Arterial hemodynamics and its correlation with retinal microarchitecture in pseudoexfoliation glaucoma / Hemodinâmica arterial e sua correlação com a microarquitetura retiniana no glaucoma pseudoesfoliativo

ABSTRACT Purpose: The study aimed to investigate the correlation between arterial hemodynamics measured by color Doppler ultrasonography and retinal microarchitecture parameters determined by spectral-domain optical coherence tomography (SD-OCT) in pseudoexfoliation glaucoma. Methods: This prospective study included 82 participants. Peripapillary retinal nerve fiber layer, ganglion cell inner plexiform layer, and ganglion cell complex values were measured. Ophthalmic artery and central retinal artery flows were evaluated with color Doppler ultrasonography, and resistivity index values were calculated. Results: The study included 47 controls and 35 pseudoexfoliation glaucoma cases. In pseudoexfoliation glaucoma group, mean peripapillary retinal nerve fiber layer and ganglion cell complex thickness were statistically significantly lower in all quadrants compared to controls (p<0.001). Resistivity index values of the ophthalmic and central retinal arteries were significantly higher in pseudoexfoliation glaucoma group than in the controls (p<0.001 and r=0.684). Resistivity index values of the ophthalmic and central retinal arteries with ganglion cell complex thickness correlated significantly. On the other hand, no significant relationship for retinal nerve fiber layer thickness was identified. Conclusions: Structural changes (ganglion cell complex and ganglion cell inner plexiform layer) in patients with pseudoexfoliation glaucoma and early glaucomatous loss showed a significant correlation with changes in ocular vascular hemodynamics. In cases where systemic vascular resistance is increased, ganglion cell complex and ganglion cell inner plexiform layer may not exactly reflect glaucoma state. In such cases, thickness changes in the retinal nerve fiber layer may give more realistic results regarding glaucoma. We have seen that pseudoexfoliation glaucoma-induced structural deterioration and increased resistance in ocular hemodynamics correlated with ganglion cell complex, but not retinal nerve fiber layer.

RESUMO Objetivo: Investigar a correlação entre a hemodi­nâmica arterial, medida pela ultrassonografia com Doppler colorido, e os parâmetros de microarquitetura da retina, determinados pela tomografia de coerência óptica de domínio espectral (SD-OCT) no glaucoma pseudoexfoliativo. Métodos: Foram incluídos 82 participantes neste estudo prospectivo. Foram medidos os valores da camada de fibras nervosas da retina peripapilar, da camada plexiforme interna de células ganglionares e do complexo de células ganglionares. Os fluxos da artéria oftálmica e da artéria central da retina foram avaliados com ultrassonografia por Doppler colorida e foram calculados os valores do índice de resistividade. Resultados: Foram incluídos no estudo 47 casos de controle e 35 casos de glaucoma pseudoexfoliativo. No grupo com glaucoma pseudoexfoliativo, a média da camada de fibras nervosas da retina peripapilar e a espessura do complexo de células ganglionares foram menores em todos os quadrantes em comparação com os controles, com significância estatística (p<0,001). Os valores do índice de resistividade das artérias oftálmica e central da retina foram significativamente maiores no grupo com glaucoma pseudoexfoliativo que nos controles (p<0,001 e r=0,684). Ao se compararem os valores do índice de resistividade das artérias oftálmica e central da retina com a espessura do complexo de células ganglionares, foi encontrada uma correlação significativa entre elas. Por outro lado, não detectamos uma relação significativa para a espessura da camada de fibras nervosas da retina. Conclusões: Alterações estruturais (complexo de células ganglionares, camada plexiforme interna de células ganglionares) em pacientes com glaucoma pseudoexfoliativo com perda glaucomatosa precoce mostraram uma correlação significativa com alterações na hemodinâmica vascular ocular. Nos casos em que a resistência vascular sistêmica é aumentada, o complexo de células ganglionares e a camada plexiforme interna de células ganglionares podem não refletir exatamente o estado do glaucoma. Nesses casos, alterações na espessura da camada de fibras nervosas da retina podem dar resultados mais realistas em relação ao glaucoma. Observou-se uma correlação da deterioração estrutural induzida pelo glaucoma pseudoexfoliativo e do aumento da resistência na hemodinâmica ocular com o complexo de células ganglionares, mas não com a camada de fibras nervosas da retina.

