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OBJECTIVES: To examine and to understand the limbal stem-cell deficiency (LSCD) because of Steven-Johnson syndrome (SJS) in line with the new classification system for the first time in the literature. METHODS: Medical records of patients with LSCD because of SJS were reviewed retrospectively. In addition to demographic data and ophthalmologic or systemic findings, anterior segment photographs of the patients were reviewed retrospectively. Limbal stem-cell deficiency severity was graded according to the classification published by the Limbal Stem Cell Working Group. RESULTS: Twenty-four eyes of 14 patients with eye involvement secondary to SJS were included in the study. The mean age of the patients was 36.09±16.70 (9-58) years and the female-to-male ratio was 11:3. The anterior segment photographs of the patients were evaluated by two independent masked observers. Limbal stem-cell deficiency severity was graded according to the classification published by Deng et al. Corneal opacity was divided into three stages according to the area of involvement. Corneal opacity was classified as Stage I if the central 5 mm region of the cornea was not affected, as Stage II if the central 5 mm region of the cornea was affected, and as Stage III if the entire corneal surface was affected. Limbal involvement was classified as Stage A if it was below 50%, as Stage B if it was between 50% and 100%, and as Stage C if it was 100%. CONCLUSION: This is the first study in the literature to describe and classify LSCD because of SJS, according to the new LSCD classification. Consistent with the results, LSCD follows a bimodal distribution. Most patients demonstrated severe (Stage III-32.14%) or mild (Stage IA-21.42%) LSCD.
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Enfermedades de la Córnea , Opacidad de la Córnea , Epitelio Corneal , Deficiencia de Células Madre Limbares , Limbo de la Córnea , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Consenso , Células Madre Limbares , Células Madre , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/etiologíaRESUMEN
PURPOSE: To evaluate limbal graft transplantation success in pediatric patients with chemical injury-induced limbal stem cell deficiency (LSCD) using the 'LSCD Working Group' staging system. METHODS: Medical records of 11 eyes of 11 children who underwent limbal graft transplantation (limbal autograft/limbal allograft) were included. Surgical success was defined as improvement in the post-operative 1st year LSCD stage. RESULTS: The mean age was 12 ± 5 (4-17) years. Causative agent was alkaline in 4(36.4%) and acid in 3(27.2%) patients. Limbal autograft was performed in 9 (81.8%) eyes with unilateral LSCD, and allograft transplantation was performed in 2 (18.2%) eyes with bilateral LSCD. The mean follow-up time was 33.89 ± 30.73 (12-102.33) months. The overall limbal graft transplantation success rate was 72.7%. Among 9 patients who receive limbal autograft, 8 had improvement in post-operative LSCD stage, 1 had stable LSCD stage. Of the 2 patients who receive limbal allograft, post-operative LSCD stage remained the same in 1 and worsened in 1 patient. The mean time between injury and the surgery was 30.47 ± 30.08 (7-108.47) months. Penetrating keratoplasty was performed in 3 (27.2%) of 11 patients following limbal graft transplantation. CONCLUSION: Management of LSCD in children is challenging and appears to be somewhat different from that of adults. Limited data in the literature indicate that cultivated or simple limbal epithelial transplantations (CLET/SLET) are primarily preferred in children. Although the tendency to take small tissue from the healthy eye is noteworthy, conventional limbal allograft and autograft transplantations also show promising results without any further complications in at least 1 year follow-up period.
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Deficiencia de Células Madre Limbares , Limbo de la Córnea , Agudeza Visual , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Quemaduras Químicas/cirugía , Trasplante de Córnea/métodos , Quemaduras Oculares/cirugía , Quemaduras Oculares/inducido químicamente , Quemaduras Oculares/diagnóstico , Estudios de Seguimiento , Deficiencia de Células Madre Limbares/inducido químicamente , Deficiencia de Células Madre Limbares/diagnóstico , Deficiencia de Células Madre Limbares/cirugía , Limbo de la Córnea/citología , Estudios Retrospectivos , Trasplante de Células Madre/métodos , Células Madre/citología , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: To report demographic characteristics and ophthalmological manifestations of patients with granulomatosis with polyangiitis (GPA) in a tertiary eye care center in Turkey. METHODS: Medical records of patients with GPA-related ocular manifestations evaluated between 2013 and 2023 were included. Demographic and clinical characteristics of the patients including nature of systemic involvement, ophthalmologic symptoms and signs, laboratory investigations and treatment modality were reviewed. RESULTS: Twelve eyes of 10 patients (5 female/5 male) were included. The mean age was 57.2 ± 12.2 (35-71) years. Five (50%) patients were already diagnosed with GPA. Ocular involvement was the first manifestation of GPA in 3 patients. The remaining 2 patients had simultaneous systemic and ocular symptoms at presentation. Conjunctival hyperemia (9 eyes) and pain (7 eyes) were the most frequent presenting symptoms followed by blurred vision (3 eyes). The frequencies of ocular manifestations were as follows:episcleritis (3 eyes), isolated peripheral ulcerative keratitis (PUK) (3 eyes), scleritis (3 eyes), simultaneous PUK and scleritis (2 eyes) and periorbital mass (1 eye). CONCLUSION: Ophthalmological manifestations can be the initial findings in GPA. Since GPA can affect different structures of the eye, it sometimes might be challenging for ophthalmologists. Therefore, it is crucial for ophthalmologists to be well-informed about GPA-related ocular findings and to have a high index of suspicion for GPA. Although PUK associated with scleritis is highly suggestive for GPA, isolated cases of PUK or scleritis can be seen in GPA. Therefore, it is important to adopt a multidisciplinary approach, consider GPA in differential diagnosis, and benefit from accurate diagnostic tests.
