matched healthy individuals enrolled as control group in the study. Corneal endothelial cell density (CD), coefficient of variation (CV) and hexagonal cell ratio (HEX) values were analyzed by specular microscopy. RESULTS: The mean CD was 2900 ± 211 cells/mm2 in the cannabinoid group and 3097 ± 214 cells/mm2 in the control group (p < 0.01). There was a significant decrease in cannabinoid group. The mean CV was 29 ± 7 and 27 ± 4 in the cannabinoid and control groups, respectively (p > 0.05). No significant difference was present between the cannabinoid and the control groups in terms of mean CV value. The mean HEX was 52 ± 5% in the cannabinoid group and 53 ± 10% in the control group (p > 0.05). There was not a significant difference between the cannabinoid and the control groups in terms of mean HEX value. CONCLUSION: A significant decrease in CD was found in cannabinoid users compared the control group.

Endoscopic transcanalicular diode laser dacryocystorhinostomy: is it an alternative method to conventional external dacryocystorhinostomy?

PURPOSE: To compare the success rates of endoscopic transcanalicular diode laser dacryocystorhinostomy (EL-DCR) and external DCR. MATERIALS AND METHODS: Operations were performed on 55 eyes of 54 patients who had distal nasolacrimal canal obstruction. External DCR was performed on 29 of the eyes and EL-DCR on 26 of them. Success was defined based on subjective relief of patients reported at their final examinations. RESULTS: There were 23 women and 6 men in group 1 and 19 women and 6 men in group 2 (p = 0.77). The mean ages of groups were 45.24 ± 12.08 (range, 15-74) and 43.2 ± 17.01 (range, 11-72) years, respectively (p = 0.63). The mean follow-up times were 8.82 ± 5.51 (range, 3-18) and 7.12 ± 2.96 (range, 2-12) months, respectively in groups (p = 0.58). The success rates based on symptoms were measured at 25 of 29 (86%) and 17 of 25 (68%) for 2 groups. The difference in the success rates was higher but not found to be statistically significant (p = 0.202). The authors found various conditions related to nasal passage in 4 of 8 unsuccessful EL-DCR, including allergic rhinitis, nasal crust, silicone tube reaction, and unsuitable passage for endoscopic surgery. CONCLUSIONS: The success rate of EL-DCR was lower than that of the external DCR; however, no statistically significant difference was observed. Endoscopic transcanalicular diode laser DCR may be considered as an alternative method to external DCR with these results.

Periocular allergic contact dermatitis following topical Mitomycin C eye drop application.

A 63-year-old women had an extensive limbal papilliform tumoural lesion of her left eye. Mitomycin C (MMC) was applied to the area at a dose of 0.2 mg/ml after total surgical excision of the lesion. The lesion was diagnosed as invasive squamous cell carcinoma on histopathology and topical 0.02% MMC was prescribed four times daily to the left eye. A severe per ocular contact dermatitis of the left eye developed two days after starting MMC. The patch test result was positive. The per ocular dermatitis resolved after discontinuation of the topical MMC and treatment with a topical corticosteroid.

Increased oxidative stress in patients with pseudoexfoliation syndrome.

PURPOSE: The objective of this study was to investigate the antioxidant/oxidant status of serum in patients with pseudoexfoliation syndrome (PEX). METHODS: Forty-seven patients with PEX and 32 healthy controls were included in the study. Serum total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using a novel automated method. RESULTS: A significant increase in serum TOS (p < 0.001) and a significant decrease in serum TAC (p < 0.0001) were observed in PEX patients compared to control subjects. CONCLUSION: TAC decreases while the oxidative stress increases in PEX.

Aripiprazole-induced transient myopia.

This study aims to present a case of transient myopia due to aripiprazole used in the treatment of depression. A 21-year-old female who was being treated for depression with 15 mg/day Aripiprazole during two months. She normally used -3.75 D glasses. She was admitted to our outpatient clinic with sudden onset blurring of vision in both eyes despite using glasses for about three days. Using of aripiprazole was observed in the patient's history. She was found to have myopia of -6.0 diopters in both eyes with measurement of otorefractometer; her visual acuity was 6/10 in both eyes with her glasses. The other eye examination findings of the patient were normal. The drug was discontinued, and the patient was followed. One mount later on examination, the patient's visual acuity increased to 10/10 in both eyes. Following the first day of the Alx values measured were 0.3 mm longer than one month after the measurement; the minimal difference between the other anterior segment findings were recorded. Although the specific mechanisms that cause acute myopia has not been fully revealed, it can be ciliary spasm, ciliary bodies effusion, peripheral uveal effusion and effects of ocular serotonergic intraneural fibers. We believe that it would be important for clinicians. They should keep in mind these conditions when prescribing aripiprazole and need to inform patients about the side effects related to the eye.