Biomechanical properties of the cornea following intravitreal ranibizumab injection.

OBJECTIVE: To evaluate intraocular pressure (IOP) and corneal biomechanical properties changes after intravitreal ranibizumab injection (IVRI). METHODS: One hundred twenty eyes of 120 patients who underwent IVRI between January and March 2018 in Adnan Menderes University Ophthalmology Clinic were included in study. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) were measured by Ocular Response Analyzer (ORA) by the same specialist preoperatively (preop), postoperative 1st (postop-1st), postoperative 3rd (postop-3rd), and postoperative 24th hours (postop-24th) after single-dose IVRI. RESULTS: Among the 120 wet age-related macular degeneration subjects, 58 (48.3%) were female and 62 (51.7%) were male. The mean age was 64.8 ± 10.4 years. Postop-1st hour IOP cc and IOPg measurements were statistically different from all other measurements (p < 0.001). Postop-1st hour CH measurements were statistically different from preop and postop-3rd (p = 0.022 and p = 0.008, respectively). CONCLUSION: After intravitreal injection, IOP pressures significantly increased. But, CH and CRF values were significantly decreased. All these changes were temporary.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model.

PURPOSE: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. METHODS: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). RESULTS: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. CONCLUSIONS: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model / Efeitos oftálmicos adversos de descongestionantes nasais em modelo experimental com ratos

ABSTRACT Purpose: To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. Methods: Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). Results: Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. Conclusions: Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

RESUMO Objetivo: Investigar os possíveis efeitos da exposição crônica de descongestionante nasal e seus excipientes em tecidos oculares, utilizando um modelo experimental com ratos. Métodos: Sessenta ratos Wistar adultos machos foram divididos aleatoriamente em seis grupos. Os primeiros dois grupos foram controle (soro fisiológico) e Otrivina®. Os quatro grupos restantes receberam os excipientes de Otrivina, tais como Xilometazolina, Benzalcônio, Sorbitol e Ácido Etilenodiamino Tetracético (EDTA). Os medicamentos foram aplicados em ambas as narinas dos ratos, duas vezes ao dia, durante 8 semanas. Antes que os ratos fossem sacrificados, a coloração epitelial, o teste de Schirmer e a medida da pressão intraocular foram realizados sob anestesia com Ketamina/Xilasina (50 e 5 mg/kg, respectivamente). Resultados: Defeitos epiteliais e olho seco foram achados comuns nos grupos de estudo. A catarata desenvolveu-se clinicamente em dois casos. A avaliação histopatológica revelou a existência de alterações em todas as partes dos tecidos oculares, tais como edema de córnea, proliferação polipoide e hialinização da parede vascular, formação cística da lente, degeneração da camada de fibra nervosa da retina (RNFL) e formação de corpos amiláceos da glândula lacrimal. Conclusões: O uso prolongado do descongestionante nasal Xilometazolina e seus excipientes pode causar vários problemas oftalmológicos, como olho seco, edema de córnea, catarata, RNFL e dano vascular em ratos. Embora esses resultados tenham sido obtidos a partir de animais experimentais, os oftalmologistas devem ter em mente os potenciais efeitos oftalmológicos adversos desse medicamento e/ou de seus excipientes.

Effects of sunitinib and bevacizumab on VEGF and miRNA levels on corneal neovascularization.