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Conjuntivitis , Úlcera de la Córnea , Granulomatosis con Poliangitis , Escleritis , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico , Ojo , Trastornos de la VisiónRESUMEN
PURPOSE: To define the use of human amniotic membrane transplantation (hAMT) for reconstruction of the ocular surface after ocular surface lesion excisions in pediatric population during the last decade in a tertiary eye center. METHODS: A total of 31 patients who underwent hAMT procedure because of the excision of ocular surface lesions between January 2009 and December 2021 were included in this study. The medical data were retrospectively evaluated. RESULTS: The female-to-male ratio was 14/17. The mean age of the patients was 10.1±4.1 (range, 1-18) years. Although a single hAMT was applied to most of the cases (94.4%; 34 eyes), more than one hAMT was applied to 5.6% of cases (2 eyes). The amniotic membrane degradation duration was found to be 21.5±10.8 (range, 13-50) days. CONCLUSIONS: Amniotic membrane is used as a biomaterial in various ocular surface diseases with its anti-inflammatory, antimicrobial, and wound healing properties. Although widely used, there are only a few studies reporting its clinical efficacy in the pediatric age group. It seems to be safe and effective in pediatric age group for ocular surface reconstruction after ocular surface lesion excisions.
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Amnios , Oftalmopatías , Humanos , Masculino , Niño , Femenino , Lactante , Preescolar , Adolescente , Amnios/trasplante , Estudios Retrospectivos , Cicatrización de Heridas , Resultado del TratamientoRESUMEN
OBJECTIVES: To report 10 years of pediatric ocular chemical burn experience in a tertiary eye care center in Turkey. METHODS: Thirty-three patients aged 18 years and younger who presented with ocular chemical burn between 2011 and 2021 were enrolled. Demographic data and clinical characteristics of patients were reviewed. Limbal stem cell deficiency (LSCD) stage was assessed according to LSCD working group's staging system. The initial and final best-corrected visual acuities were recorded. RESULTS: The mean age was 10.4±5.5 (0.25-18) years with an F/M ratio of 12/21. Eleven (33.3%) of the patients were injured with acid and 5 (15.1%) with alkaline. The most common causative agent was nail polish remover (n=7, 21.2%), followed by cologne (n=5, 15.1%) and hand sanitizer (n=4, 12.1%). The severity of burn was ≥grade 4 in 20 patients (60.6%). Chemical injury resulted in LSCD in 18 patients (54.5%). Surgery was performed (LSCD ≥Stage 2 B) in 13 patients (39.3%); limbal stem cell transplantation (LSCT) (n=11), staged amniotic membrane transplantation, and symblepharon release (n=2). Penetrating keratoplasty after LSCT was performed in three of 11 patients. The mean follow-up time was 31.9±28.6 months (6-102.33) after the surgery. CONCLUSIONS: In pediatric population, accurate diagnosis and management of ocular chemical burns are challenging. Although the severity of burn and consequently LSCD rate seems to be high in children, comparative studies in a larger population are still needed.
