Choroidal vascular index in cystoid macular edema associated with retinitis pigmentosa.

BACKGROUND: Retinitis pigmentosa (RP) is an inherited degenerative disease characterized by night blindness (nyctalopia), visual field defects, and varying degrees of vision loss. Choroid tissue has an essential role in the pathophysiology of many chorioretinal diseases. The choroidal vascularity index (CVI) is a choroidal parameter obtained as the ratio of the luminal choroidal area to the total choroidal area. The study aimed to compare the CVI of RP patients with and without CME with each other and with healthy individualsAU: Please confirm that the provided email ''ademoztel@hotmail.com" is the correct address for official communication, else provide an alternate e-mail address to replace the existing one.. METHODS: A retrospective, comparative study of 76 eyes of 76 RP patients and 60 right eyes of 60 healthy subjects was conducted. The patients were divided into two groups: those with and those without cystoid macular edema (CME). The images were obtained using enhanced depth imaging optical coherence tomography (EDI-OCT). CVI was calculated by using the binarization method with ImageJ software. RESULTS: The mean CVI was significantly lower in RP patients compared to the control group (0.61±0.05 and 0.65±0.02, respectively, p<0.01). The mean CVI in RP patients with CME was significantly lower than in those without CME (0.60±0.54 and 0.63±0.35, respectively, p=0.01) The CVI was positively correlated with subfoveal choroidal thickness (r=0.74, p=0.001), central macular thickness (r=0.27, p<0.001) and visual acuity (logMAR) (r=-0.23 p=0.03) in RP patients. CONCLUSIONS: The CVI is lower in RP patients with CME than in patients without CME and in RP patients compared to healthy subjects, indicating an ocular vascular involvement in the pathophysiology of the disease and the pathogenesis of RP-associated cystoid macular edema.

Use of Intravitreal Bevacizumab for the Treatment of Secondary Glaucoma Caused by Metastatic Iris Tumor.

PURPOSE: The purpose of this article was to report the efficacy of intravitreal bevacizumab to resolve secondary angle-closure glaucoma caused by biliary tract carcinoma metastasis to the iris. MATERIALS AND METHODS: A 52-year-old white woman who was under systemic chemotherapy for biliary tract carcinoma presented with a metastatic tumor in the left iris. At presentation, her visual acuity was at the 20/50 level. The tumor was occupying the nasal half of the iris, and had already occupied 5.5 clock hours of the angle, resulting in intraocular pressure elevation to 34 mm Hg. Several small clumps of tumor seeds were also observed on the iris and along the angle. Her intraocular pressure remained high despite full medical therapy with dorzolamide, timolol, brimonidine, and oral acetozolamide. Because of the vascularized nature of the tumor, antivascular endothelial growth factor (anti-VEGF) treatment with 3 repeated injections of bevacizumab (1.25 mg/0.05 mL) was applied 1-month apart. Bevacizumab treatment resulted in an abrupt decrease in tumor mass and disappearance of tumoral seeds from the anterior chamber. The patient's vision improved to 20/20, and intraocular pressure decreased to normal levels. CONCLUSIONS: Anti-VEGF treatment with intravitreal bevacizumab can restore sight and achieve intraocular pressure control in metastatic iris tumors complicated with secondary glaucoma. Anti-VEGF drugs are viable alternatives for the treatment of secondary angle-closure glaucoma induced by metastatic iris tumors and can prevent enucleation of these eyes.

Visual Results Following Implantation of a Refractive Multifocal Intraocular Lens in One Eye and a Diffractive in the Contralateral Eye.

OBJECTIVES: To assess the visual outcomes in patients who underwent cataract surgery with multifocal intraocular lens (IOL) implantation using a "mix and match" approach. MATERIALS AND METHODS: Twenty patients (40 eyes) were involved in this prospective, nonrandomized study. Refractive multifocal IOLs (ReZoom NXG1) were implanted in patients' dominant eyes and diffractive multifocal IOLs (Tecnis ZMA00) were implanted in their non-dominant eyes. Monocular and binocular uncorrected distance, intermediate and near visual acuity (logMAR), and contrast sensitivity levels were measured at 1, 3, and 6 months after cataract surgery. Defocus curves, reading speeds, patient satisfaction, spectacle dependence, and halo and glare symptoms were also evaluated at 6 months after the surgery. Postoperative quality of life was assessed with the Turkish version of National Eye Institute Visual Function Questionnaire-25. RESULTS: The study group comprised 8 females and 12 males with a mean age of 69.45±10.76 years (range, 31-86 years). The uncorrected distance and intermediate visual acuity levels were significantly better in the ReZoom-implanted eyes at postoperative 6 months (p=0.026 and p=0.037, respectively). There was no statistically significant difference in uncorrected near visual acuity (p>0.05). There was no statistically significant difference in contrast sensitivity, reading speed, halos, or glare between the groups (p<0.05). Mild glare/halo was reported by 40% of the subjects. The mean patient satisfaction was 95% and all patients were spectacle independent. CONCLUSION: Mixing and matching multifocal IOLs in selected cataract patients provides excellent visual outcome, a high level of patient satisfaction, and spectacle independency.

Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.

PURPOSE: To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. MATERIALS AND METHODS: Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. RESULTS: Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. CONCLUSION: Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.

Persistence of the Cone on the Posterior Corneal Surface Affecting Corneal Aberration Changes After Intracorneal Ring Segment Implantation in Patients With Keratoconus.

PURPOSE: To analyze the changes in anterior and posterior corneal surfaces and aberrations in patients who underwent intracorneal ring segment (ICRS) implantation for the treatment of keratoconus. METHODS: Eighty-nine eyes of 59 patients with keratoconus who underwent ICRS implantation were analyzed. All eyes were evaluated using a tomography system combining a Placido disc and Scheimpflug photography before and at least 6 months after surgery. Total, anterior, and posterior corneal aberrations, anterior and posterior sagittal and tangential anterior and posterior curve analysis, keratometry (K), minimum corneal thickness, and anterior chamber depth were analyzed before and after surgery. RESULTS: Flattening with a decrease in the cone shape on the anterior corneal surface and steepening in the paracentral area with persistence of cone appearance on the posterior corneal surface were noted in all cases after ICRS implantation. The total corneal higher-order aberrations (HOAs) significantly decreased from 1.09 ± 0.43 to 0.71 ± 0.32 µm, and anterior corneal HOAs significantly decreased from 0.98 ± 0.46 to 0.81 ± 0.37 µm, whereas the posterior corneal HOAs increased from 0.53 ± 0.29 to 0.66 ± 0.25 µm after ICRS implantation (P < 0.05). There was a significant decrease in anterior maximum keratometry, but there was a significant increase in posterior maximum keratometry after ICRS implantation (P < 0.05). CONCLUSIONS: The cone shape persists on the posterior corneal surface despite its correction on the anterior corneal surface, leading to a decrease in anterior corneal aberrations and an increase in posterior corneal aberrations after ICRS implantation in eyes with keratoconus.

Alterations in biomechanical properties of the cornea among patients with polycystic kidney disease.

PURPOSE: The aim of this study was to evaluate the corneal biomechanical features in polycystic kidney disease (PKD) patients and compare them with the healthy individuals. METHODS: Totally 81 patients with a mean age of 48.46 ± 14.51 years and 60 control cases with a mean age of 44.68 ± 12.69 years were included in the study. All of the subjects underwent a complete ophthalmological examination, including visual acuity testing, biomicroscopic anterior and posterior segment examinations. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) were evaluated with the ocular response analyzer, and the central corneal thickness was evaluated with Sirius® corneal topography. RESULTS: PKD patients had significantly increased CH values, without any alterations in IOP or CCT values, compared with the control cases (p:0.001). Among PKD patients, 23 were having liver cysts accompanying renal cysts. There was not any statistically significant difference between PKD patients with or without liver cysts regarding biomechanical properties of the cornea. However, both patient groups had statistically significantly increased CH values compared with the control cases. CONCLUSION: Patients with PKD present with higher CH values than age-matched controls. Larger studies are warranted to elucidate the alterations in corneal biomechanical properties and their clinical relevance in PKD patients.

Corneal biomechanical features in patients with ankylosing spondylitis / Características biomecânicas da córnea entre pacientes com espondilite anquilosante

ABSTRACT Purpose: To evaluate the corneal biomechanical features and central corneal thickness in ankylosing spondylitis patients and to evaluate correlations of these parameters with disease activity. Methods: The study included 51 patients diagnosed with ankylosing spondylitis (mean age, 40.80 ± 13.15 years; range, 18-72 years) and 34 age- and sex-matched healthy controls (mean age, 42.00 ± 12.32 years; range, 18-60 years). All underwent a complete ophthalmological and physical examination, including visual acuity testing and biomicroscopic anterior and posterior segment examinations. Corneal hysteresis, corneal resistance factor, Goldmann-correlated intraocular pressure, and corneal compensated intraocular pressure were evaluated with an ocular response analyzer, and the central corneal thickness was measured with Sirius® corneal tomography. The Bath Ankylosing Spondylitis Disease Activity Index, Functional Index, and Metrology Index scores were recorded. Results: In the ankylosing spondylitis patients, the mean disease duration was 7.73 ± 6.05 (range, 1-30) years. There was no statistically significant difference between the patients and controls in the corneal biomechanical features. The Goldmann-correlated intraocular pressure and corneal compensated intraocular pressure both showed positive correlations with age (p=0.003 and p=0.001, res­pectively). There was a negative correlation between corneal hysteresis and disease duration (p=0.002), and between central corneal thickness and the Bath Ankylosing Spondylitis Metrology Index score (p=0.003). Conclusion: This study demonstrated a significant negative correlation between corneal hysteresis and disease duration in ankylosing spondylitis patients. Furthermore, the central corneal thickness value decreased with an increase in Bath Ankylosing Spondylitis Metrology Index score, which may result in an underestimate of intraocular pressure readings and thus an inaccurate risk assessment of glaucoma.

