Evaluation of corneal thickness with spectral-domain optical coherence tomography following keraring implantation for keratoconus: five year follow-up.

To evaluate the change in the position of intrastromal corneal ring segments (ICRS) implanted in keratoconus patients within five years of implantation. Participants in this study included keratoconus patients who received Keraring 10 ICRS implantation and had a follow-up time of at least 5 years. The distances from apex to anterior corneal surface (AA), from outer basal corner to posterior corneal surface (BP), and from inner basal corner to posterior corneal surface (CP) were measured at every postoperative visit (6 months, 1 year, 3 years, and 5 years) and compared to each other. Thirty eyes of 22 patients were included. The CP showed a statistically significant decrease at all 15 time points (p < .001); however, no statistically significant difference was found at 5 years regarding AA or BP (p > .05 for all). Triangular ICRS implanted in keratoconus patients remained stable for five years without any complications, which is an extremely important aspect of ICRS surgery. The only difference was a slight posterior movement of the inner basal corner, although without anterior chamber perforation.

The Impact of Vitamin D Deficiency on Retinopathy and Hearing Loss among Type 2 Diabetic Patients.

AIM: The current study was aiming to investigate the relation between vitamin D, retinopathy, and hearing loss among type 2 diabetes mellitus (T2DM) patients. METHODS: Cross-sectional study carried on 638 subjects aged between 20 and 60 years who visited the Endocrinology, Ophthalmology, and ENT Outpatient Clinics of the Medipol Hospital during the period from March 2016 to May 2017. Two audiometers Grason Stadler GSI 61 and Interacoustics AC40 Clinical audiometer were used to evaluate the hearing loss. Risk factors for diabetic retinopathy were evaluated, including age, sex, diabetes duration, glycated hemoglobin (HbA1c), hypertension, and lipid profiles. RESULTS: The mean age (± SD, in years) for retinopathy with hearing loss versus normal subjects was 47.7 ±10.2 versus 48.5±9.1. The associated risk factors were significantly higher in T2DM with hearing loss, hypertension (32.6% versus 15.7%), tinnitus (40.0% versus 18.0%), vertigo (59.7% versus 26.8%), and headache (54.9% versus 45.3%), than in normal hearing diabetes. There were statistically significant differences between hearing impairment versus normal hearing for vitamin D [19.40±9.71 ng/ml versus 22.67±9.28 ng/ml; p<0.001], calcium, magnesium, phosphorous, cholesterol, HDL-C, LDL-C, albumin, systolic blood pressure [131.70±9.25 Hg versus 127.73±11.98 Hg], diastolic blood pressure [82.20±8.60 mm Hg versus 79.80±8.20 mm Hg], and microalbuminuria. Multivariate logistic regression analysis revealed that variables such as vertigo, duration of DM, mobile/I pad phone, vitamin D deficiency, sleeping disturbance, headache, frequently TV watching, tinnitus, cigarette smokers, and hypertension were considered at higher risk as a predictors of retinopathy with hearing loss among diabetic patients. CONCLUSION: Vitamin D deficiency is considered as a risk factor for diabetic retinopathy and hearing loss among diabetic patients. Meanwhile, hyperglycemia could be considered as a modifiable risk factor for diabetic retinopathy; tight glycemic control may be the most effective and important therapy for improving quality of life and substantially reducing the incidence of retinopathy and in T2DM patients.

Predicting the refractive outcome and accuracy of IOL power calculation after phacoemulsification using the SRK/T formula with ultrasound biometry in medium axial lengths.