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Quemaduras Químicas , Quemaduras Oculares , Limbo de la Córnea , Adolescente , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/cirugía , Niño , Preescolar , Quemaduras Oculares/inducido químicamente , Quemaduras Oculares/diagnóstico , Quemaduras Oculares/terapia , Humanos , Turquía/epidemiología , Agudeza VisualRESUMEN
OBJECTIVES: To report demographic characteristics, types and grades of injury, regional distribution of injury severity, clinical findings, and long-term results of acute ocular chemical burns. METHODS: Medical records of patients with chemical burns between 2010 and 2020 who were admitted to Ege University less than 72 hr after the injury were reviewed. Age, gender, cause of the burn, injury severity, initial and final best-corrected visual acuity, surgical intervention, and complications were recorded. The injury severity was graded according to Dua classification. RESULTS: A total of 104 patients (137 eyes) were included. The mean age was 42.69±17.39 (7-90) years with a male-to-female ratio of 86:18. The most common causes were home (32.6%) and industrial accidents (45.1%). The causative agent percentages for alkaline, acid, and neutral were 49.0%, 35.5%, and 5.7%, respectively. The percentages of eyes in each grade (1-6) were 16.0%, 16.0%, 15.3%, 16.7%, 17.5%, and 18.2%, respectively. Complications mostly occurred in eyes with grade 2 or higher injuries (83.7%). The relationship between injury grade and limbal stem-cell deficiency was statistically significant (P<0.001). Surgery was mostly needed in grade 4 or higher injuries (44 eyes). CONCLUSION: The severity of the burn is one of the most important prognostic factors in chemical burns. It is important to determine the spreading of the regional injury severity beside the global one to predict complication risk of the injuries. In the present study, the injury distribution was homogeneous in all grades. Limbal stem-cell deficiency development took place mostly in grade 5 and 6 burns as expected.
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Quemaduras Químicas , Enfermedades de la Córnea , Quemaduras Oculares , Lesiones Oculares , Limbo de la Córnea , Adulto , Quemaduras Químicas/etiología , Quemaduras Químicas/cirugía , Quemaduras Oculares/inducido químicamente , Quemaduras Oculares/diagnóstico , Quemaduras Oculares/cirugía , Lesiones Oculares/epidemiología , Lesiones Oculares/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Agudeza VisualRESUMEN
BACKGROUND: Exposure keratopathy may lead to serious complications such as microbial keratitis, corneal perforation, and visual impairment if not treated. AIM: To compare the effect of carbomer eye drops when used alone and in combination with polyethylene covers in the healing of exposure keratopathy. METHODS: A single blind randomized-controlled trial (RCT) in two intensive care units (ICUs) was carried out in a university hospital in Western Turkey between September 2011 and December 2012. The control group received only carbomer, eye drops while the intervention group received both carbomer eye drops and polyethylene covers. The primary outcome was the decrease or absence of corneal damage, which refers to healing. Corneal damage was followed up with a fluorescein dye test (decrease/absence of the corneal staining) by the same ophthalmologist for 10 days. RESULTS: A total of 43 corneas in 24 patients were studied. Corneal epithelial defects decreased in the intervention group by day 2 and progressed or remained unchanged in the control group every day (P = .001). Patient characteristics did not affect the grade ranges of corneal staining in the groups except for level of consciousness. CONCLUSION: Carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy. RELEVANCE TO CLINICAL PRACTICE: Corneal damage and further ocular complications can be reduced with the utilization of polyethylene covers in nursing care and treatment.
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Unidades de Cuidados Intensivos , Polietileno , Humanos , TurquíaRESUMEN
BACKGROUND: The sparsity of established tools for the grading of limbal stem cell deficiency hinder objective assessments of the clinical outcome of cultivated limbal epithelial cell transplantation. To advance towards the development of standards for the comparison of the outcomes of these bio-surgical protocols we have now applied a battery of recognized objective and patient-declared subjective outcome criteria to the autologous modality of cultivated limbal epithelial cell transplantation. METHODS: The prospective study involved ten patients (M/F = 9/1; mean age = 42.1 years) displaying overt unilateral limbal stem cell deficiency complying with the inclusion criteria described in Methods. Limbal biopsies were obtained from the contralateral eye and their outgrowths after 2-week cultures were transplanted on the affected eye after pannus resection. Outcomes were followed up for 12 months. The objective tests were scores for best-corrected visual acuity (BCVA); using the LogMAR scale, a multiparametric ocular surface score (OSS), and the Schirmer's test. Subjective scores were based on patient answers to a) perception of visual improvement/pain; b) the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25); and c) the 12-item Ocular Surface Disease Index Questionnaire (OSDI). All procedures were performed under good manufacture practices using solely xeno-free reagents. In all cases, a single biopsy was divided into two pieces and they were expanded in order to prevent outgrowth failure. In 5 patients, both biopsies generated healthy culture sheet. In those cases the lesser outgrowth were used for immune-histological characterization. RESULTS: The experimental parallel outgrowth samples showed a similar percent of p63α+ cells. PreOp and 12-month PostOp BCVAs and OSSs were, respectively, 1.15 ± 0.70; 0.21 ± 0.13 and 7.40 ± 2.01; 2,30 ± 1.30, (p < 0.05). Patient's responses to all three question sets except ocular pain were consistent with significant improvement (p < 0.05). CONCLUSION: Objective clinical metrics demonstrate that in patients with limbal stem cell deficiency, cultivated limbal epithelial cell transplantation improves vision and ocular surface health and subjective visual perceptions.