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

PURPOSE: To compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications. METHODS: Twenty-six patients receiving high-dose (>0.5 mg/kg per day) systemic isotretinoin treatment and 25 patients treated with low-dose systemic isotretinoin (<0.5 mg/kg per day) underwent complete ophthalmologic assessment of both eyes before treatment, at days 45 and 90 of treatment, and 1 month after the completion of treatment, together with a microbiologic evaluation of conjunctival flora, tear film break-up time (BUT), and anesthetized Schirmer test of the right eye of each patient. RESULTS: When the results of the anesthetized Schirmer test for Groups 1 and 2 were compared (pretreatment, days 45 and 90 of treatment, and 1 month after treatment), there was no statistically significant difference between the groups (p > 0.05). Although BUT did not differ significantly between the two groups before treatment (p >0.05), there was a statistically significant decrease in BUT in Group 1 when compared with Group 2 at days 45 and 90 of treatment (p <0.05). One month after the completion of treatment, there was no difference in BUT between the two groups (p >0.05). No difference in Staphylococcus aureus colonization was detected between the two groups at days 45 and 90 of treatment (p >0.05). CONCLUSIONS: During systemic isotretinoin treatment, eye dryness was related to the dose used, at least during the period of treatment. Conversely, the rate of conjunctival S aureus colonization was unrelated to the dose of isotretinoin.

The conjunctival flora in vernal conjunctivitis patients.

We investigated conjunctival flora changes in vernal conjunctivitis (VC) (n = 30) patients compared to the normal eye (n = 30). Growth was observed in 86.6% of the vernal group, and 80% of the control group specimens. We believe that administering prophylactic treatment would be helpful in VC patients who are to have intraocular surgery to prevent postoperative endophthalmitis.

Familial association of keratoconus and granular corneal dystrophy: The familial case series.

OBJECTIVE: The aim of the present study was to evaluate the coexistence of bilateral keratoconus and granular corneal dystrophy (GCD) in the members of a family. METHODS: A total of 22 patients were examined in four generations of the family tree in this family screening study. Visual acuity test, biomicroscopic examination, and fundus examination were performed in all patients. The diagnosis of granular dystrophy was based on biomicroscopic examination findings. Corneal topography was performed on the patients diagnosed with granular dystrophy and other family members aged >5 years with normal examination findings. Corneal photographs were obtained from all patients with granular dystrophy except one case. RESULTS: Keratoconus or subclinical keratoconus was detected in seven cases. In addition, GCD type 1 was found in six of the seven cases. All patients diagnosed with keratoconus and granular dystrophy were females. On the other hand, there was no ophthalmologic problem in the men of the family tree. Although an autosomal dominant inheritance was found, the onset of the disease only in women suggests that there may be a variant expression. CONCLUSION: The present study showed an association of GCD and keratoconus in four generations of a family. More research is required to further explain this association.

Serum alpha-1-antitriypsin levels in patients with pseudoexfolative syndrome.

PURPOSE: To evaluate the levels of serum alpha 1-antitrypsin in patients with pseudoexfoliation syndrome (PEX) and healthy control subjects without PEX. MATERIAL AND METHODS: Forty-four patient with PEX and 40 healthy control subjects (84 subjects total) were enrolled into the study. Serum ATT levels were measured using nephelometry. RESULTS: The mean serum AAT concentration in PEX group was significantly higher than in the controls (p=0.0001). CONCLUSION: Serum AAT levels were found to be increased in patients with PEX. Increased serum AAT levels in PEX may explain the role of inflammation in this group of patients.

Aqueous humor and serum levels of chromium in cataract patients with and without diabetes mellitus.