RESUMO Objetivo: Avaliar as características biomecânicas da córnea e espessura central da córnea em pacientes com espondilite anquilosante e analisar a correlação destes parâmetros no grupo de estudo com a atividade da doença. Métodos: Foram incluídos no estudo 51 pacientes com diagnóstico de espondilite anquilosante e 34 controles saudáveis com idade e sexo. Todos os sujeitos foram submetidos a um exame oftalmológico e físico completo, incluindo exames de acuidade visual, exames de segmento anterior e posterior biomicroscópicos. Foram avaliados o coeficiente de resistência da córnea, a pressão intraocular correlacionada com Goldmann e a pressão intraocular compensada da córnea com o analisador de resposta ocular, a espessura corneana central com a tomografia corneana pelo Sirius®. Se o índice de atividade da doença de espondilite anquilosante de banho, o índice funcional de espondilite anquilosante de banho, o índice de metrologia de espondilite anquilosante de banho. Resultados: Foram incluídos no estudo 51 pacientes com idade média de 40,80 ± 13,15 (intervalo: 18-72) anos e 34 casos de controle com idade média de 42,00 ± 12,32 (intervalo: 18-60) anos. No grupo espondilite anquilosante a duração média da doença foi de 7,73 ± 6,05 (1,00-30,00) anos. Não houve diferença estatisticamente significante entre dois grupos quanto às características biomecânicas da córnea. Na análise de correlação, no grupo de estudo; pressão intraocular correlacionada com Goldmann e pressão intraocular compensada da córnea estavam positivamente correlacionados com a idade (p=0,003, p=0,001, respectivamente). Houve uma correlação negativa entre a duração da doença e CH (p=0,002), e entre índice de metrologia de espondilite anquilosante de banho e espessura corneana central (p=0,003). Conclusão: Este estudo demonstrou correlação negativa significativa entre a duração da doença e a histerese corneal em pacientes com espondilite anquilosante. Além disso, com um aumento na pontuação de índice de metrologia de espondilite anquilosante de banho, o valor de espessura corneana central também estava di­minuindo o que pode causar uma diminuição nas leituras de pressão intraocular artificialmente e resultar em avaliação de risco imprecisa de glaucoma.

Green laser induced foveal cyst sustained in a recreational laser light show.

We report the case of a 9-year-old boy complained of visual loss in his right eye after watching green laser light show being hit by a ray of a laser at shopping center before five days ago. The laser had a maximum power rating of 30 mW (US Food and Drug Administration class IIIB). Best-corrected visual acuity in his right eye was 0.2 with Snellen at 5 days after the injury. Dilated fundoscopic examination demonstrated a macular hole appearance in the right eye. Spectral domain optical coherence tomography (OCT, Spectralis, Heidelberg Engineering, Heidelberg, Germany) demonstrates a steep fovea contour, a thickening of the macular edges, intraretinal cysts, disruption of the photoreceptor inner segment/outer segment layer and macular pseudohole formation. Central foveal thickness (515 µm) was increased. Two months after the injury, the patient's visual acuity improved to 0.9 in the right eye without any ocular treatment. Spectral domain OCT revealed the closure of the macular hole with the resolution of the cystic spaces. At 6-months follow-up, visual function had fully recovered and macular assessment was normal.