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Quemaduras Químicas , Enfermedades de la Córnea , Epitelio Corneal , Quemaduras Oculares , Limbo de la Córnea , Adulto , Quemaduras Químicas/cirugía , Trasplante de Células , Quemaduras Oculares/inducido químicamente , Humanos , Estudios Prospectivos , Células Madre , Trasplante Autólogo , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVES: To evaluate the risk factors, causative microorganisms, and presenting features of infection in patients with contact lens-associated microbial keratitis (CLAMK) admitted to a tertiary referral center in Turkey. METHODS: A retrospective review of the medical records of 62 patients who were diagnosed as CLAMK in our clinic between 2012 and 2018 was conducted. RESULTS: The mean age of the patients (22 men and 40 women) at the time of diagnosis was 24.5±8.3 years (range, 16-48). The mean best-corrected visual acuity (BCVA) was 0.7±0.9 log of minimal angle of resolution (logMAR) (0-3) before treatment and increased to 0.1±0.1 logMAR (0-0.4) at the end of the follow-up. All patients, except one using rigid gas-permeable CL, were frequent replacement soft CL users. Thirty-one (50%) patients declared overnight wear, and 37 (58.9%) patients declared showering or swimming in CLs regularly. Cultures of either corneal scrapings or CL materials were positive in 40 (64.5%) eyes, 12 (19.4%) of which had mixed infections. Thirteen strains of microorganisms were demonstrated, among which there were seven (53.8%) gram-negative bacteria, one (7.7%) gram-positive bacteria, four (30.7%) fungi, and Acanthamoeba (7.7%). The most common pathogen was Pseudomonas aeruginosa, followed by Serratia marcescens and Stenotrophomonas maltophilia. According to culture results, P. aeruginosa infections were associated with significantly worse BCVA. Keratitis foci were either centrally or paracentrally located in 39 (62.9%) eyes, and 16 eyes (25.8%) presented with hypopyon. CONCLUSION: Along with growing number of CL users, CLAMK constitutes an important problem with possibly worse visual outcomes. Thus, in addition to meticulous treatment, management of risk factors and behavioral modifications is crucial.
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Lentes de Contacto/microbiología , Úlcera de la Córnea/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones Fúngicas del Ojo/microbiología , Hongos/aislamiento & purificación , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Adolescente , Adulto , Antibacterianos/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/tratamiento farmacológico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Centros de Atención Terciaria , Turquía , Agudeza Visual/fisiología , Adulto JovenRESUMEN
PURPOSE: To establish the clinical features and outcomes of patients with chronically retained, feathery chestnut-burr spine-related corneal injury. METHODS: The data of the patients who presented with chestnut-burr-related corneal injury between 2010 and 2018 were retrospectively evaluated. Nineteen eyes of 19 patients, with chronically retained corneal intrastromal feathery chestnut-burr spines, were included. RESULTS: The mean age of the patients (11 male and 8 female) was 29.8 ± 19.9 years. Best-corrected visual acuity was 0.13 ± 0.23 logMAR at initial examination and increased to 0.0 ± 0.0 logMAR at last visit. Chestnut-burr spines were located in the peripheral cornea in 14 eyes (73.7%) and in the central cornea in 5 eyes (26.3%). Localized corneal edema surrounding the chestnut-burr spines were detected in all eyes. No eyes were Seidel positive. Three eyes (15.8%) had low-grade anterior chamber reaction. None of the patients had epithelial ulceration or any sign of infection at initial presentation. In order to control acute localized inflammation, all patients were put on topical steroid (loteprednol etabonate). The mean duration of topical steroid treatment was 3.8 ± 1.8 (range 2-7) months. During the follow-up period, inflammation was controlled and no sign of reinflammation occurred. CONCLUSION: Acute inflammation in intrastromal chestnut-burr spines can be well controlled with easy tapering of topical steroids. However, as the reinflammation possibility cannot be excluded, long-term follow-up of these patients is mandatory.
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Edema Corneal , Lesiones de la Cornea , Adolescente , Adulto , Niño , Córnea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Instrumentos Quirúrgicos , Adulto JovenRESUMEN
OBJECTIVES: This study aimed to investigate the levels of 11 oral species in plaque samples and cytokine levels in biofluid samples of patients with idiopathic uveitis (IU) and systemically healthy individuals (H) with or without gingival inflammation. MATERIAL & METHODS: Twenty-one patients with IU (n = 21), and 22 systemically healthy individuals (n = 22) were enrolled in the study. Clinical periodontal measurements were recorded. Cytokine levels in the biofluid samples were determined by ELISA. Bacterial gene copy numbers were determined by qPCR on plaque microbial DNA preparations. RESULTS: According to two-step cluster analysis, anova and t-test: GCF, serum and salivary TNF-α, IL-17A, IL-17A/E; GCF and serum IL-6; salivary IL-17F, and salivary and serum IL-17A/F levels were higher in the IU group than the H group (p < 0.05). However, serum IL-10 and IL-17E levels were higher in the H group than the IU group (p < 0.05). A. actinomycetemcomitans, F. nucleatum, S. oralis, A. naeslundii, and V. dispar counts were higher in IU group compared to H group (p < 0.05). CONCLUSION: Altered local and systemic cytokine profiles are associated with differences in the microbial plaque composition in IU. Anti-inflammatory cytokines; IL-10, IL-17E are reduced in patients with IU and Th-1 and Th-17 driven inflammatory responses in biofluids are altered.