PURPOSE: To evaluate the aqueous humor and serum levels of chromium (Cr) in cataract patients with and without diabetes mellitus. METHODS: Levels of Cr were measured using atomic absorption spectrometry in the serum from 20 patients and aqueous humor aspirates taken during anterior segment surgery from 20 eyes of 20 patients who had diabetic cataracts and from 20 eyes of 20 patients who had senile cataract only. RESULTS: The mean aqueous humor Cr concentration in eyes with diabetes cataract was significantly lower than that from eyes with senile cataract (p < 0.001). There was also a statistically significant difference between the serum Cr concentrations of the diabetic group and the control group (p < 0.001). CONCLUSION: The aqueous humor and serum Cr levels are decreased in eyes with diabetic cataract.

Conjunctival flora in Behçet patients.

BACKGROUND: To determine the difference in conjunctival flora in Behçet patients compared with the normal population. METHODS: This study was carried out on a study group of 50 patients in the inactive period of Behçet's disease and a control group of 50 age- and sex-matched healthy subjects with no systemic or ocular disease. A swab was taken from the lower fornix using a sterile swab and inoculated into bloody eosin methylene blue, chocolate, and Sabouraud dextrose agar media. RESULTS: The mean age was 36.04 (SD 2.16) years for the Behçet group and 35.64 (SD 1.96) years for the control group. Bacterial growth was observed in 92% (n = 46) of the Behçet group and 56% (n = 29) of the control group. The Behçet group results were Staphylococcus aureus in 12 (24%), coagulase negative staphylococci (CNS) in 32 (64%), Moraxella spp in 8 (16%), Streptococcus spp in 8 (16%), Bacillus spp in 4 (8%), Neisseria spp in 4 (8%), Candida spp in 3 (6%), and Haemophilus spp in 1 (2%). In the control group, the results were S. aureus in 2 (4%), CNS in 24 (48%), Moraxella spp in 2 (4%), Streptococcus spp in 1 (2%), Bacillus spp in 3 (6%), Neisseria spp in 3 (6%), and Candida spp in 1 (2%). INTERPRETATION: S. aureus, Moraxella spp, and Streptococcus spp colonization was significantly higher in the conjunctival flora of Behçet patients than in that of the control group. A bacterial etiology may be involved in the pathogenesis of Behçet's disease.

Corneal endothelial changes in patients with vitamin D deficiency.

Purpose: The purpose of this study is to evaluate the effect of vitamin D deficiency on corneal endothelial layer using specular microscopy. Methods: Fifty-eight eyes of 58 patients whose vitamin D level was below 15 ng/ml and who had no ocular pathology were included in the study (Group 1). Forty eyes of 40 age-and sex-matched subjects were enrolled as control group (Group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical Inc., Nishinomiya, Japan). The obtained data were compared between the groups. Results: There was no significant difference between the groups in terms of age and gender (P = 0.344, P = 0.399, respectively). The mean CD value was 2772.79 ± 202.21 cells/mm2 in Group 1 and 2954.97 ± 116.89 cells/mm2 in Group 2 (P = 0.001). The mean CV value was 30.31 ± 3.65 in Group 1 and 28.20 ± 2.71 in Group 2 (P = 0.003). The mean HEX value was 46.56 ± 6.32 in Group 1 and 51.07 ± 5.28 in Group 2 (P = 0.001). The mean CCT value was 555.87 ± 36.90 µ in group 1 and 549.0 ± 37.39 µ in Group 2 (P = 0.96). Conclusion: Vitamin D deficiency may affect the corneal endothelial layer. Patients with vitamin D deficiency should be evaluated for endothelial parameters in particular before an intraocular surgery. Further studies are needed to confirm our results.

Corneal Endothelial Changes in Behçet's Patients with Inactive Ocular Involvement.

PURPOSE: The purpose of this article is to evaluate alterations in the corneal endothelial layer in Behçet's disease (BD) with inactive ocular involvement using specular microscopy. MATERIALS AND METHODS: Thirty-three eyes of 33 BD patients who had at least one anterior segment involvement and no active inflammation in the last 3 months were included in the study (group 1). Twenty-seven of the 33 BD patients had an anterior uveitis attack and six of them had a panuveitis (both anterior and posterior involvement) attack. Thirty-three eyes of 33 age- and sex-matched healthy subjects were enrolled in the control group (group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical, Nishinomiya, Japan), and the results were compared between groups. RESULTS: The mean CD was 2739 ± 164.18 cells/mm2 in group 1 and 2922 ± 107.60 cells/mm2 in group 2 (p = 0.001). The mean CV was 32.9 ± 4.76 in group 1 and 28.5 ± 3.06 in group 2 (p = 0.001). The mean HEX was 44.7 ± 6.51 in group 1 and 49.7 ± 6.10 in group 2 (p = 0.019). The mean CCT was 545.75 ± 40.89 µ in group 1 and 545.66 ± 30.09 µ in group 2 (p > 0.05). CONCLUSIONS: Ocular attacks in our BD patients may have caused permanent changes in the corneal endothelial layer. However, these changes did not lead to corneal decompensation, but further studies are necessary to confirm these results.

