The Effect of Prolactinoma on Tear Film Function.

Objectives: To compare dry eye parameters in prolactinoma patients and healthy controls and evaluate their correlation with prolactin (PRL) levels and the duration of hyperprolactinemia. Materials and Methods: Consecutive patients with prolactinoma and healthy controls were included in the study. Schirmer, tear break-up time (TBUT), tear osmolarity values, and ocular surface disease index (OSDI) scores were evaluated for each patient. Follow-up time and total duration of hyperprolactinemia were recorded for prolactinoma patients. Results: The study included 39 eyes of 39 patients with prolactinoma and 39 eyes of 39 age- and gender-matched healthy controls. Prolactinoma patients showed lower Schirmer (14.1±8.4 vs. 24.8±8.9 mm; p<0.001) and TBUT values (7.0±3.2 vs. 11.6±2.6 s; p<0.001) and higher OSDI scores (20.6±16.6 vs. 5.8±2.4; p<0.001) compared to the healthy controls. While the mean osmolarity of the prolactinoma patients was 301.6±8.3 mOsm/L, it was 297.7±12.5 mOsm/L for the healthy controls (p=0.07). The duration of hyperprolactinemia in prolactinoma patients showed a negative correlation with Schirmer (r=-0.395; p=0.013) and TBUT values (r=-0.377; p=0.018) and a positive correlation with OSDI scores (r=0.337; p=0.036). Conclusion: Prolactinoma patients had significantly lower Schirmer and TBUT levels and higher OSDI scores compared to the healthy controls, but no significant difference in tear osmolarity. The effect of high PRL levels on tear film function was duration-dependent.

Effect of the Rigid Gas-Permeable Contact Lens Use on the Endothelial Cells in Patients With Keratoconus.

OBJECTIVES: To compare the changes in the corneal endothelial cells of both the patients with keratoconus who use rigid gas-permeable (RGP) contact lens and who do not use any contact lens with healthy population. METHODS: Thirty-three patients with keratoconus who use RGP contact lenses (group 1), 20 patients with keratoconus who do not use any contact lens (group 2), and 40 healthy controls were included in the study. Changes in the corneal endothelial cells of all patients were evaluated using a noncontact specular microscope. Endothelial cell density (ECD), coefficient of variability (CV), hexagonal cell percentage (%HEX), and central corneal thickness (CCT) of the patients were evaluated in the study. RESULTS: In the groups 1, 2, and 3, the mean ECD was 2,420.8±247, 2,579.5±240, and 2,589.5±271 cells/mm, the mean CV was 357±9, 34±7, and 34±6, the mean %HEX was 54.3±13, 59.1±14, and 57.4±10, and the mean CCT was 508±33, 504±43, and 561±34 µm, respectively. There was no significant difference between the groups in terms of ECD, CV, and %HEX. Although significant differences between the groups 1 to 3 and groups 2 to 3 in terms of CCT were detected (P=0.001 and P=0.004, respectively), no significant difference was observed between the groups 1 and 2. CONCLUSIONS: Although significant difference was found between the groups 1 to 2 and normal population in terms of CCT, no difference was detected between all the groups in terms of the other parameters. In this study, we report that long-term use of RGP contact lens in patients with keratoconus had no effect on the corneal endothelial cells.

Treatment of plasminogen deficiency patients with fresh frozen plasma.

Congenital plasminogen (Plg) deficiency leads to the development of ligneous membranes on mucosal surfaces. Here, we report our experience with local and intravenous fresh frozen plasma (FFP). We retrospectively reviewed medical files of 17 patients and their eight first-degree relatives. Conjunctivitis was the main complaint. Thirteen patients were treated both with intravenous and conjunctival FFP. Venous thrombosis did not develop in any. Genetic evaluation revealed heterogeneous mutations as well as polymorphisms. Diagnosis and treatment of Plg deficiency is challenging; topical and intravenous FFP may be an alternative treatment.

Effects of the rigid gas permeable contact lense use on tear and ocular surface among keratoconus patients.