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Gingivitis , Líquido del Surco Gingival , Humanos , Inflamación , Interleucina-17 , UveítisRESUMEN
OBJECTIVES: To evaluate the results of toric intraocular lens (IOL) implantation in patients with cataract and postpenetrating keratoplasty astigmatism. METHODS: Seven eyes of 7 patients with cataract and more than 3.5 diopters (D) astigmatism following penetrating keratoplasty were included in this retrospective case series study. All of the eyes underwent phacoemulsification and Acrysof toric IOL (t5-t9) implantation at least 6 months later than the complete suture removal. Corrected visual acuity (CVA), manifest astigmatism, the keratometry measurements, and complications were assessed. RESULTS: The mean preoperative CVA significantly increased (0.7±0.3 [range: 0.3-1.3] logMAR to 0.1±0.04 [range: 0.05-0.15] logMAR; P<0.05) at mean 8.71±4.11 months after the surgery. The mean preoperative corneal astigmatism and the average manifest refractive astigmatism at the last visit were 5.4±0.9 D (range: 4.25-7 D) and 1.6±0.6 D (range: 0.5-2.5 D), respectively. The mean attempted cylinder correction at spectacle plane was 4.3±0.9 D (range: 2.4-4.7 D) whereas the mean cylinder correction was 4.6±0.5 D (range: 3.9-5.9 D), showing a slightly tendency for overcorrection. All eyes (100%) were within 1 D of predicted residual astigmatism. No complication occurred during the follow-up. CONCLUSION: Toric IOL implantation seems to be an effective, predictable, and safe procedure in patients with cataract formation and high astigmatism after penetrating keratoplasty.
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Astigmatismo/cirugía , Queratoplastia Penetrante/efectos adversos , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares , Facoemulsificación/métodos , Adulto , Astigmatismo/etiología , Catarata , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
The purpose of this study was to evaluate the dynamic reality of the corneal transplant (CT) waiting list and if the CT candidates are really eager to operation. We evaluated the response of consecutive 96 CT candidates to call for operation. The age, functional visual acuity, CT indication, waiting period, and the excuse of refusal for candidates that postponed the operation were also evaluated. The patients were classified into two groups according to the availability (Group 1, available; Group 2, unavailable). To find an available candidate for transplantation of 48 consecutive corneal tissues, 96 patients had to be called. The mean age of the patients was 57.49 ± 18.75. The mean age of Group 1 and Group 2 was 54.28 ± 18.12 (13-80) and 60.44 ± 19.01 (9-88) years, respectively (p = 0.108). It was found that the call refusal was higher in patients elder than age 70 (p = 0.04). The mean time between being added to the list and the call was 22.96 ± 7.80 (9-39) months for Group 1, 27.02 ± 8.25 (9-53) months for Group 2 (p = 0.015). The estimation point for waiting period was 22 months (p = 0.044). The most common reasons of excuse were inconvenience of timing, giving up operation, and secondary health problems, whereas anticoagulant use was the most common reason for postponement. As the waiting period gets longer and CT candidates get older, they tend to give up operation. The secondary health problems and use of systemic anticoagulants are important problems that might cause postponing the CT surgery and ruin the dynamicity of the waiting lists.
