Development of posttraumatic stress disorder and depression after open globe injury in adults.

PURPOSE: To investigate the prevalence of posttraumatic stress disorder (PTSD) and depression after open globe injury in adults. METHODS: A total of 95 participants, 43 adult patients with open globe injury and 52 age-sex similar subjects (control group), were included in this cross-sectional study. Age, gender, education level, occupation, accident history, psychiatric history, trauma type, cause of trauma, and visual acuity were recorded. One to six months after trauma, PTSD and depression symptoms of the participants were evaluated with the Posttraumatic Stress Disorder Questionnaire-Civil Version Scale (PTSD-S) and Beck Depression Inventory (BDI), respectively. RESULTS: Patients with open globe injury had a higher PTSD-S total score than the control group, but not significant (23.67 ± 20.41 vs. 18.56 ± 13.13, p = 0.580). Patients with eye trauma exhibited a much higher prevalence of PTSD compared to the control group (20.9% vs. 3.8%, p = 0.010). Patients with trauma had a significantly higher BDI total score than the control group (12.47 ± 10.08 vs. 7.69 ± 6.10, p = 0.015). Also, patients had a higher rate of depression symptoms than controls (25.6% vs. 7.7%, p = 0.017). A significant positive correlation was observed between PTSD-S and BDI scores in the trauma group (r = 0.720, p < 0.001). CONCLUSION: An increased prevalence of PTSD and depression was observed in adults after open globe injury. The significant relationship between PTSD-S and BDI scores indicates that patients with open globe injuries should be questioned in terms of both symptoms. For patients with open globe trauma, a holistic approach with psychosocial assessment in addition to physical intervention would be beneficial.

Intraocular pressure increase after Nd:YAG laser capsulotomy and anterior segment optical coherence tomography analysis.

This study is to determine whether post-procedure intraocular pressure (IOP) increase is associated with the anterior chamber angle in cases of Neodymium: yttrium-aluminum garnet (Nd: YAG) laser capsulotomy. The study included 51 eyes with posterior capsule opacification. Initial IOP values of the patients were compared with IOP values without intraocular pressure-lowering administration at the end of the 1st hour, 1st day, 3rd day, and 7th day after Nd:YAG laser capsulotomy. The anterior segment angle configuration was evaluated using anterior segment optical coherence tomography analysis without dilatation before the procedure. The anterior chamber angle (ACA) and angle opening distances of 500 and 750 µm (AOD500 and AOD750) in the nasal and temporal quadrants were examined. The mean pre-laser IOP value only increased significantly at 1st hour post-laser (13.02 ± 3.02 mmHg vs 14.16 ± 4.07 mmHg, p = 0.016). In eyes with ACA below 40° in both the nasal and temporal quadrants, mean IOP increased significantly at 1st hour post-laser (p = 0.025 and p = 0.032, respectively), while it was not significant in eyes with ACA above 40° (p > 0.05). No correlation was found between ACA, AOD500, and AOD750 values and IOP changes at the first hour (p > 0.05). Except for the first hour after Nd:YAG laser capsulotomy, no significant increase in IOP was observed. This elevation was higher in eyes with ACA less than 40°. In patients with a narrow ACA, first-hour follow-up may be beneficial in terms of susceptibility to increased IOP.

Assessment of the Retinal Nerve Fibre Layer, Retina, and Choroid in Osteogenesis Imperfecta.

BACKGROUND: Osteogenesis imperfecta (OI) is a genetic disorder in which there are problems in tissues containing type I collagen, predominantly the cornea and sclera in the eye. Although there are many studies on problems with the anterior segment of the eye in patients with OI, studies on posterior structures are limited. Involvement of the sclera may affect the retinal nerve fibre layer (RNFL), which is indirectly related to intraocular pressure. In addition, the retina and choroid containing type I collagen may be affected. The aim of the study was to compare the posterior segment structures of the eye, including the RNFL, retina, and choroid, in patients with OI to those of healthy control subjects. METHODS: This cross-sectional study recruited 19 patients with OI, as well as 22 age- and gender-similar healthy control subjects. Measurements of the RNFL, retina, and choroid were obtained with optical coherence tomography (Spectralis SD-OCT, Heidelberg Engineering, Heidelberg, Germany). RESULTS: Patients with OI (mean age 14.32 ± 5.08 years) and the control group (mean age 13.73 ± 3.56 years) had similar age, refractive error, and intraocular pressure values (p > 0.05). There was no difference between groups in terms of RNFL thickness, including the superonasal, nasal, inferonasal, inferotemporal, temporal, and superotemporal sectors, retinal thickness, and choroidal thickness from five different locations (p > 0.05, for all). CONCLUSION: According to these results, OI does not clinically affect the RNFL, retina, and choroid in childhood.

