Clinical Outcomes of Enhanced Monofocal (Mono-EDOF) Intraocular Lenses with the Mini-Monovision Technique versus Trifocal Intraocular Lenses: A Comparative Study

Objectives: It was aimed to compare the clinical results of the mini-monovision technique (MMV) with enhanced monofocal intraocular lens (IOL) and trifocal IOL applications and to evaluate the intereye differences in the MMV group. Materials and Methods: This retrospective observational study evaluated the results of cataract surgeries performed on 48 eyes of 24 patients. Surgeries in Group I were performed for MMV using the RayOne EMV IOL targeting emmetropia in dominant eyes (Group IA) and -0.70 diopter (D) myopia in non-dominant eyes (Group IB), while those in Group II were performed with the AcrySof® IQ PanOptixTM TNFT00 IOL targeting emmetropia. After the surgeries, uncorrected and corrected distance, intermediate, and near distance visual acuities, contrast sensitivity measurements, and defocus curves were determined. Subjective evaluation was made with the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The groups were compared statistically. Results: Postoperative refraction mean spherical equivalent was -0.25±0.22 D, -0.67±0.33 D, and -0.16±0.31 D in the three groups, respectively. A statistical difference was identified in favor of Group IA for uncorrected distance vision and in favor of Group IB for near vision (p<0.05). There was no difference in bilateral uncorrected visions in Groups I and II (p>0.05). While contrast sensitivity was better in Group I at all spatial frequencies (p<0.05), better vision was achieved in the defocus curve at distance in Group IA and at near in Group IB. In the binocular evaluation, it was seen that Groups I and II had similar results. In the subjective evaluation, NEI-VFQ-25 scores were 94.1±4.2/100 in Group I and 91.5±3.0/100 in Group II at 6 months (p>0.05). Photic complaints were significantly more common in Group II. Conclusion: With the MMV technique, it was observed that enhanced monofocal lenses provided better visual acuity at all distances and less dysphotopsia than trifocal lenses, whereas trifocal lenses were better at providing independence from glasses.

Comparison of Two Presbyopia-Correcting Trifocal Intraocular Lenses: A Prospective Study.

Objectives: To evaluate the clinical results of a new trifocal intraocular lens (IOL) with sinusoidal design by comparing with a traditional trifocal IOL. Materials and Methods: A total of 79 patients undergoing uneventful microincisional cataract surgery with bilateral implantation of one of two types of trifocal IOLs, the Acriva Trinova IOL (VSY) or Acrysof IQ PanOptix IOL (Alcon), were enrolled in this prospective study. Visual and refractive outcomes, contrast sensitivity (CS), and defocus curve were assessed at 3 months after surgery. Patient satisfaction and incidence of photic phenomena were also evaluated. Results: The number of patients/eyes were 48/96 in the Trinova group and 31/62 in the PanOptix group. There were no significant differences between the groups for monocular and binocular corrected/uncorrected distance or intermediate (at 60 cm) and near visual acuities (VA) postoperatively. The Trinova group had statistically significantly better intermediate VA at 80 cm than the PanOptix group (p<0.05). The CS results of both groups were within the normal limits. In the binocular defocus curve of both IOLs, we observed a peak of good VA at 0.0 diopters defocus and a useful wide range for intermediate distances. The incidence of photic phenomena in the Trinova group was lower at postoperative 1 month (p<0.05) but this difference disappeared at 3 months. A total of 47 patients (97.9%) in the Trinova group and 30 patients (96.7%) in the PanOptix group stated that they would recommend the same IOL. Conclusion: Both trifocal IOLs provide good visual quality outcomes and patient satisfaction.

Clinical correlations and impact of conjunctivochalasis in soft contact lens wearers.