AIM: To evaluate the effects of sunitinib (0.5 mg/ml) and bevacizumab (5 mg/ml) on VEGF-A, VEGFR-2 and microRNA (miRNA) levels on corneal neovascularization (CNV). METHODS: In this study, CNV was induced by silver nitrate application to the cornea, and 40 Albino male rats were equally divided into four subgroups: Group 1 (sunitinib): After silver nitrate application to the cornea, 0.5 mg/ml sunitinib eyedrop was administered twice daily for two weeks (n = 10). Group 2 (bevacizumab): After silver nitrate application to the cornea, 5 mg/ml bevacizumab eyedrop was administered twice daily for two weeks (n = 10). Group 3 (control): After silver nitrate application to the cornea, normal saline eyedrop was administered twice daily for two weeks (n = 10). Group 4 (vehicle): After silver nitrate application to the cornea, 1% DMSO eyedrop was administered twice daily for two weeks (n = 10). After two weeks from the silver nitrate application, corneas were evaluated by hand-held biomicroscope for their vascularization status. Then, corneas were excised and the expression levels of VEGFR-2, VEGF-A and the common miRNA markers for neovascularization (miR-15 b, miR-16, miR-23a, miR-126, miR-188, miR-210, miR-221, miR-222, miR-410 and miR-423) were evaluated by real-time PCR. RESULTS: It was seen that the CNV was decreased in sunitinib- and bevacizumab-administered groups compared to the control and DMSO groups. Also, in comparison with the control group; VEGF-A expression was downregulated by nearly 0.75 times in sunitinib group and nearly 0.52 times in bevacizumab group. VEGFR-2 expression was downregulated by 0.89 times in sunitinib group and 0.68 times in bevacizumab group, compared to the control group. miR-15 b, miR-16 and miR-126 levels were statistically lower in sunitinib and bevacizumab groups, but miR-188 and miR-410 levels were two-fold higher compared to the control group. The miR-210 level was found higher only in sunitinib group compared to the control group. There were no statistically significant changes in miR-23a, miR-221, miR-222 and miR-423 levels among the groups. CONCLUSION: Topical application of bevacizumab (5 mg/ml) and sunitinib (0.5 mg/ml) decreases the levels of VEGFR-2 and VEGF-A in CNV. Further studies are needed for detailed analysis of genes which are targeted by up- or downregulated miRNAs in this study.

Effects of Topical Thymoquinone in an Experimental Dry Eye Model

Objectives: To comparatively evaluate the effects of thymoquinone (TQ), the biologically active main component of volatile oil derived from Nigella sativa seeds, in an experimental dry eye model. Materials and Methods: A total of 36 BALB/c mice 10 weeks of age were used in the study. The mice were divided into 6 groups of 6 mice. Two groups were negative and positive controls, and the other 4 groups were treated with balanced salt solution, fluorometholone (FML), TQ, or vehicle (Tween80). After 1 week of treatment, the mice were killed and the eyes removed for histopathologic examination and cytokine analysis. Interleukin (IL)-1α tumor necrosis factor-α, interferon-γ, IL-2, IL-6, IL-10, and lactoferrin levels in the conjunctival tissue were measured by multiplex immunobead assay. The presence of inflammatory cells in ocular tissue samples were investigated by hematoxylin-eosin and periodic acid-Schiff staining. Inflammatory T cells containing CXT receptor in the conjunctiva were determined by flow cytometry. Results: FLML and TQ groups had less inflammatory cell density and more goblet cells compared to the other groups. High levels of IL-1α and IL-2 were found in the TQ group. Conclusion: TQ treatment was associated with reduced inflammation in pathological examination, but did not significant lower cytokine levels.

The effects of topical everolimus and sunitinib on corneal neovascularization.

PURPOSE: To evaluate the effects of topical everolimus and sunitinib on corneal neovascularization (CNV). METHODS: CNV was induced by application of silver nitrate to the cornea for all groups. Rats were divided into four groups of 10 rats each, and two corneas were obtained from each rat. Group I received 1 mg/ml everolimus, Group II received 0.5 mg/ml sunitinib, Group IV received no treatment (control group) and Group IV received 1% Dimethylsulfoxide (DMSO). All treatments were administrated twice daily for 2 weeks. The right corneas were used for extracellular signal-regulated kinase 1/2 (ERK 1/2) protein analysis by western blot analysis and the left corneas were used for ERK 1/2 and vascular endothelial growth factor-receptor (VEGFR-2) gene expression analysis by quantitative real-time PCR. RESULTS: VEGFR-2 mRNA expression levels (ΔCt, median, min-max) were reduced in the everolimus 1.0 (0.25-1.81) and sunitinib 1.06 (0.24-2.68) treated groups compared with the control 4.74 (1.02-14.74) and DMSO groups 7.41 (0.72-13.10). The expression of ERK 1/2 protein and mRNA levels were reduced in everolimus group compared with the control group (p < 0.05). These differences were not seen between the sunitinib and control groups. CONCLUSION: Topical administration of both everolimus and sunitinib reduced VEGFR-2 levels and inhibited CNV. In additon, everolimus reduced ERK 1/2 levels and seems to be more effective than sunitinib on CNV.