Corneal Effect of Air Bubble After Phacoemulsification.

Objectives: The aim of the study was to investigate the effect of air bubble on the cornea at the end of the cataract surgery with phacoemulsification. Methods: This prospective and case-control study included 71 patients with air bubble injected into the anterior chamber at the end of the operation and 63 age-sex-matched control patients without air bubble. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality rate (HEX), and central corneal thickness (CCT) measurements were taken using non-contact specular microscopy preoperatively and at 1-day, 1-week, and 1-month postoperatively. Results: No significant difference was determined between the groups preoperatively in respect of mean visual acuity, anterior chamber depth, ECD, CV, HEX, and CCT values (p>0.05). The intraoperative average ultrasound power, effective phaco time, and ultrasound time values were similar (p>0.05). The CCT value was lower in the study group than in the control group on post-operative day 1 (p=0.012), but similar at 1 week and 1 month (p=0.102, p=0.330, respectively). No significant difference was determined between the groups in mean visual acuity, anterior chamber reaction, ECD, CV, and HEX values at 1-day, 1-week, and 1-month postoperatively (p>0.05). Conclusion: Air bubble may be used as an alternative method to reduce corneal edema on the 1st post-operative day. According to the results, although air bubble has no detrimental effect, there is also seen to be no protective effect on the corneal endothelium.

Aqueous Humor Levels of Vascular Endothelial Growth Factor and Stromal Cell-Derived Factor-1α in Age-Related Macular Degeneration.

OBJECTIVES: This study investigated the contribution of vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α (SDF-1α) angiogenic mediators in eyes with age-related macular degeneration (AMD). METHODS: Aqueous humor specimens taken during cataract surgery in 7 cases of intermediate stage (nonexudative) AMD and 7 cases of late stage (exudative) AMD were evaluated using chemiluminescent immunoassay testing in this prospective case-control study. Mediator levels were compared with the normal reference values of 7 patients without any disease other than cataract. RESULTS: The groups were similar in terms of age and gender (p>0.05). The aqueous humor levels of VEGF in both the intermediate AMD (median: 224.3 pg/mL, range: 44.8-380.4 pg/mL) and late-stage AMD (median: 108.7 pg/mL, range: 61.9-223.5 pg/mL) patients were similar to those of the control group (median: 121.1 pg/mL, range: 24.9-156.6 pg/mL) (p=0.256). Moreover, there was no significant difference in the SDF-1α concentrations between the intermediate AMD (median: 160.9 pg/mL, range 130-166.3 pg/mL), late AMD (median: 161 pg/mL, range: 154.1.9-171.6 pg/mL), and control group values (median: 161 pg/mL, range: 155.2-219 pg/mL) (p=0.763). CONCLUSION: The aqueous humor levels of VEGF and SDF-1α were within the normal range in patients with intermediate and late-stage AMD.

The effect of lubricating eye drop containing hydroxypropyl guar on perimetry results of patients with glaucoma and trachomatous dry eye.

PURPOSE: To evaluate the effects of a mid-viscosity mucomimetic lubricant eye drop containing hydroxypropyl guar (HPG) as a gelling agent on computerized perimetry FASTPAC test results of primary open-angle glaucoma (POAG) patients with trachomatous dry eye. METHODS: Both eyes of 33 patients with bilateral POAG and trachomatous dry eye were included in the study. They were treated with the same antiglaucomatous eye drop and underwent computerized perimetry. Before and after the treatment with lubricant eye drop (Systane) for 8 weeks, tear function tests (Schirmer test with topical anesthesia, fluorescein staining and tear film break-up time) and FASTPAC test with computerized perimetry were performed. Pre- and posttreatment tear functions, visual field test global indices, reliability indices, test duration and numbers of depressed points in pattern deviation plots were compared. RESULTS: We found significant improvements in tear function tests results, in computerized perimetry FASTPAC test indices, test duration and the number of depressed points in pattern deviation plots in the posttreatment evaluations. CONCLUSION: This study indicates that there was a benefit of mid-viscosity lubricant eye drop containing HPG treatment on computerized perimetry FASTPAC test performance in POAG subjects with trachomatous dry eye. We assume that the positive effect of this therapy is probably due to a better tear film stability, resulting in a higher optical quality of the repaired anterior corneal surface.