PURPOSE: To evaluate the correlation between clinical tests, patient symptoms, and conjunctivochalasis in contact lens wearers and non-wearers. METHODS: This study comprised 40 eyes of 40 current soft contact lens users and 40 eyes of 40 control subjects. Cross-sectional areas of conjunctivochalasis at three locations (nasal, central, temporal) during straight and downward gazes were determined using anterior segment optical coherence tomography in all participants. Tear film break up time test and Schirmer test with anesthesia were performed and for evaluation of symptoms, the participants completed ocular surface disease index questionnaire. RESULTS: During straight gaze, the mean cross-sectional areas of conjunctivochalasis were 0.0112 ± 0.009 and 0.006 ± 0.005 mm2 at nasal, 0.0096 ± 0.007 and 0.002 ± 0.004 mm2 at central, 0.0176 ± 0.014 and 0.008 ± 0.009 mm2 at temporal in contact lens and control groups, respectively. Regardless of location and gaze direction, the mean cross-sectional conjunctivachalasis areas of the contact lens group were significantly higher than those of the controls (all, p < 0.05). Significant positive correlations between ocular surface disease index score and measured conjunctivachalasis areas (in all sites) during straight gaze and downward gaze were observed in the contact lens group (all, p < 0.05 and r > 0.450). CONCLUSION: Wearing soft contact lenses is associated with increased conjunctivochalasis areas. Anterior segment optical coherence tomography determined conjunctivochalasis area is an objective clinical measurement value that is positively correlated with patients' symptoms in soft contact lens wearers.

Can Lamina Cribrosa Indicate Optic Neuritis in Multiple Sclerosis?

Background: In this study, we aimed to evaluate the association of lamina cribrosa thickness (LCT) and lamina cribrosa depth (LCD), as determined by spectral domain optical coherence tomography (SD-OCT), with visual evoked potentials (VEPs) in patients with multiple sclerosis (MS). Materials and Methods: Patients enrolled in this prospective, cross-sectional study were divided into three groups. Group 1 consisted of 25 relapsing-remitting MS patients with VEP pathology in one or both eyes. In patients with VEP pathology in both eyes, one eye was chosen randomly. Group 2 comprised 25 relapsing-remitting MS patients with no VEP pathology or optic neuritis history. A randomly selected single eye of each patient was evaluated. Group 3 consisted of 25 age- and sex-matched healthy volunteers; a randomly selected single eye of these participants was examined. LCT, LCD, and retinal nerve fiber layer (RNFL) thickness measurements were determined in four quadrants (superior, inferior, nasal, and temporal) by SD-OCT. Results: The three groups were similar in terms of age and sex. The mean LCT was lower in Group 1 than in Group 2, but the difference was not statistically significant (268.80 ± 36.69 µm [min-max = 222-394 µm] versus 285.80 ± 12.00 µm [min-max = 249-338 µm]; P = 0.148). The mean LCT was significantly lower in Group 1 than in Group 3 (268.80 ± 36.69 µm [min-max = 222-394 µm] versus 294.80 ± 12.00 µm [min-max = 232-351 µm]; P = 0.012). There was a weak positive correlation between LCT and RNFL-inferior, RNFL-nasal, and RNFL-temporal. Conclusion: We found that the lamina cribrosa was thinner in MS patients with VEP pathology. To the best of our knowledge, this is a novel finding. Our results imply that LCT could be used as an indicator of optic neuritis in MS patients.

The alterations of retinal vasculature detected on optical coherence tomography angiography associated with chronic obstructive pulmonary disease.

OBJECTIVES: This study aimed to evaluate the retinal vasculature of the macula and optic disc in patients with chronic obstructive pulmonary disease (COPD) by optical coherence tomography angiography (OCTA). METHODS: The right eyes of 70 COPD patients and 71 healthy individuals were evaluated. These patients had moderate airflow limitation and mean PO2 of 60 mmHg, and their average age was less than 60 years. Superficial and deep capillary plexus vascular densities, foveal avascular zone (FAZ) width, and optic disc parameters were measured with OCTA. In addition, the correlation between the PO2 level in COPD patients and superficial, deep, and peripapillary vascular densities and FAZ was examined in the study. RESULTS: The COPD group had a significant decrease in the vascular density in the superficial (fovea [p = 0.019]; parafovea [p = 0.013]; and perifovea [p = 0.001]) and deep capillary plexus (fovea [p = 0.028]; parafovea [p = 0.005]; and perifovea [p = 0.002]). Also, the enlargement of the FAZ (p = 0.002) and a decrease in the peripapillary vascular density (p = 0.006) were observed in the COPD group. There was a positive correlation between PO2 level and superficial, deep, and peripapillary vascular densities in COPD patients and a negative correlation with FAZ (r = 0.559-0.900). CONCLUSION: Hypercapnia, respiratory acidosis, and chronic hypoxia associated with COPD may affect the macula and optic nerve, resulting in a serious decrease in vascular density, and OCTA can be a very important tool in the follow-up and treatment of these patients.

Evaluation of corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome.

PURPOSE: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). METHODS: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. RESULTS: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group (p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group (p < 0.001). CONCLUSION: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

Is ocular vascularity affected in young migraine patients? A pilot study.