PURPOSE: To investigate changes in tear and ocular surface of patients with keratoconus using rigid gas permeable contact lenses (RGPCL) and compare them against keratoconus patients who were not using lenses as well as a control group of healthy subjects. METHODS: 24 keratoconus patients using RGPCL (Group 1) 22 patients who were not using lenses (Group 3) and 21 healthy subjects (Group 3) were included in the study. Subjective complaints about the subjects' eyes have been investigated using the ocular-surface disease index (OSDI). After the control of best-corrected visual acuity, anterior chamber and fundus examinations were performed. RESULTS: Schirmer (p-value=0.01) and tear break up mean comparison tests (p-value=0.002) revealed significant differences across different groups but tear osmolarity analysis did not (p-value >0.05). Oxford and OSDI scores were compatible with Schirmer and tear break up test comparisons. (for both p-value=0.001) Moreover, no statistical differences were seen in impression cytology measures between groups. (p-value >0.05) CONCLUSIONS: The erosion in the tear film stability is in line with the erosion in the ocular surface epithelium. Taking into account the statistical indifference between the impression cytology measures across groups, the break up time differences may be attributed to the collagen destruction in tear.

Molten metal-related ocular thermal burn: report on two cases / Queimadura térmica ocular por metal derretido: relato de dois casos

ABSTRACT We report two cases of severe thermal burns on the ocular surface and its adnexal appendages that developed secondary to exposure to molten heavy metal with a melting temperature of near-thousand degree Celsius. Despite aggressive intervention and strict monitoring, the profound inflammation caused significant damage to the ocular surface, ending up in an intractable infection with an unfavorable outcome. The heat of the molten metal at impact, the heat-retaining capacity of the heavy metal, the total area of the ocular surface exposed to the molten metal, and the duration of exposure determined the severity of the injury. The unfavorable outcome, despite an intensive treatment, in terms of visual acuity and cosmetic appearance, should be explicitly explained to the patient, and a psychiatrist consultation should be considered if necessary.

RESUMO Relatamos dois casos de queimaduras graves da superfície ocular e seus anexos causadas por exposição à metais pesados derretidos com temperatura de fusão de quase mil graus Celsius. Embora rigorosamente acompanhados, a inflamação intensa causou danos significativos para a superfície ocular, que acabou em uma infecção intratável com um resultado desfavorável. O calor do metal fundido no momento do impacto, a capacidade de retenção de calor do metal pesado, a área total da superfície ocular exposta ao metal fundido e a duração da exposição determinaram a gravidade da lesão que vai ocorrer. O resultado desfavorável, apesar do tratamento intensivo, em relação à acuidade visual e à aparência estética, devem ser claramente explicados ao paciente e uma consulta ao psiquiatra deve ser considerada, se necessário.

Richner-Hanhart syndrome (tyrosinemia type II): a case report of delayed diagnosis with pseudodendritic corneal lesion.

Richner-Hanhart syndrome (tyrosinemia type II) is a rare autosomal recessive disease associated with high serum tyrosine levels caused by the deficiency of tyrosine aminotransferase enzyme. We report a 15-year-old female patient with complaints of bilateral photophobia and tearing, which started during the infancy period. Biomicroscopic examination revealed bilateral circular corneal opacities on the inferior quadrant and small dendritic lesions at the center of the circular opacities. Blood tests showed a tyrosine level of 508 micromol/L (normal range: 30-150). On her dermatologic examination, plantar hyperkeratosis and seborrheic dermatitis were noted, and mild mental retardation was detected. One and a half months after the tyrosine- and phenylalanine-restricted diet, her tyrosine level dropped to 395 micromol/L level, her corneal lesions subsided, and a symptomatic relief was achieved. Tyrosinemia type II should be suspected in patients demonstrating dermatologic signs, especially palmoplantar keratosis, associated with bilateral pseudodendritic corneal lesions unresponsive to antiviral therapy.

Traumatic corneal flap dehiscence 6 years after LASIK.