Aqueous humor erythropoietin levels in patients with primary open-angle glaucoma.

PURPOSE: To evaluate the levels of erythropoietin (EPO) in the aqueous humor in eyes with primary open-angle glaucoma (POAG) and without glaucoma. METHODS: Levels of EPO were measured using a sandwich enzyme-linked immunosorbent assay kit in aqueous humor aspirates taken during anterior segment surgery from 45 patients, of whom 20 had POAG and 25 had senile cataract only. RESULTS: The mean aqueous humor EPO concentration in eyes with POAG (10.91+/-4.32 mU/mL) was significantly higher than that from eyes with cataract (8.24+/-1.77 mU/mL, P=0.008). There was no significant difference between the serum EPO concentrations of POAG (26.46+/-10.36 mU/mL) and the control group (24.50+/-7.59 mU/mL, P=0.468). There was no correlation (P=0.165) between the EPO aqueous humor concentration and the EPO serum concentration while there was no correlation between the EPO aqueous humor concentration and the EPO serum concentration in the control group (P=0.819). CONCLUSIONS: The aqueous humor EPO level is increased in eyes with POAG.

The Influence of Corneal Collagen Crosslinking on Conjunctival Flora.

PURPOSE: To investigate the influence of corneal collagen crosslinking (CXL) on conjunctival flora. MATERIALS AND METHODS: Included in this study were 42 patients, all of whom were treated with CXL for progressive keratoconus (KC). Conjunctival swab samples were collected under operating-room conditions immediately before and immediately after the procedure. Samples were quickly immersed in Amies Transport Medium (ATM), transferred to the microbiology laboratory, diluted, and inoculated into three areas each of blood agar, chocolate agar, eosin methylene blue (EMB) agar, and Saboraud-Dextrose agar plates. Inoculated plates were incubated at 35°C for 24-48 h. Preliminary species identification of isolated bacterial colonies was based on catalase and oxidase tests, Gram staining, and colony morphology. Definitive identification of isolates was made with Vitek-II fully automated identification kits. RESULTS: Cultures were positive in 24 (57.1%) preoperative and 10 (23.8%) postoperative samples (p ˂ 0.05). Microorganisms isolated from preoperative conjunctival samples included coagulase-negative Staphylococcus (CNS) spp. in 23 (54.8%) samples, S. aureus in three (7.1%), Moraxella spp. in two (4.8%), Streptococcus spp. in three (7.1%), Corynebacterium spp, in one (2.4%), Micrococcus spp. in one (2.4%), and Candida spp. in one (2.4%). Microorganisms isolated from postoperative conjunctival samples included CNS spp. in nine (21.4%) samples, S. aureus in one (2.4%), Corynebacterium spp. in two (4.8%), and Acinetobacter spp. in one (2.4%). CONCLUSIONS: CXL appears to have a significant impact on conjunctiva flora.

Depression and anxiety in patients with pseudoexfoliative glaucoma.

OBJECTIVE: This study aimed to determine whether patients with pseudoexfoliative glaucoma (PXG), associated with vascular disorders, have more depressive and anxiety symptoms than patients with primary open-angle glaucoma (POAG) and controls without glaucoma. The vascular depression model was tested in this study. METHOD: The sample consisted of 41 PXG patients, 32 POAG patients and 40 controls. Each subject was diagnosed as having PXG or POAG or chosen as a control patient by an ophthalmologist and then evaluated by a psychiatrist. The Structured Clinical Interview for DSM-IV, Turkish version; Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Mini Mental State Examination; and Montgomery-Asberg Depression Rating Scale (MADRS) were administered to all subjects. RESULTS: The HDRS and MADRS scores of the PXG patients were significantly higher than those of the POAG and the control group (chi(2)=9.858, p=.007 and chi(2)=11.618, p=.003, respectively). The HARS scores did not show a significant difference between the patients with PXG or POAG and the control subjects (chi(2)=1.615, p=.446). In each of the three groups, there was no correlation between the HDRS, HARS or MADRS scores and any of the following parameters: duration of glaucoma, medical treatment, visual acuity, intraocular pressure, perimetric stage, cup-disc ratio and number of glaucoma operations (p>.05). CONCLUSION: A relationship between PXG and severity of depressive symptoms was shown by our data. However, no significant difference could be found between the anxiety levels of the three groups.