PURPOSE: To evaluate the accuracy of the SRK/T formula using ultrasound (US) biometry in predicting a target postoperative refraction of ±1.00D in eyes with medium axial length (AL) that underwent phacoemulsification. METHODS: The present study was a retrospective analysis, which included 538 eyes with an AL from 22.0 to 24.60 mm that underwent phacoemulsification and foldable intraocular lens (IOL) implantation (six different IOLs) in the bag. Preoperative AL was measured by US biometry and IOL power (IOLp) was calculated with the SRK/T formula. Patients had a complete ophthalmic examination, preoperatively and 1, 7, and 30 days after surgery. The achieved spherical equivalent (SE) and the prediction error (PE) were calculated. The prediction error was defined as the difference between attempted predicted target refraction and the achieved postoperative SE refraction. Statistical analysis was performed with SPSS V21. RESULTS: The mean age of the patients was 66.96±9.67 years, the mean AL was 23.29±0.62 mm, the mean K1 was 43.62±1.49D, the mean K2 was 43.69±1.53D, the mean IOL power was 21.066±1.464D, the mean attempted (predicted) SE was -0.178±0.266D, and the mean achieved SE was -0.252±0.562D. The mean PE (difference between predicted and achieved SE) showed a relatively hyperopic shift (mean ± standard deviation: 0.074±0.542D, ranging from -1.855 to 2.170D, P=0.001). A total of 93.87% of eyes were within ±1.00D of the PE and 92.75% of eyes within ±1.00D of achieved postoperative refraction. A total of 39 eyes (7.25%) had a refractive surprise. A total of 32 of 39 eyes were more myopic than -1.00D and 7 of them were more hypermetropic than +1.00D. There was no correlation between the mean PE and IOL type, AL, K1, K2, and IOLp. There were a positive statistically significant correlation between PE and age (r=0.095; P=0.028) and a negative statistically significant correlation between achieved SE and AL (Spearman's r=-0.125; P=0.04), and age (r=-0.141; P=0.01). CONCLUSION: The IOLp calculation using the SRK/T formula with US biometry may demonstrate very good postoperative refractive outcomes in medium eyes with a few refractive surprises.

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.

Performance of the SRK/T formula using A-Scan ultrasound biometry after phacoemulsification in eyes with short and long axial lengths.

BACKGROUND: The SRK/T formula is one of the third generation IOL calculation formulas. The purpose of this study was to evaluate the performance of the SRK/T formula in predicting a target refraction ±1.0D in short and long eyes using ultrasound biometry after phacoemulsification. METHODS: The present study was a retrospective analysis, which included 38 eyes with an AL < 22.0 mm (short AL), and 62 eyes ≥24.6 mm (long AL) that underwent uncomplicated phacoemulsification. Preoperative AL was measured by ultrasound biometry and SRK/T formula was used for IOL calculation. Three different IOLs were implanted in the capsular bag. The prediction error was defined as the difference between the achieved postoperative refraction, and attempted predicted target refraction. Statistical analysis was performed with SPSS V21. RESULTS: In short ALs, the mean age was 65.13 ± 9.49 year, the mean AL was 21.55 ± 0.45 mm, the mean K1 and K2 were 45.76 ± 1.77D and 46.09 ± 1.61D, the mean IOL power was 23.96 ± 1.92D, the mean attempted (predicted) value was 0.07 ± 0.26D, the mean achieved value was 0.07 ± 0.63 D, the mean PE was 0.01 ± 0.60D, and the MAE was 0.51 ± 0.31D. A significant positive relationship with AL and K1, K2, IOL power and a strong negative relationship with PE and achieved postoperative was found. In long ALs, the mean age was 64.05 ± 7.31 year, the mean AL was 25.77 ± 1.64 mm, the mean K1 and K2 were 42.20 ± 1.57D and 42.17 ± 1.68D, the mean IOL power was 15.79 ± 5.17D, the mean attempted value was -0.434 ± 0.315D, the mean achieved value was -0.42 ± 0.96D, the mean PE was -0.004 ± 0.93D, the MAE was 0.68 ± 0.62D. A significant positive relationship with AL and K1, K2 and a significant positive relationship with PE and achieved value, otherwise a negative relationship with AL and IOL power was found. There was a little tendency towards hyperopic for short ALs and myopic for long ALs. The majority of eyes (94.74 %) for short ALs and (70.97 %) for long ALs were within ±1 D of the predicted refractive error. No significant relationship with PE and IOL types, AL, K1, K2, IOL power, and attempted value, besides with MAE and AL, K1, K2, age, attempted, achieved value were found in both groups. CONCLUSION: The SRK/T formula performs well and shows good predictability in eyes with short and long axial lengths.