Tear osmolarity and ocular surface parameters in patients with psoriasis / Parâmetros de osmolaridade lacrimal e da superfície ocular em pacientes com psoríase

ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1) and 30 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT) test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively) than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all). TBUT was significantly lower in group 1 (8.7 ± 3.6 s) than in group 2 (18.1 ± 2.8 s; p<0.001). No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629). Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a osmolaridade da lágrima, função do filme lacrimal e alterações da superfície ocular em pacientes com psoríase. Método: Em um único centro, 30 olhos de 30 pacientes com psoríase (grupo 1) e 30 olhos de 30 indivíduos saudáveis (grupo 2) foram avaliados pelo questionário do Índice de Doença da Superfície Ocular (OSDI), teste de Schirmer tipo I, tempo de ruptura do filme lacrimal (TBUT), coloração por fluoresceína da superfície ocular utilizando a escala de Oxford modificada e osmolaridade lacrimal. Resultados: Os valores de osmolaridade lacrimal, OSDI e escores da escala de Oxford foram significativamente maiores no grupo 1 (309,8 ± 9,4 mOsm, 38,9 ± 1,1 e 0,7 ± 1,1, respectivamente) em comparação com o grupo 2 (292,7 ± 7,7 mOsm, 4,2 ± 0,3 e 0,1 ± 0,3, respectivamente) (p<0,01 para todos). TBUT no grupo 1 (8,7 ± 3,6 s) foi significativamente menor em comparação com o grupo 2 (18,1 ± 2,8 s) (p<0,001). Não foram detectadas diferenças significativas nos valores de teste de Schirmer (16,2 ± 2,5 mm no grupo 1 e 16,6 ± 2,3 mm no grupo 2, p=0,629). Conclusões: Este estudo mostrou que a psoríase pode influenciar osmolaridade lágrima e função do filme lacrimal. Os pacientes com psoríase apresentaram hiperosmolaridade lágrima e disfunção do filme lacrimal.

A very sensitive flow-injection spectrophotometric determination method for iron (II) and total iron using 2', 3, 4', 5, 7-pentahydroxyflavone.

In this study, an ultra-sensitive and highly selective, rapid flow-injection spectrophotometric method for the determination of iron (II) and total iron has been proposed. The method was based on the reaction between iron (II) and 2', 3, 4', 5, 7-pentahydroxyflavone in slightly acidic solution with a strong absorption at 415 nm. The carrier solution used was 1 × 10(-5) M 2', 3, 4', 5, 7-pentahydroxyflavone in 0.1 M HAc/Ac(-) buffer solution at pH 4.5. Parameters that affect simultaneously the determination of iron (II) and interfering ions were tested. The relative standard deviation for the determination of 50 µg L(-1) iron (II) was 0.85 % (n = 10), and the limit of detection (blank signal plus three times the standard deviation of the blank) was 3 µg L(-1), both based on injection volumes of 20 µL. The method has been successfully applied to the determination of iron (II) and total iron in water samples and ore samples. The method was verified by analysing a certified reference material Zn/Al/Cu 43XZ3F.

Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block.

BACKGROUND: Although several studies have described effects of dexmedetomidine on peripheral nerve blocks, to date there is limited knowledge available on the impact of dexmedetomidine adjunct to levobupivacaine in axillary brachial plexus block. OBJECTIVE: In this study, we aimed to investigate the effects of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. METHODS: A total of 64 patients of American Society of Anesthesiologists physical status I/II scheduled to undergo forearm and hand surgery, in which an axillary block was used, were enrolled. The patients were randomly divided into 2 groups: in group L patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% plus 1 mL of isotonic sodium chloride. In group D patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% and 1 mL dexmedetomidine 1 µg/kg(-1) plus isotonic sodium chloride. Demographic data, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Spo2), sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, intraoperative verbal analog scale, postoperative visual analog scale (VAS) data, and side effects were recorded for each patient. RESULTS: There were no significant differences in patient and surgery characteristics between the 2 groups. Sensory block onset time was shorter in group D (P < 0.05). Sensory and motor block duration and time to first analgesic use were significantly longer in group D (P < 0.05), and the total need for analgesics was lower in group D (P < 0.05). Intraoperative 5- and 10-minute verbal analog scale values and postoperative VAS value at 12 hours were significantly lower in group D (P < 0.05). Intraoperative MAP and HR values, except at 5 minutes and postoperatively at 10 and 30 minutes and 1 and 2 hours, were significantly lower in group D (P < 0.01). Bradycardia, hypotension, hypoxemia, nausea, vomiting, and any other side effects were not seen in any patients. CONCLUSIONS: It was concluded in our study that adding dexmedetomidine to axillary brachial plexus block shortens sensory block onset time, increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects. ClinicalTrials.gov identifier ISRCTN67622282.

Acute vitreomacular traction syndrome after uneventful phacoemulsification.

We prospectively evaluated 59 eyes following uneventful phacoemulsification and intraocular lens implantation with optic coherence tomography at one and seven postoperative days (POD). Acute vitreomacular traction was observed in two eyes (3.3%) at the first POD. Spontaneous resolution occurred in both eyes within one week. The temporary visual loss associated with acute vitreomacular traction syndrome may go unnoticed as visual acuity rapidly improves.