OBJECTIVE: This study aimed to evaluate ocular vascularity in young adult migraine patients with visual aura and without visual aura. MATERIAL AND METHODS: The study included 30 patients with migraine with visual aura (MWVA), 30 patients with migraine without visual aura (MWOVA), and 30 healthy control subjects, all between ages ≥18 and <45. Migraine patients were applied Headache Impact Test (HIT) and Migraine Disability Assessment Scale (MIDAS). Retinal nerve fiber layer thickness and ocular vascularity of all participants were evaluated with optical coherence tomography (OCT) and OCT angiography (OCTA). RESULTS: The MWVA group had significantly lower superficial and deep foveal vascular density values compared to the control group (p = 0.039, p = 0.028, respectively). The foveal avascular zone was significantly enlarged in the MWVA group compared to the control group (p = 0.033). MWVA patients had significantly lower whole optic disc, optic disc inside, peripapillary, superior hemisphere, inferior hemisphere, superior quadrant, and temporal quadrant vascular density values compared to the control group (p < 0.05 all), while there was no significant difference in the nasal quadrant (p = 0.083). Migraine attack frequency, MIDAS, and HIT were negatively correlated with ocular vascular density values. CONCLUSION: The results of our study indicate that young adult patients with MWVA are at risk of decreased ocular vascularity and that this risk may increase with frequency and severity of migraine attacks.

Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope. METHODS: The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm2 ), corneal thickness (CT) (µ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, µm2 ) were analyzed by specular microscopy (SM). RESULTS: The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012). CONCLUSION: The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.

Effect of Deviated Nasal Septum on Choriodal Thickness.

INTRODUCTION: Nasal septal deviation (NSD) is one of the major causes of upper airway obstruction. Chronic hypoxia and hypercapnia due to NSD may affect the choroidal blood flow and may change the choroidal thickness (CT). In this study, the authors aimed to research the assessment of CT before and after septoplasty in patients with NSD. METHODS: Ninety-two patients who underwent septoplasty surgery with the diagnose of nasal septum deviation and 58 patients for control group were enrolled to the study. CT values measured before and three months after septoplasty surgery. RESULTS: CT values were subfoveal 272.51 ±â€Š27.62, nasal 245.50 ±â€Š21.22, temporal 248.35 ±â€Š30.25 and subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82,temporal 227.12 ±â€Š28.80 for the control and NSD groups, respectively (P < 0.001). Also choroid thickness values (subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82, temporal 227.12 ±â€Š28.80; subfoveal 252 ±â€Š18.90, nasal 228 ±â€Š22.12, temporal 240 ±â€Š25.80) were significantly different in patients with NSD, before and after septoplasty procedure, respectively (P < 0.001). CONCLUSION: To the authors' knowledge this is the first study investigating choroid thickness measurements before and after septoplasty in patients with NSD. We found significant correlation between NSD and CT. After septoplasty surgery at 3rd month, CT increased significantly in comparision with the preoperative values.

Effects of chronic smoking on the meibomian glands.

PURPOSE: To evaluate the effects of chronic smoking on tear function tests and meibomian glands. METHODS: This prospective study included 40 volunteers with a long-term (> 5 years) cigarette smoking history (study group) and 43 non-smoking healthy individuals (control group). The symptoms of all the participants were scored using the Ocular Surface Disease Index (OSDI) questionnaire, and a detailed ophthalmological examination was performed including the tear breakup time (TBUT) and Schirmer test (with anaesthesia). The upper and lower lid meibomian glands were evaluated with meibography using the Sirius anterior segment analysis system (Sirius, CSO, Florence, Italy). RESULTS: The groups showed homogenous distribution in respect of age and gender (p > 0.05). The patients in the study group were determined with 22.59 ± 17.25 packet/year cigarette usage. The mean OSDI score was 36.67 ± 21.47 in the study group and 31.65 ± 15.60 in the control group (p = 0.64). The TBUT and Schirmer test values were determined as 9.65 ± 6.14 s and 8.90 ± 4.95 mm, respectively, in the study group and 11.23 ± 5.94 s and 13.08 ± 8.61 mm in the control group (p > 0.05). In the upper lid meibography, loss of 24.68 ± 16.54% was determined in the study group and 17.87 ± 7.06% in the control group (p = 0.01). No statistically significant difference was determined between the groups in respect of the lower lid meibomian gland loss: study group 14.70 ± 8.49% versus control group 12.48 ± 6.44% (p = 0.20). CONCLUSIONS: Smoking results in meibomian gland damage which may be a risk factor for dry eye. In cases of ocular surface disorders related to chronic smoking, meibomian gland damage should be taken into consideration.