Serum homocysteine, vitamin B 12 and folic acid levels in different types of glaucoma.

BACKGROUND: This study was performed to compare levels of serum homocysteine (Hcy), vitamin B12 and folic acid in patients with primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PEXG), normotensive glaucoma (NTG) and healthy controls. METHODS: Twenty-five patients with POAG, 24 with PEXG, and 18 with NTG, along with 19 control healthy subjects were included this prospective study. Levels of serum Hcy were measured using immunoassay, and those of serum vitamin B12 and folic acid were measured using competitive chemiluminescent enzyme immunoassay. RESULTS: The mean Hcy concentration in the PEXG group was significantly higher (P < 0.001) as compared to the other groups. There were no significant differences with respect to the mean Hcy concentrations among other groups (P > 0.05). There were no statistical differences in serum vitamin B12 levels among POAG, PEXG, NTG and control subjects (P > 0.05). The mean serum folic acid level was significantly lower in the subjects with PEXG (P < 0.009). However, the mean folic acid concentrations among the other groups did not differ significantly (P > 0.05). CONCLUSION: Elevated levels of Hcy in PEXG may explain the role of endothelial dysfunction among patients with PEXG.

Evaluation of Anterior Segment's Structures in Tilted Disc Syndrome.

Purpose. To evaluate anterior segment's structures by Pentacam in patients with tilted disc syndrome (TDS). Methods. Group 1 included forty-six eyes of forty-six patients who have the TDS. Group 2 including forty-six eyes of forty-six cases was the control group which was equal to the study group in age, gender, and refraction. A complete ophthalmic examination was performed in both groups. All cases were evaluated by Pentacam. The axial length (AL) of eyes was measured by ultrasound. Quantitative data obtained from these measurements were compared between two groups. Results. There was no statistically significant difference for age, gender, axial length, and spherical equivalent measurements between two groups (p = 0.625, p = 0.830, p = 0.234, and p = 0.850). There was a statistically significant difference for central corneal thickness (CCT), corneal volume (CV), anterior chamber angle (ACA), and pupil size measurements between two groups (p = 0.001, p = 0.0001, p = 0.003, and p = 0.001). Also, there was no statistically significant difference for anterior chamber depth (ACD), anterior chamber volume (ACV), and lens thickness (LT) measurements between two groups (p = 0.130, p = 0.910, and p = 0.057). Conclusion. We determined that CCT was thinner, CV was less, and ACA was narrower in patients with TDS. There are some changes in the anterior segment of the eyes with tilted disc.

Systemic Prolidase Activity and Oxidative Stress in Keratoconus.

AIM: Our aim was to evaluate the serum prolidase activity, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with keratoconus. MATERIAL AND METHOD: A total 69 keratoconus patients and 72 control subjects with similar age and gender were evaluated within the scope of this study. The keratoconus group was divided into four stages with the modified Krumeich classification. Serum prolidase activity, TAC and TOS were measured and compared between the patient and control groups. RESULTS: The median serum prolidase enzyme activity value was 528.3 (684.1-416.7) U/L in the keratoconus group and 606.2 (812.9-482.3) U/L in the control group. The difference between the groups was statistically significant (p = 0.027). The median TAC value was 1.24 (1.37-1.05) mmol/L in the keratoconus group and 1.29 (1.38-1.18) mmol/L in the control group. The median TOS value was 2 (4-1) µmol/L in the keratoconus group and 3 (4-2) µmol/L in the control group. There was no statistically significant difference between the two groups in terms of TAC or TOS (p = 0.113 and p = 0.366, respectively). There was a positive correlation between TAC and TOS in keratoconus group but not in the control group (r = 0.670, p = 0.001 and r = 0.141, p = 0.241, respectively). No significant relationship was seen between the keratoconus group stages and serum prolidase activity, TAS or TOS (p = 0.894, p = 0.155 and p = 0.381, respectively). CONCLUSION: In conclusion, a significant relationship was found between decreased serum prolidase activity and keratoconus but there was no significant relationship between keratoconus and serum TAC or TOS.