Changes in Anterior Chamber Depth after Combined Phacovitrectomy.

OBJECTIVES: To evaluate changes in anterior chamber depth (ACD) and postoperative refractive outcomes after combined phacovitrectomy. MATERIALS AND METHODS: This study included 10 eyes of 10 patients that underwent combined phacovitrectomy (study group) and 14 eyes of 14 patients that underwent phacoemulsification surgery (control group) at Istanbul Medipol University Ophthalmology Department. Preoperative and 3-month postoperative best corrected visual acuity (BCVA), ACD, change in ACD and refractive outcomes were compared between the two groups. RESULTS: Preoperative ACD, postoperative ACD at 3 months and change in ACD were similar between two groups (p=0.403, p=0.886, p=0.841). Postoperative mean refractive outcomes were 0.22±0.51 diopter in the phacovitrectomy group and -0.39±0.53 diopter in the phacoemulsification group (p=0.019). BCVA was increased in both groups (p=0.001). CONCLUSION: Postoperative refractive outcomes in eyes that underwent combined phacovitrectomy are different from those in eyes that underwent only phacoemulsification surgery. This is important in determining preoperative intraocular lens power before combined phacovitrectomy.

Tear Osmolarity and Tear Film Parameters in Patients With Ocular Rosacea.

OBJECTIVES: The aim of this study was to evaluate tear osmolarity and tear film parameters in patients with ocular rosacea. METHODS: In a single center, 25 eyes of 25 patients with ocular rosacea (group 1), 25 eyes of 25 patients with rosacea without ocular involvement (group 2), and 20 eyes of 20 healthy individuals (group 3) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), scoring of ocular surface fluorescein staining using modified Oxford scale, and tear osmolarity. RESULTS: Tear osmolarity values, OSDI and Oxford scale scores were significantly higher in group 1 than in groups 2 and 3 (P<0.001 for all). Schirmer I test and TBUT in group 1 were significantly lower than in groups 2 and 3 (P<0.001 for all). There were no significant differences in OSDI, Schirmer I test, TBUT, Oxford scores, or tear osmolarity between groups 2 and 3 (P=0.629, P=0.175, P=0.713, P=865, and P=0.388, respectively). CONCLUSIONS: This study showed that ocular rosacea is associated with tear hyperosmolarity and tear film dysfunction.

Anterior Segment Optical Coherence Tomography Assessment After Laser Capsulotomy in Pseudophakic Eyes With Pseudoexfoliation.

PURPOSE: To assess changes in anterior-chamber depth (ACD) and angle width after neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy pseudophakia in eyes with pseudoexfoliation (PEX). METHODS: This prospective and interventional case series study included 25 pseudophakic eyes of 25 patients with PEX and 26 pseudophakic eyes of 26 patients without PEX scheduled for Nd:YAG laser capsulotomy in a single institution. Anterior-chamber depth and angle width were measured with anterior segment optical coherence tomography before and three days after Nd:YAG laser capsulotomy. Preoperative and postoperative measurements of ACD and angle width included the angle opening distance (AOD), measured as the perpendicular distance from the trabecular meshwork at 500 and 750 mm anterior to the scleral spur to the anterior iris surface (AOD500 and AOD750, respectively) and anterior-chamber angle (ACA) in the nasal and temporal quadrants. Main outcome measures were the changes in ACD and angle width parameters. RESULTS: The mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.67±0.12 mm, 0.63±0.05 mm and 0.65±0.05 mm, 0.67±0.06 mm and 0.77±0.04 mm, 35.25±1.69° and 35.37±1.68° in eyes with PEX and 3.73±0.11 mm, 0.6±0.05 mm and 0.63±0.05 mm, 0.66±0.06 mm and 0.74±0.06 mm, 34.24±1.6° and 34.6±1.47° in control eyes, respectively (P>0.05 for all). After Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.76±0.09 mm, 0.73±0.05 mm and 0.76±0.05 mm, 0.75±0.06 mm and 0.87±0.04 mm, 36.82±1.46° and 35.06±1.52° in eyes with PEX and 3.77±0.1 mm, 0.68±0.06 mm and 0.72±0.06 mm, 0.72±0.05 mm and 0.84±0.06 mm, 34.95±1.4° and 35.79±1.36° in control eyes, respectively (P=0.811, P=0.019, P=0.021, P=0.109, P=0.126, P=0.001, and P=0.01, respectively). CONCLUSIONS: The depth and width of the anterior chamber in eyes with PEX and in control eyes increased significantly after Nd:YAG laser capsulotomy. The change in the width of the anterior chamber in eyes PEX was statistically significant comparing control eyes.