Amplitude of Accommodation in Patients with Multiple Sclerosis.

Purpose: To evaluate the effect of multiple sclerosis (MS) on the amplitude of accommodation (AA) and retinal nerve fiber layer (RNFL) thickness.Materials and Methods: A total of 25 MS patients with visual-evoked potential (VEP) abnormalities (MS/+VEP Group), 25 MS patients without VEP abnormalities (MS/-VEP Group), and 25 controls (Control Group) were enrolled. Only findings from the right eye of the participants were included in the analysis. Each participant underwent a pattern-reversal visual-evoked potential (PVEP) recording, an RNFL thickness analysis by optic coherence tomography (OCT) in all quadrants, and a measurement of amplitude of accommodation (AA) with minus lens technique. The AA and the RNFL thickness were compared between the groups.Results: The mean age and sex distributions did not differ significantly across the groups (p= .788, p= .906, respectively). The mean AA was 5.36 ± 0.7 D in MS/+VEP group, 6.06 ± 1.4 D in MS/-VEP group, and 6.4 ± 0.9 D in control group (p= .002). The difference in the mean AA values between MS/+VEP and control groups were significant (p = .002). AA was significantly correlated with age, P100 latency and amplitude values in MS/+VEP group (r = -0.832, p < .001; r = -0.596, p = .002 and r = 0.498, p = .011, respectively). In a multivariable regression model, age and P100 latency were significant parameters for affecting AA in patients with MS (p < .001 and p = .001). In another multivariable regression model, age and average RNFL thickness were significant parameters for affecting AA in patients with MS (p < .001 and p = .010).Conclusions: We found that the AA was lower in MS patients with VEP abnormalities compared to age-matched healthy individuals. P100 latency was a significant parameter for predicting AA in MS/+VEP group. These results suggest that MS patients with VEP abnormalities might experience presbyopia earlier in life than people without MS, probably due to the chronic demyelination of neural pathways.

Evaluation of the Ocular Surface in Different Contact Lens Replacement Schedules.

PURPOSE: To evaluate the effects of different contact lens (CL) replacement schedules and different CL materials on the ocular surface and tear function. METHODS: Daily disposable hydrogel CLs were given to group 1 (n = 22), daily disposable silicone hydrogel CLs were given to group 2 (n = 25), and reusable silicone hydrogel CLs were given to group 3 (n = 24). Tear function tests and inflammatory cytokine [interleukin (IL)-6, IL-8, IL-17A, and matrix metalloproteinase (MMP)-9] levels were evaluated before and at 1 and 3 months after CL usage. Impression cytology was evaluated before and at 3 months after CL usage. RESULTS: At the first and third months of CL usage, a statistically significant difference was determined between the groups in the levels of IL-6, IL-8, and IL-17A in tears, with the lowest levels in group 1 and the highest levels in group 3 (all P < 0.05). At the third month of CL usage, the levels of these cytokines (in picograms/milliliter) were 6.06 ± 0.83, 78.18 ± 12.42, 61.69 ± 13.95, and 37.71 ± 5.95 in group 1 and 8.04 ± 0.89, 107.34 ± 14.40, 68.63 ± 13.72, and 46.26 ± 6.50 in group 3, respectively. A statistically significant decrease was determined over time in the Schirmer test in group 1, in only the tear breakup time in group 2, and in the tear breakup time and Schirmer test in group 3 (all P < 0.05). A statistically significant increase was determined over time in the levels of IL-6, IL-8, IL-17A, and MMP-9 in all groups. In the third month, a significant progression was observed in the Nelson grade (P < 0.05) in all groups. CONCLUSIONS: The wear of daily disposable CLs can be considered to cause less damage to the ocular surface and less increase in proinflammatory cytokine levels.

Effect of Amblyopia Treatment on Choroidal Thickness in Children with Hyperopic Anisometropic Amblyopia.