The effect of adjustable suture (Khaw) trabeculectomy on intraocular pressure: a retrospective case series.

The aim of the study is to investigate long-term intraocular pressure (IOP) outcome as well as complications associated with adjustable suture trabeculectomy in glaucoma patients who were uncontrolled under maximum medical therapy. In this retrospective case series, 35 eyes of 30 patients are included in the study. Adjustable suture trabeculectomy with 0.2 mg/cc mitomycin-C for 3 min was performed by the same surgeon. Subconjunctival 5-fluorouracil injection, transconjunctival suture adjustment, digital massage, and/or argon suturolysis were utilized postoperatively as needed. Complete success, qualified success, and failure were defined as IOP ≤ 18 mmHg without medication, IOP ≤ 18 mmHg with one or more medications, and IOP >18 mmHg with medication or need for additional glaucoma surgery, respectively. Of the 35 eyes, 13 had primary open angle, 18 had psuedoexfoliative, 1 had juvenile, 1 had pigmentary, 1 had uveitic, and 1 had chronic angle-closure glaucoma. Mean preoperative IOP of 30.1 ± 10.5 mmHg dropped to 10.8 ± 4.7 mmHg (p < 0.001) after a mean follow-up of 595 ± 435 days. Nine eyes had the desired IOP on first postoperative day where no transconjunctival suture adjustment was performed. Remaining 26 eyes required a mean of two adjustments (range 1-7) during the first postoperative 24 days in order to achieve a desirable IOP. Complete success, qualified success, and failure were observed in 28 (80 %), 5 (14 %), and 2 (6 %) eyes, respectively. There were no serious complications related to adjustable suture trabeculectomy. We believe adjustable suture trabeculectomy to be a safe and effective alternative to standard trabeculectomy where a desirable low IOP can be achieved.

Tear Osmolarity, Break-up Time and Schirmer's Scores in Parkinson's Disease.

OBJECTIVES: Dry eye is an important problem in Parkinson's disease (PD) with a potential to affect life quality. Tear osmolarity, accepted as the gold standard in dry eye diagnosis, has not been studied in this subset of patients so far. Therefore, in this study we aimed to evaluate tear osmolarity, Schirmer's test scores and tear film break-up time (TBUT) in PD patients. MA­TE­RI­ALS AND MET­HODS: PD patients with a minimum follow-up of 1 year and healthy controls who admitted for refractive abnormalities were enrolled to the study. Subjects using any systemic medication with a possibility to affect tear tests were not included in the study. The presence of any ocular surface disorder, previous ocular surgery, previous dry eye diagnosis, any topical ophthalmic medication or contact lens use were other exclusion criteria. Age, gender, disease duration, and Hoehn and Yahr (H&Y) score for disease severity were noted, and blink rate (BR), Schirmer's test score, TBUT and tear osmolarity of the right eye were measured in both groups. RE­SULTS: Thirty-seven PD patients and 37 controls were enrolled to the study. The groups were age and gender matched. The mean disease duration and H&Y score were 5.70±2.64 years and 1.70±0.93, respectively. H&Y staging and disease duration were not correlated to BR, Schirmer's scores, TBUT, or tear osmolarity (p>0.05). The mean BR was 8.54±4.99 blinks/minute in PD patients and 11.97±6.36 blinks/minute in the control group. Mean Schirmer's scores, TBUT and osmolarity values were 9.08±4.46 mm, 11.38±4.05 seconds and 306.43±12.63 mOsm/L in the PD group and 17.16±9.57 mm, 12.81±3.66 seconds and 303.81±16.13 mOsm/L in the control group. The differences were significant only in BR and Schirmer's scores. CONCLUSION: BR and Schirmer's scores decreased significantly in PD patients. Although not significant, the demonstrated tear osmolarity increment might be important to document the dry eye and inflammatory process of the ocular surface in PD patients.