Evaluation of the effects of serum iron levels on lacrimal gland secretion.

In our study we aimed to demonstrate the relationship between the serum iron levels, and tears quality and quantity in term newborns. This study was conducted at a single institution between March 2013 and May 2013. A total of 46 newborns were prospectively enrolled. Serum iron levels were measured via the umbilical cord blood. Infants were divided into two groups according to their serum iron levels. Group A, serum iron level ≤70 µg/dL (n = 27) and Group B, serum iron level > 70 µg/dL (n = 19). The evaluation of the osmolarity was tested by using the TearLab Osmolarity System (TearLab Co, San Diego, CA, USA). The assessment of quantity was performed by using Schirmer I test. Osmolarity testing and Schirmer I test (with/without anesthesia) were performed bilaterally on the 1(st) day of life by an ophthalmologist. The outcomes of Schirmer I and tear osmolarity showed no statistically significant difference between right and left eyes of any infant in the groups. Moreover, there was no statistical difference between sexes in these two groups. Osmolarity was found to have a moderate negative correlation coefficient with serum iron level (r = -0.4, p < 0.01). Furthermore, there was a high positive correlation between Schirmer I with anesthesia and serum iron levels (r = 0.7, p < 0.01). We observed that the quality and quantity of the tears was lower in term newborns with lower serum iron levels than healthy newborns. These results indicate that low serum iron level could affect lacrimal gland functions.

Compare the effects of two silicone-hydrogel bandage contact lenses on epithelial healing after photorefractive keratectomy with anterior segment optical coherence tomography.

PURPOSE: To evaluate the efficacy of two silicone hydrogel bandage lenses (SiHy) on epithelial healing following photorefractive keratectomy (PRK) with anterior segment optical coherence tomography (AS-OCT). METHODS: Forty-two eyes of 21 patients who underwent PRK were included in a contralateral eye comparison study. At the end of the procedure, one eye of each patient was fitted with a Lotrafilcon B contact lens whereas the fellow eye was fitted with a Comfilicon A lens. Patients were examined on the day of surgery and at days 1-5 postoperatively. Main outcome measures were number of reepithelialized eyes, epithelial defect size, patient discomfort score and average complete reepithelization time. RESULTS: The number of mean reepithelialized eyes was showed no statistical significance between both groups during the follow up. Average epithelial defect size for Comfilcon A and Lotrafilcon B was 32.7±12.2mm(2) vs. 33.3±12mm(2) at day 1 (p=0.279) and 13.1±6mm(2) vs. 14.5±9mm(2) at day 3 postoperatively (p=0.018). Average re-epithelialization time was 3.1 days for Comfilcon A and 3.6 days for Lotrafilcon B (p=0.03). Mean subjective discomfort score was 2.25±0.96 in eyes with Lotrafilcon B and 1.64±0.67 in eyes with Comfilcon A on the first exam the day after surgery and until third day the differences were statistically significant (p=0.011 and p=0.012, respectively). CONCLUSIONS: AS-OCT is a reliable and noncontact method for assessment of reepithelialization under contact lenses after PRK. Eyes with Comfilcon A showed a statistically significant better discomfort score and faster reepithelialization time.

Anterior segment optical coherence tomography evaluation of corneal epithelium healing time after 2 different surface ablation methods.