PURPOSE: To evaluate choroidal thickness (CT) in the eyes of children with hyperopic anisometropic amblyopia and to assess changes in CT during amblyopia treatment using spectral-domain optical coherence tomography (SD-OCT). METHODS: This longitudinal study, initially enrolled 40 patients, aged 3-9 years with hyperopic anisometropic amblyopia. Patients underwent treatment with refractive correction alone for 16 weeks and if needed, with refractive correction and patching treatment thereafter (6 months). CT was measured perpendicularly (from the outer edge of the hyper-reflective retinal pigment epithelium to the inner sclera) at the fovea, and 1.5-mm temporal, 3.0-mm temporal, 1.5-mm nasal, and 3.0-mm nasal to the fovea using SD-OCT in amblyopic eyes and fellow eyes during treatment and in the control subjects (n = 22). RESULTS: The baseline subfoveal CT measurement was mean 367.9 ± 54 in the amblyopic eyes, 283.9 ± 39.6 in the fellow eyes, and 267.3 ± 41.3 µm in the control eyes. Before amblyopia treatment, the subfoveal CT and CT at 1.5-mm nasal and temporal to the fovea and 3.0-mm nasal to fovea in the amblyopic eyes were significantly thicker than those of the control subjects after adjustment for refraction and axial length by multivariate ANCOVA. CT at all locations decreased significantly after treatment in the amblyopic eyes. The final measurement of subfoveal choroid and CT at 1.5-mm nasal to the fovea of the amblyopic eyes was significantly thicker than those of the control subjects after adjusting for axial length and refraction. CONCLUSIONS: The findings of this study indicate that children with hyperopic anisometropic amblyopia have significant CT alterations, and these changes partially regress after amblyopia treatment.

Effects of topical acne treatment on the ocular surface in patients with acne vulgaris.

PURPOSE: To assess the ocular side effects during topical retinoid-antibiotic combination treatment in patients with facial acne vulgaris. METHODS: Forty-three patients applying topical isotretinoin+erythromycin combination (isotrexin gel, GlaxoSmithKline) once daily for the treatment of acne vulgaris were enrolled. Full ophthalmologic examination, Schirmer test (with topical anesthesia), fluorescein break-up time (BUT), corneal fluorescein staining and tear osmolarity measurement with the TearLab system (TearLab Corporation) were carried out before and at the end of the first month of the treatment. For evaluation of symptoms participants completed the ocular surface disease index (OSDI) questionnaire at each visit. RESULTS: The mean age of the patients was 23.16±3.03 (18-30) years. Mean tear osmolarity increased significantly from 282.09±8.95 mOsm/L at baseline to 300.39±16.65 mOsm/L after the treatment (p<0.001). BUT decreased from an average of 11.93±1.12s at baseline to 6.65±3.03s at the end of the first month (p<0.001). The OSDI score worsened significantly (5.41±3.65 vs 21.53±12.95, p<0.001) and punctate epitheliopathy was seen in 51% of eyes after the treatment. The average Schirmer values were 13.09±1.90 and 12.41±2.44mm/5min before and at the end of the first month of the treatment, respectively (p=0.117). CONCLUSIONS: The findings of this study indicate that topical retinoid-antibiotic combination treatment causes significant signs and symptoms of dry eye. Patients receiving topical treatment for acne should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface.

Evaluation of choroidal thickness changes after phacoemulsification surgery.

PURPOSE: The aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT). METHODS: In this prospective study, 38 eyes of 38 patients having phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including preoperative axial length (AXL) measurement with optical biometry and intraocular pressure (IOP) measurement preoperatively and 1 month postoperatively. The CT was measured perpendicularly at the fovea and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal using SD-OCT preoperatively and 1 month postoperatively. Changes in the CT after surgery and correlation of this change with age, AXL, preoperative IOP, and IOP change were evaluated. RESULTS: There was a statistically significant increase in the CT at all regions evaluated. This increment was more prominent in the nasal and subfoveal regions. The IOP decreased significantly 1 month after surgery (16.14±4.94 mmHg vs 13.91±4.86 mmHg; P<0.001). The change in IOP was correlated with the CT changes at all regions, whereas age, AXL, and preoperative IOP had no significant correlations with the changes in CT. CONCLUSION: Phacoemulsification surgery may cause significant increase in CT, which is correlated with surgery-induced IOP change in the short term. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

Evaluation of the Macular Choroidal Thickness Using Spectral Optical Coherence Tomography in Pseudoexfoliation Glaucoma.