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Trasplante de Córnea , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Listas de Espera , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Adulto JovenRESUMEN
The purpose of this study was to investigate the interocular symmetry of ultrasonic biometric characteristics and anterior segment measurements between the fellow eyes of hyperopic anisometropes. Forty-two healthy hyperopic anisometropic cases (1 D mean spherical equivalent difference between eyes) without strabismus were recruited. A range of refractive and ultrasonic biometric parameters were measured in both eyes of each subject including keratometry, mean spherical equivalent, anterior chamber depth (ACD), lens thickness, vitreous depth (VD), axial length (AL), and anterior segment parameters (central corneal thickness (CCT), ACD, anterior chamber volume (ACV)) with Pentacam. Mean spherical equivalent anisometropia was 2.66 ± 1.233 (range 1.125 and 6.25) D, and there was a strong correlation between the degree of anisometropia and the interocular difference in AL (r = 0.632, P < 0.001). A total of 61.3 % of the anisometropia was related with AL (50.7 %) and mean keratometry (10.6 %). Every 1 mm change in AL and every 1 D change in mean keratometry caused a total of 2.82 D and 2.14 D refractive difference, respectively. Among Pentacam parameters, ACD was correlated with ACV (r = 0.528; P < 0.001) and AL (r = 0.510; P = 0.001); ACV was correlated with VD (r = 0.358; P = 0.020); and CCT was correlated with ACV (r = 0.510; P = 0.001) and AL (r = 0.318; P = 0.040). Among ultrasonographic measurements, ultrasonic-ACD was correlated with CCT (r = 0.510; P = 0.001) and lens thickness (r = -0.556; P < 0.001), and VD was correlated with AL (r = 0.937, r 2 = 0.877, P < 0.001). The hyperopic and the fellow eyes displayed a high degree of interocular symmetry for the other measured parameters. AL and mean keratometry are the leading causes of hyperopic anisometropia. However, ACD as measured with Pentacam also shows difference in hyperopic anisometropic eyes.
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Anisometropía/fisiopatología , Segmento Anterior del Ojo/patología , Hiperopía/fisiopatología , Refracción Ocular/fisiología , Adolescente , Adulto , Longitud Axial del Ojo/fisiopatología , Biometría/métodos , Niño , Preescolar , Femenino , Humanos , Cristalino/fisiopatología , Masculino , Agudeza Visual/fisiología , Cuerpo Vítreo/fisiopatología , Adulto JovenRESUMEN
OBJECTIVES: In this study, we aimed to define demographic data and trends in use of amniotic membrane transplant during the past decade at a tertiary eye center. MATERIALS AND METHODS: We included 272 patients who underwent amniotic membrane transplant for ocular surface pathology from January 2009 to December 2021. We retrospectively evaluated the medical data. RESULTS: The male-to-female ratio of patients was 41/23. Mean age of the patients was 50 ± 23.6 years (range, 1-91 years). Indications consisted of ocular surface lesion excision surgery (n = 184; 66.7%), chemical injury (n = 25; 9.1%), persistent epithelial defect (n = 23; 8.3%), keratitis (n = 22; 8%), noninfectious corneal perforation (n = 9; 3.3%), bullous keratopathy (n = 9; 3.3%), and ocular cicatricial pemphigoid (n = 4; 1.4%). Single amniotic membrane transplant was applied to 236 patients (85.5%), and multiple transplant was applied to 40 patients (14.5%). We observed repeated amniotic membrane transplant rates and amniotic membrane degradation durations that were associated with primary disease (P = .005 and P < .001, respectively). Degradation time was shorter in cases of chemical burns and keratitis than in cases after ocular surface lesion excision. Amniotic membrane transplant indication rates were statistically different between the first 6 years and the last 6 years of the 12 years of data (P = .041). The frequency of amniotic membrane transplant application in microbial keratitis has increased substantially in the past 2 years. CONCLUSIONS: Amniotic membrane is used as a biomaterial in various ocular surface diseases due to its anti-inflammatory, antimicrobial, and wound-healing properties. After transplant, the amniotic membrane, which is directly related to the inflam-matory processes of the primary disease, degrades gradually. There may be changes in the trend of amniotic membrane transplant, the indications of which are progressively expanding over time.
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Amnios , Centros de Atención Terciaria , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Amnios/trasplante , Estudios Retrospectivos , Anciano , Adolescente , Adulto Joven , Niño , Centros de Atención Terciaria/tendencias , Preescolar , Anciano de 80 o más Años , Resultado del Tratamiento , Lactante , Factores de Tiempo , Factores de Riesgo , Pautas de la Práctica en Medicina/tendencias , Oftalmopatías/cirugía , TurquíaRESUMEN
HPLC-PDA, LC-MS/MS methods were developed for simultaneous determination of a group of oxidative stress biomarkers (OSBs); 2dA, 2dC, 2dU, 3NLT, 5HMU and 8OHdG in 10 simulated artificial body fluids. O-phosphoric acid and methanol composed mobile phases A and B for gradient elution in HPLC-PDA using ODS-2 column. Linearity obtained for 1.0×10-6-1.0×10-4M range. LODs were 1.73×10-6, 1.19×10-6, 2.59×10-6, 1.40×10-6, 2.21×10-6 and 4.07×10-6M for 2dU, 8OHdG, 2dA, 2dC, 5HMU and 3NLT, respectively. LOQs were 5.29×10-6, 4.02×10-6, 6.82×10-6, 4.02×10-6, 6.82×10-6 and 9.92×10-6M. About 10 mM aqueous ammonium acetate solution and methanol containing 0.1% (v/v) formic acid composed mobile phases A and B for gradient elution in LC-MS/MS. Linearity obtained for 1.0×10-8-1.0×10-6M range. LODs were 2.88×10-10, 1.01×10-8, 3.38×10-9, 1.36×10-7, 1.81×10-7 and 1.40×10-8M for 2dU, 8OHdG, 2dA, 2dC, 5HMU and 3NLT, respectively. LOQs were 9.37×10-10, 3.22×10-8, 1.91×10-8, 4.53×10-7, 5.90×10-7 and 2.18×10-8M. Both methods were validated using ICH Q2(R1) guideline. Specificity, linearity, range, accuracy, precision, reproducibility, LOD, LOQ and recovery were achieved. Chemometric analysis was performed on raw PDA and MS data to check their significance for discrimination of OSBs. Sets of single and triple quadrupole fragmentations were evaluated for principle component analysis. Chosen number of PCs successfully distinguished OSBs of interest.