Combined eye gel containing sodium hyaluronate and xanthan gum for the treatment of the corneal epithelial defect after pterygium surgery.

AIM: The aim of this study is to compare the effectiveness of the ophthalmic gels containing hyaluronate, xanthan gum, and netilmycine with fusidic acid in terms of recovery periods of corneal epithelium in the patients who underwent pterygium surgery. METHODS: Patients who underwent pterygium surgery were separated into two groups. Forty patients in group 1 were given eye gel containing sodium hyaluronate, xanthan gum, and netilmycine, and 40 patients in group 2 were given one drop of eye gel containing fusidic acid. The patients in both groups were examined at the 12th, 24th, and 48th hours in the postoperative period by using slit-lamp technique. The subjective complaints of the patients such as pain and stinging, and the recovery periods of the corneal epithelial defect were evaluated comparatively by fluorescein staining. RESULTS: The mean ages were 26±8 years (range: 18-35) and 24±6 years (range: 18-33) in groups 1 and 2, respectively. The closure period of the corneal epithelial defect was observed as 24±8 hours (range: 16-42) and 36±12 hours (range: 18-48) in groups 1 and 2, respectively. The number of the patients suffering from subjective complaints such as pain and stinging in the first 12 hours was six and 29 in groups 1 and 2, respectively. The difference was significant both clinically and statistically (P=0.001). CONCLUSION: Combined eye gel containing hyaluronate, xanthan gum, and netilmycine accelerates the recovery of corneal epithelial defect and reduces the complaints of the patients, when compared to the fusidic acid gel. Combined eye gel should be considered as an option for the treatment of the corneal epithelial defect related with pterygium surgery.

Ocular biometric characteristics during the menstrual cycle.

PURPOSE: To determine the ocular biometric characteristics during the menstrual cycle using the optical low-coherence reflectometry (OLCR) biometry. METHODS: Twenty-two healthy women between the ages of 19 and 36 years with regular menstrual cycles were enrolled in this prospective study. Subjects with irregular menstrual cycles, those taking contraceptive pills, those with a history of ocular surgery or trauma, and women unable to cooperate with the ocular biometry device were excluded from this study. A complete ophthalmic examination was performed between 8.30 and 10.30 am for all participants. Also, central corneal thickness, axial length, anterior chamber depth, lens thickness, and keratometric measurements were made at the same time using the OLCR device. Measurements were taken at the beginning of the cycle (1-3 days), at ovulation (12-16 days), and at the end of the cycle (26-32 days). RESULTS: The mean age of the participants was 22.86±4.22 (range: 18-36) years. The difference in central corneal thickness, axial length, anterior chamber depth, lens thickness, and keratometry values were not statistically significant during the menstrual cycle. CONCLUSION: The ocular biometric parameters did not significantly vary during the menstrual cycle according to the OLCR biometry.

Comparison of surgically induced astigmatism in patients with horizontal rectus muscle recession.

AIM: To compare surgically induced astigmatism (SIA) following horizontal rectus muscle recession surgery between suspension recession with both the "hang-back" technique and conventional recession technique. METHODS: Totally, 48 eyes of 24 patients who had undergone horizontal rectus muscle recession surgery were reviewed retrospectively. The patients were divided into two groups. Twelve patients were operated on by the hang-back technique (Group 1), and 12 by the conventional recession technique (Group 2). SIA was calculated on the 1(st) wk, 1(st) and in the 3(rd) mo after surgery using the SIA calculator. RESULTS: SIA was statistically higher in the Group 1 all postoperative follow-up. SIA was the highest in the 1(st) wk, and decreased gradually in both groups. CONCLUSION: The suspension recession technique induced much more SIA than the conventional recession technique. This difference also continued in the following visits. Therefore, the refractive power should be checked postoperatively in order to avoid refractive amblyopia. Conventional recession surgery should be the preferred method so as to minimize the postoperative refractive changes in patients with amblyopia.