PURPOSE: To report a case of LASIK flap dehiscence caused by blunt trauma 6 years after uneventful refractive surgery. METHODS: A 32-year-old man presented 3 hours after being struck by a carton edge in his left cornea, causing dehiscence of the LASIK flap. RESULTS: At initial examination, uncorrected visual acuity (UCVA) was 20/200 in the left eye. Minimal flap dehiscence was seen on the inferior corneal quadrant. A therapeutic bandage soft contact lens was placed and topical medical therapy was administered. Ten days after trauma, UCVA was 20/50 and best spectacle-corrected visual acuity was 20/30 in the left eye. At 7-month follow-up, the patient's clinical status did not change. CONCLUSIONS: Blunt corneal trauma occurring several years after uneventful LASIK may cause corneal flap dehiscence. Appropriate and prompt treatment usually is successful.

Lymphocyte subgroups and natural killer cell activity in recurrent herpetic stromal keratitis.

PURPOSE: Although the role of natural killer cells in the defense against certain viral infections has been published, little is known about the role of lymphocyte subgroups in recurrent herpetic stromal keratitis. Accordingly, serum levels of major immunoglobulins (IgG, IgA, and IgM) and IgG subgroups, the lymphocyte subgroups, and natural killer cell activity were investigated in patients with recurrent herpetic stromal keratitis. METHODS: Eleven patients with recurrent herpetic stromal keratitis and 10 healthy subjects were included. A delayed-type hypersensitivity skin test was performed in addition to the determination of serum immunoglobulin levels, IgG subgroups, peripheral blood lymphocyte percentages, and natural killer cell activity in both groups. RESULTS: The result of the delayed-type hypersensitivity skin test was positive in all patients with recurrent herpetic stromal keratitis and healthy subjects. No significant difference was obtained in serum immunoglobulin levels and IgG subgroups between the patients and healthy subjects. Among the cell surface antigens (CD3, CD4, CD8, CD16, CD19, and CD20), only CD8+ (i.e., cytotoxic) T-lymphocyte percentages were significantly increased (P=0.003), and the CD4:CD8 ratio was significantly decreased in the patients compared to the healthy subjects (P=0.021). There was no significant difference in the expression of CD16+ natural killer cells between both groups, despite a significantly lower natural killer cell activity in patients with recurrent herpetic stromal keratitis (P=0.011). CONCLUSIONS: These results indicate that human cytotoxic T cells show a difference in numbers and natural killer cell activity that may affect the prognosis of recurrent herpetic stromal keratitis.

Corneal topography in thyroid orbitopathy after orbital irradiation.

PURPOSE: The orbital tonus changes in thyroid orbitopathy, so it may be expected that corneal topographic results also change. Orbital irradiation may reduce the orbital tonus, and thus, it may affect the topographic changes. Corneal topographic results were examined before and after orbital irradiation in patients with thyroid orbitopathy to determine whether there was a difference. METHODS: Twenty eyes of 10 patients with thyroid orbitopathy were included in this study. Corneal topography was performed with Topographic Modeling System 2 (Tomey). The refractive power of the corneal curvature was measured at the center of the corneal apex and in each of the eight quadrants, 1.5 mm and 3 mm from the corneal apex, on the corneal topographer. A total dose of 20 Gy was given in 10 fractions over 2 weeks to the orbital structures sparing the lens, and corneal topography was performed 6 weeks and 8 months later. The measures of the refractive power of the cornea were taken again. Repeated-measures analysis of variance was used to evaluate the differences between the measures. RESULTS: There were no statistically significant differences in refractive power of the cornea in the topographic maps obtained before the radiotherapy and the two follow-up examinations after the radiotherapy. CONCLUSIONS: Thyroid orbitopathy is an orbital disease and may affect corneal topographic results. Orbital irradiation reduces or eliminates pathogenic orbital lymphocyte infiltration, thereby reducing orbital and extraocular muscle edema in patients with thyroid orbitopathy. In the current study group, corneal topographic changes were observed minimally as a result of the orbital irradiation, but they were not statistically significant.