PURPOSE: To evaluate the choroidal thickness (CT) in pseudoexfoliative (PEX) glaucoma and age-matched healthy subjects using spectral optical coherence tomography (SD-OCT). PATIENTS AND METHODS: In this prospective study, 32 eyes of 32 PEX glaucoma patients and 30 eyes of 30 age-matched healthy subjects were enrolled. The CT is measured perpendicularly (from the outer edge of the hyperreflective retinal pigment epithelium to the inner sclera) at the fovea, and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal to the fovea using SD-OCT (RTVue-100). RESULTS: The groups were similar regarding the mean age and axial length values (both, P>0.05). The CT measurements were 182.12 ± 39.88 and 201.56 ± 32.00 µm at 1.5 mm nasal to the fovea (P=0.039), and 126.47 ± 32.12 and 146.60 ± 31.37 µm at 3.0 mm nasal to the fovea (P=0.015) in the PEX glaucoma and control groups, respectively. There were no significant differences in the subfoveal and temporal CT measurements among the 2 groups (all, P>0.05). CONCLUSIONS: The findings of this study indicate that PEX glaucoma causes significant thinning in the nasal choroid. Thus, measuring the CT with SD-OCT may be the way of better clarification of the relationship between PEX and glaucomatous optic neuropathy.

Effects of osmoprotective eye drops on tear osmolarity in contact lens wearers.

OBJECTIVE: To evaluate the impact of osmoprotective eye drops on tear osmolarity and patient comfort, and to compare its efficacy with a commercially available lubricant in contact lens (CL) wearers. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: Forty eyes of 20 first-time CL wearers were included. METHODS: Tear osmolarity measurements using TearLab osmolarity system were performed in each eye of subjects at 8 am, and 2, 4, and 8 h after that on the first and second days, and at 12:00 on the third day and eighth days. On the second day and afterward, all eyes were fitted Purevision 2 (Bausch & Lomb) soft CLs. Subjects instilled Optive (Allergan) osmoprotective eye drops into their 1 eye (group 1) and Refresh tears (Allergan) eye drops into their other eyes (group 2) after 2 hours of CL wear on the third day and afterward. Ocular comfort with eye drops was also assessed. RESULTS: There were no significant differences between the tear osmolarity measurements of the groups on the first day. On the second day, osmolarity significantly increased from baseline after 4 h of CL wear (p < 0.05) but returned to baseline after 8 h of CL wear (p > 0.05) in both groups. Tear osmolarity measurements of group 1 were significantly lower than those of group 2 on the third and eighth days (both p < 0.05). The mean comfort scores were significantly higher in group 1. CONCLUSIONS: Tear osmolarity increases within the first hours of CL wear, and instillation of osmoprotective eye drops prevents this increment in patients wearing CLs.

In Vivo confocal microscopic changes of the corneal epithelium and stroma in patients with herpes zoster ophthalmicus.

PURPOSE: To analyze the density and morphology of corneal epithelial cells and keratocytes by in vivo confocal microscopy (IVCM) in patients with herpes zoster ophthalmicus (HZO) as associated with corneal innervation. DESIGN: Prospective, controlled and masked cross-sectional study. METHODS: setting: Single-center study. PATIENTS: Thirty eyes with the diagnosis HZO and their contralateral clinically unaffected eyes, 15 eyes of 15 normal controls. intervention procedures: In vivo confocal microscopy and corneal esthesiometry of the central cornea. MAIN OUTCOME MEASURES: Changes in morphology and density of the superficial and basal epithelial cells and stromal keratocytes, and correlation with corneal sensation. RESULTS: The density of superficial epithelial cells in HZO eyes with severe sensation loss (766.5 ± 25.2 cells/mm(2)) was significantly lower than both healthy control eyes (1450.23 ± 150.83 cells/mm(2)) and contralateral unaffected eyes (1974.13 ± 298.24 cells/mm(2)) (P = .003). Superficial epithelial cell size (1162.5 µm(2)) was significantly larger in HZO eyes with severe loss of sensation, as compared to contralateral (441.46 ± 298.14) or healthy eyes (407.4 ± 47.2µm(2); all P < .05). The density of basal epithelial cells, anterior keratocytes, and posterior keratocytes did not show statistical significance between patients, controls, and contralateral unaffected eyes. Changes in superficial epithelial cell density and morphology correlated strongly with corneal sensation. CONCLUSIONS: In vivo confocal microscopy reveals profound HZO-induced changes in the superficial epithelium, as demonstrated by increase in cell size, decrease in cell density, and squamous metaplasia. We demonstrate that these changes strongly correlate with changes in corneal innervation in eyes affected by HZO.