The effects of diazepam on blood pressure levels in cataract surgery.

OBJECTIVE: To evaluate the effects of oral diazepam on blood pressure (BP) alterations in patients that underwent cataract surgery under topical anesthesia. METHODS: A total of 147 patients that underwent phacoemulsification surgery under topical anesthesia, were reviewed retrospectively. The study took place in the Department of Ophthalmology, Adnan Menderes University Medical Faculty, Aydin, Turkey, between January 2011 and July 2013. Patients were divided into 2 groups: Group 1: received 5 mg diazepam per oral one hour prior to surgery, and Group 2 (control group): none administered preoperatively. The BP readings of all patients were scanned through their files. Five readings were chosen for statistical analysis. The first reading was taken in the ophthalmology ward on the morning of the operation, the second was taken in the premedication room just before the surgery, 2 readings were taken intraoperatively and recorded as third and fourth values, and the fifth reading was recorded from those taken in the ophthalmology ward after surgery. RESULTS: Group 1 had a mean age of 62.17 +/- 10.01 years, while the Group 2 had a mean age of 64.31 +/- 10.88 years. There were no differences between the 2 groups by means of systolic and diastolic BP levels measured preoperatively in the ophthalmology ward. Intraoperative systolic and diastolic BP levels were significantly higher in Group 2 (p<0.001). CONCLUSION: Elevated BP can undermine surgical outcomes; and may lead to unforeseen complications. To prevent the elevation of BP to risky levels in the intraoperative period, diazepam administration may be beneficial, even in normotensive patients.

The ocular biometric differences of diabetic patients.

PURPOSE: To investigate the differences in ocular biometric and keratometric characteristics in comparison with biometric measurements using the noncontact optical low coherence reflectometer (OLCR) (Lenstar LS 900, Haag-Streit) on diabetic patients. METHODS: The eyes of 170 patients were included in this study, including 81 diabetic and 89 nondiabetic subjects. Optical biometric measurements of diabetic and nondiabetic patients (between the ages of 25 and 85 years) who applied to the ophthalmology clinic were noted from March to June 2013. Detailed ophthalmologic examinations were done for every subject. Biometric measurements were done using the noncontact OLCR device. RESULTS: Patient age ranged from 29 to 83 years. Subgroup analyses were done in diabetic patients according to their Hba1C levels. The minimum Hba1C value was 5.3, maximum was 12.4, and mean was 7.56 ± 1.48. The median duration of diabetes was 5 years (25th-75th percentile 3.00-11.75). Diabetic patients were found to have thicker lens and shallower anterior chamber in both eyes compared to nondiabetic control subjects. There were no statistical differences between the groups according to central corneal thickness, axial length, or keratometric values in both eyes. However, lens thicknesses were found to be thicker and anterior chamber depth values were found to be shallower in the diabetic group in both eyes. CONCLUSIONS: It may useful to determine eyeglasses prescription, refractive surgery calculation, lens selection, and previous cataract surgery according to biometric measurements after the regulation of blood glucose.

Oculoplastic approach to congenital cutis laxa syndrome.

UNLABELLED: Cutis laxa is a rare congenital or acquired disorder of elastic tissue, characterized by loose skin with folds and multiple internal organ involvement, which may cause life-threatening complications. We present a patient with cutis laxa syndrome who had cross eyelids with esotropia. Bilateral lateral canthal tendon repositioning and bilateral medial rectus recession procedures were performed in a single session. The patient had acceptable eyelid and globe cosmesis after the procedure. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Successful treatment of early relapse of ocular myeloma with bortezomib and steroid after autologous stem cell transplantation.