Intravitreal aflibercept treatment for choroidal neovascularization secondary to laser pointer.

A 15-year-old male was presented with blurred vision in his right eye for 2 weeks. The patient had a history of looking with the right eye for 5-6 s at a distance of 20 cm from green laser beam (class 3a, 5 mW, 532 nm). Dilated fundus examinations revealed a yellow lesion in the right eye, resulting in loss of foveal reflection at the fovea. Fundus fluorescein angiography (FFA) images and spectral-domain optical coherence tomography (OCT) scans were compatible with active classic choroidal neovascularization (CNV). A single dose of intravitreal aflibercept was performed to the right eye, and at the 1st month after the injection, the best-corrected visual acuity improved to 20/100 from 20/200. FFA showed staining of the scar with no leakage, and OCT revealed scar formation. At the follow-up visits, during 38-month follow-up, no CNV activity was observed. Intravitreal aflibercept may be an appropriate treatment option in cases with laser pointer injury-induced CNV.

Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye.

PURPOSE: The purpose of this study was to evaluate the efficacy of topical cyclosporine A (CsA) treatment in patients with severe trachomatous dry eye. METHODS: Sixty-four severe trachomatous dry eye patients who had undergone Schirmer testing with topical anaesthetic measured 5 mm or less and a tear film break-up time (TFBUT) of 5 s or less were included in the study. Thirty-two patients were treated with CsA 0.05% ophthalmic emulsion twice daily and concomitant five times daily non-preserved artificial tear, and the other 32 patients who were designated as the control group received vehicle emulsion twice daily and non-preserved artificial tear five times daily. Pretreatment and post-treatment evaluations included subjective assessment of the patients (total symptoms scores and ocular surface disease index [OSDI] scores), Schirmer testing with topical anaesthesia, TFBUT, rose Bengal and fluorescein staining scores, conjunctival impression cytological scoring and goblet cell counting. RESULTS: Following 6 months of CsA treatment, the differences between the pretreatment and post-treatment test results including total symptoms scores and OSDI scores, the rose Bengal and fluorescein staining scores, TFBUT values, and the Schirmer testing measurements were found to be statistically significant. Impression cytology also showed improvement of squamous metaplasia in 26 patients (81.25%) and increase in goblet cell density in 23 patients (71.88%). CONCLUSIONS: Topical CsA was effective in the treatment of severe trachomatous dry eye, yielding improvements in both objective and subjective measurements with a safety profile.

The effect of topical cyclosporine A treatment on corneal thickness in patients with trachomatous dry eye.

PURPOSE: The purpose of the present study was to evaluate the effect of topical cyclosporine A (CsA) treatment on corneal thickness (CT) in patients with trachomatous dry eye. METHODS: Sixty-four patients with trachomatous dry eye with a Schirmer test showing 5 mm or less and a tear film break-up time (TFBUT) of five seconds or less were included. Thirty-two patients were treated with twice daily application of CsA (0.05% ophthalmic emulsion) plus non-preserved artificial tears, while the remaining 32 patients serving as controls received only non-preserved artificial tears. CT was measured using ultrasonic pachymetry at five locations of the central (CCT) and mid-peripheral cornea, at baseline and after one, three and six months of treatment. RESULTS: At the sixth month of treatment, CT measurements were significantly changed in both groups, compared to baseline. In the CsA treatment group, the mean CCT before and after six months of treatment were 517.4 +/- 36.2 and 546.5 +/- 32.4 microm, respectively (p < 0.001); yielding an average CCT increase of 29.1 +/- 8.0 microm (5.62 per cent) from baseline. In the control group, corresponding figures were 520.2 +/- 34.2 and 526.0 +/- 35.4 microm, respectively (p < 0.01), with an average increase of 5.8 +/- 3.1 microm (1.11 per cent). CONCLUSIONS: In the present study, the CsA treatment group exhibited significantly greater increases in CT compared to controls. Such an increase may indicate an improvement in the integrity of the ocular surface and resolution of the underlying inflammation as a consequence of topical CsA treatment.