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Quimiometría , Espectrometría de Masas en Tándem , Cromatografía Líquida de Alta Presión/métodos , Cromatografía Liquida/métodos , Espectrometría de Masas en Tándem/métodos , 8-Hidroxi-2'-Desoxicoguanosina , Reproducibilidad de los Resultados , Metanol , Estrés Oxidativo , BiomarcadoresRESUMEN
OBJECTIVE: To evaluate the surgical results and the variables affecting the outcomes in conjunctival-limbal allograft transplantation (CLAL). METHODS: Patients who underwent CLAL for limbal stem cell deficiency (LSCD) between 2007 and 2019 were included in the study. LSCD staging was performed according to the staging system developed by the 'Limbal Stem Cell Working Group'. Stage 1C and higher stage LSCD patients were included in the study. 'Successful surgical outcome' was defined as improvement in LSCD stage at 1 year postoperatively. RESULTS: A total of 19 eyes of 19 LSCD patients were included. The mean age of the patients was 40.21 ± 14.65 (6-65) years, and the male/female ratio was 12/7. CLAL was performed in 9 (47.3%) patients with Stage 2B, 9 (47.3%) patients with Stage 3 and 1 (5.4%) with Stage 1C. LSCD aetiology; chemical injury (12), vernal keratoconjunctivitis (2), aniridia (1), corneal degeneration (1), and unknown (3). Surgery was successful in 52.6% of cases. Surgical success was associated with lower LSCD stage (p = 0.04). Lower grades of chemical injury at presentation and a longer time interval between injury and CLAL were associated with higher surgical success (p = 0.001; p = 0.001). The mean postoperative follow-up time was 50.77 ± 29.46 (6-98) months. CONCLUSIONS: Despite graft rejection and long-term use of immunosuppressants, CLAL is still one of the most preferred techniques in the treatment of bilateral LSCD. Preoperative LSCD stage and degree of chemical burn are important factors affecting the surgical outcome. Also, CLAL surgery should not be rushed and should be performed when inflammation has subsided.
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Quemaduras Químicas , Enfermedades de la Córnea , Distrofias Hereditarias de la Córnea , Epitelio Corneal , Deficiencia de Células Madre Limbares , Limbo de la Córnea , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades de la Córnea/cirugía , Trasplante de Células Madre/métodos , Agudeza Visual , Estudios Retrospectivos , Resultado del Tratamiento , AloinjertosRESUMEN
OBJECTIVES: We evaluated limbal stem cell transplant success in limbal stem cell deficiency due to chemical injury at a tertiary eye care center in Turkey with a novel system for describing limbal stem cell deficiency, as developed by the Limbal Stem Cell Working Group. MATERIALS AND METHODS: Medical records of 80 eyes of 80 patients after limbal stem cell transplant for limbal stem cell deficiency secondary to chemical injury were included, with patients grouped according to surgical procedure, ie, limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplant. Surgical success was defined as improvement in postoperative year 1 of limbal stem cell deficiency stage. RESULTS: Patients' mean age was 37.9 ± 15.7 years (range, 4-71 years). Male/female ratio was 2.4. Forty-five patients (56.3%) were injured with alkaline substance, and 16 (20%) with acid substance. Mean follow-up time was 60.3 ± 30.6 months (range, 6-118.6 months). Limbal autograft, allograft, and cultivated limbal epithelial cell transplants were performed in 58 (72.5%), 12 (15%), and 10 (12.5%) eyes, respectively. Intervals between injury and surgery in limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplants were 43.3 ± 94.1 months (range, 0.5-592 months), 14.5 ± 10.6 months (range, 2.4-32.5 months), and 122.8 ± 158.9 months (range, 21.1-504 months),respectively (P = .02); and surgical success rates in each group were 65.5%, 41.7%, and 90%, respectively (P = .03). Overall surgical success rate was 65%. CONCLUSIONS: Accurate determination of the limbal stem cell deficiency stage is crucial for proper evaluation of surgical success. Surgery type and interval between injury and surgery were the most important factors associated with higher surgical success rates. Despite the limited number of patients in the subgroups, the results were remarkable to emphasize the significance of a novel limbal stem cell deficiency scoring system.