Autologous stem cell transplantation (ASCT) can prolong remission duration, overall and progression free-survival in multiple myeloma (MM). Ocular relapse is rare in MM. Here we present a patient with only ocular relaps and without evidence of bone marrow progression after ASCT. Ig A kappa myeloma, stage IIIA was diagnosed in a 53-year-old man, according to Kyle-Greipp and Durie Salmon. He was treated with three courses of VAD therapy. Then he received high dose melphalan (200 mg/m2), followed by the ASCT. After two months from ASCT, he had bilateral blurry vision, pain, redness in both eyes and diplopia. We detected 5 mm of right-sided proptosis by Hertel exophthalmometry (base 110, 20 mm right eye, 15 mm left eye). Ocular motility of oculus dexter (OD) was restricted in up and lateral gaze. He has diplopia in up gaze. His color vision was 7 of 12 in the right eye and 10 of 12 in the left eye with Ishihara plates. Best corrected visual acuity was 6/10 in the right eye and 7/10 in the left eye. Intraocular pressures were 19 mmHg for OD and 18 mmHg for oculus sinister (OS). Slit lamp biomicroscopy revealed subconjunctival hemorrhages superiorly and temporally in the right eye and bilateral conjunctival hyperemia with chemosis. Fundus examinations of both eyes were unremarkable. Computed tomography and magnetic resonance imaging of orbita revealed a right intraorbital extraconal soft tissue density mass that involved the lacrimal gland and lateral rectus muscle. Prednisolon 1mg/kg/day and bortezomib 1.3 mg/m2 were started (1, 4, 8, 11 days). Eye findings were recovered after one month. Ocular relapse should be considered if there are ocular findings after ASCT for MM. Bortezomib and steroid may be useful for ocular extramedullary relapse of MM (Fig. 2, Ref. 8).

Prevention of suture exposure in transscleral intraocular lens fixation: an original technique.

BACKGROUND: In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure. METHODS: Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes). RESULTS: The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%) (p = 1.000). INTERPRETATION: Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.

Post-LASIK epithelial dendritic defect associated with Alternaria.

PURPOSE: To report a case of a dendritic epithelial defect with interface inflammation associated with Alternaria sp. after laser in situ keratomileusis (LASIK) surgery. METHODS: A case report of a 46-year-old woman who presented with a dendritic epithelial defect and interface inflammation after LASIK surgery. RESULTS: After an apparent post-LASIK herpes simplex keratitis with related interface inflammation failed to respond to medical therapy, cornea culture results were positive for Alternaria fungal sp. 2 weeks and 6 days after presentation. Viral cultures and polymerase chain reaction were negative for herpes simplex virus. Six months after penetrating keratoplasty (and 1 year after LASIK), the patient underwent a cataract extraction OD. Best-corrected visual acuity 18 months after the original LASIK procedure was 20/25 OD. CONCLUSIONS: Alternaria keratitis may present with a dendritic epithelial defect with interface inflammation mimicking herpes simplex virus.

Visual outcome and rehabilitation in a case of bilateral acanthamoeba sclerokeratitis.

PURPOSE: To report a rare and complicated case of bilateral Acanthamoeba sclerokeratitis (ASK). METHODS: Case report of a 42-year-old patient who was referred to the Massachusetts Eye and Ear Infirmary 7 months after a history of culture-confirmed bilateral Acanthamoeba polyphaga sclerokeratitis. At the time of referral to the MEEI, he was noted to have iris neovascularization and chronic mydriasis in both eyes. The anterior chambers were shallow, and there were mature cortical cataracts that obscured the posterior pole in both eyes. His visual acuity in both eyes was limited to hand motions. RESULTS: The patient underwent sequential cataract extraction, penetrating keratoplasty (PK), and yttrium-argon-garnet laser capsulotomy of the right eye over a span of 3 months. This treatment substantially improved the vision in his right eye to 20/400. Cataract extraction surgery and a PK have been scheduled for this patient's left eye in the near future. CONCLUSIONS: Some patients with ASK and apparently poor visual prognosis can achieve substantial visual improvement after anterior-segment surgery. This report describes the management and outcome of only the second reported case of bilateral ASK in the world.