OBJECTIVES: To compare epithelial healing time following laser epithelial keratomileusis (LASEK) and photorefractive keratectomy (PRK) with anterior segment optic coherence tomography (AS-OCT). METHODS: This prospective interventional case series study comprised 56 eyes of 28 patients that underwent laser refractive surgery in the Department of Ophthalmology, Medipol University Medical Faculty, Istanbul, Turkey, between March 2014 and May 2014. Each patient was randomized to have one eye operated on with PRK, and the other with LASEK. Patients were examined daily for 5 days, and epithelial healing time was assessed by using AS-OCT without removing therapeutic contact lens (TCL). Average discomfort scores were calculated from ratings obtained from questions regarding pain, photophobia, and lacrimation according to a scale of 0 (none) to 5. RESULTS: The mean re-epithelialization time assessed with AS-OCT was 3.07±0.64 days in the PRK group, 3.55±0.54 days in the LASEK group, and the difference was statistically significant (p=0.03). Mean subjective discomfort score was 4.42±0.50 in the PRK eyes, and 2.85±0.44 in the LASEK eyes on the first exam day (p=0.001). The score obtained on the second (p=0.024), and third day (p=0.03) were also statistically significant. The fourth (p=0.069), and fifth days scores (p=0.1) showed no statistically significant difference between groups. CONCLUSION: The PRK showed a statistically significant shorter epithelial healing time, but had a statistically significant higher discomfort score until the postoperative fourth day compared with LASEK.

Ocular surface and tear parameters in patients with chronic hepatitis C at initial stages of hepatic fibrosis.

PURPOSE: The aim of this study was to evaluate changes in ocular surface and tear function parameters in chronic hepatitis C at initial stages of hepatic fibrosis. METHODS: Thirty-one patients with biopsy-proven chronic hepatitis C and 31 age- and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I, tear film break-up time, and scoring of ocular surface fluorescein and Rose Bengal staining using modified Oxford and van Bijsterveld scoring systems, respectively. RESULTS: All ocular surface parameters, except OSDI and corneal staining scores, were significantly worse in hepatitis C group. The control group had greater OSDI scores than the hepatitis C group, but there was no statistically important difference. In subgroup analysis, progression of hepatic fibrosis was found to be correlated strongly with decreased Schirmer test I, increased OSDI, lid parallel conjunctival folds, conjunctival, and corneal staining scores. CONCLUSION: Patients with chronic hepatitis C were more likely to exhibit severe ocular surface damage and signs of dry eye.

Anterior segment optical coherence tomography measurement after neodymium-yttrium-aluminum-garnet laser capsulotomy.

PURPOSE: To evaluate changes in anterior chamber depth (ACD) and angle width after neodymium-yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy. DESIGN: Prospective interventional case series. METHODS: In a single institution, 43 eyes of 43 consecutive pseudophakic patients with symptomatic posterior capsule opacification (PCO) underwent Nd:YAG laser capsulotomy. Anterior chamber depth and angle width in pseudophakic eyes with posterior capsule opacification were measured with anterior segment optical coherence tomography (AS-OCT) before and 3 days after Nd:YAG laser capsulotomy. Preoperative and postoperative measurements of anterior chamber depth and angle width included the angle opening distance, measured as the perpendicular distance from the trabecular meshwork at 500 µm and 750 µm anterior to the scleral spur to the anterior iris surface (AOD500 and AOD750, respectively), and anterior chamber angle (ACA) in the nasal and temporal quadrants. Main outcome measures were the changes in ACD and angle width parameters. RESULTS: The mean patient age was 63.4 ± 3.6 years. Before Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.71 ± 0.11 mm, 0.61 ± 0.054 mm, 0.67 ± 0.063 mm, and 34.5 ± 1.67 degrees and 34.8 ± 1.55 degrees, respectively. Three days after Nd:YAG laser capsulotomy, mean ACD, AOD500, AOD750, and ACA (nasal and temporal) measurements were 3.77 ± 0.1 mm, 0.69 ± 0.06 mm, 0.73 ± 0.06 mm, and 35.51 ± 1.64 degrees and 36.17 ± 1.51 degrees, respectively (P < .01 for all). CONCLUSIONS: The depth and width of the ACA in pseudophakic eyes with PCO increased significantly after Nd:YAG laser capsulotomy, as shown by AS-OCT, a reliable and noncontact method for measuring anterior ocular structures. Our study shows that the different angle parameters such as ACD, AOD500, AOD750, and ACA measurements seem highly correlated.