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Quemaduras Químicas , Enfermedades de la Córnea , Limbo de la Córnea , Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Enfermedades de la Córnea/diagnóstico , Enfermedades de la Córnea/cirugía , Células Madre Limbares , Limbo de la Córnea/cirugía , Agudeza Visual , Trasplante de Células Madre/efectos adversos , Trasplante de Células Madre/métodos , Trasplante Autólogo , Quemaduras Químicas/diagnóstico , Quemaduras Químicas/cirugíaRESUMEN
Objectives: To evaluate the demographic data, ocular and systemic findings, clinical management, and outcomes of patients with ocular cicatricial pemphigoid (OCP). Materials and Methods: The medical records of 11 patients diagnosed as having OCP in the ophthalmology department of Ege University between 2008 and 2021 were evaluated retrospectively. Results: The patients' mean follow-up time was 14±5.76 months. All eyes (100%) had conjunctival involvement and 18 (81.81%) had corneal involvement. According to the Tauber staging system, 7 (31.81%), 8 (36.36%), and 7 (31.81%) of the eyes were stage 2, 3, and 4, respectively. The diagnosis was confirmed in 6 (66.66%) of 9 patients who underwent biopsy. Amniotic membrane transplantation was performed in 7 eyes, entropion surgery in 2 eyes, and electrocauterization for trichiasis in 5 eyes. Systemic involvement was observed in 45.45% (5/11) of patients, most commonly oral mucosal involvement (18.18%). Review of medical records showed that alkylating agents, steroids, and dapsone were used in patients treated before 2020. Mycophenolate mofetil was preferred to be used in combination with corticosteroids. Although treatment responses before mycophenolate mofetil usage could not be evaluated well because of loss to follow-up, 4 (66.66%) of 6 patients who received steroid treatment combined with mycophenolate mofetil showed partial or complete clinical remission. No serious side effects and drug withdrawal were observed. Conclusion: OCP is a sight-threatening autoimmune disease that affects older adults. Although positive biopsy results are valuable for diagnosis, negative results do not exclude the diagnosis. The main treatment is systemic immunosuppressives. Disease activity can be suppressed, especially with early initiation of drug therapy. These patients require a multidisciplinary approach. Especially in the presence of isolated ocular findings, ophthalmologists should be able to make the decision to start immunosuppressive treatment, and systemic treatment should not be delayed.
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Penfigoide Benigno de la Membrana Mucosa , Humanos , Anciano , Penfigoide Benigno de la Membrana Mucosa/complicaciones , Penfigoide Benigno de la Membrana Mucosa/diagnóstico , Penfigoide Benigno de la Membrana Mucosa/tratamiento farmacológico , Ácido Micofenólico/uso terapéutico , Estudios Retrospectivos , Inmunosupresores/uso terapéutico , Conjuntiva/patologíaRESUMEN
OBJECTIVES: To evaluate the results of toric intraocular lens (IOL) implantation during cataract surgery in eyes with high regular astigmatism associated with prior penetrating keratoplasty (PK). METHODS: A retrospective data analysis of patients with prior PK, who underwent uncomplicated cataract surgery with hydrophobic toric single piece IOL (EyeCryl Toric®, Biotech Vision Care, Luzern, Switzerland). RESULTS: A total of 18 eyes of 18 patients were included in the study. The mean age was 53.4 ± 12.4 (25-70) years. The mean follow-up period was 15.5 (4-24) months. The mean best corrected visual acuity (BCVA) significantly increased from 1.36 ± 1.0 logMAR to 0.31 ± 0.17 logMAR (p < .001) pre- and post-operative 4 weeks, respectively. There was no significant change in mean BCVA during follow-up; mean BCVA was 0.32 ± 0.17 logMAR at the last visit. The mean pre-operative topographic astigmatism was 6.52 ± 1.80 diopters (D). The mean manifest refraction astigmatism was decreased from 6.55 ± 1.62 D to 2.80 ± 1.43 D (pË0.001). The mean Surgically induced astigmatism (SIA) was 3.74 ± 0.77 D according to vector analysis. There was no patient with graft rejection or failure, the mean endothelial cell loss rate was 12.75 ± 3.76% (7-17%). There was no patient requiring IOL reposition. CONCLUSIONS: Toric IOL implantation during cataract surgery provides an option to correct astigmatism in post-PK eyes with high regular astigmatism. When appropriate patients are selected it is a safe method to achieve significant improvements in visual acuity and astigmatism.