The effect of sodium hyaluronate on dry eye and corneal epithelial thickness following cataract surgery.

PURPOSE: To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery. METHODS: The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1 week and 1 month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared. RESULTS: A statistically significant difference was determined between the two groups at postoperative 1 month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1 month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1 month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1 week (p < 0.01) and preoperative values were reached at 1 month postoperatively. CONCLUSION: In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium.

Evaluation of the retinal nerve fiber layer and choroidal thickness with optical coherence tomography in patients with psoriasis.

BACKGROUND: To evaluate the retinal nerve fiber layer (RNFL), central retinal thickness (CRT), and choroidal thickness (CT) in patients with psoriasis. METHODS: The study included 43 patients diagnosed with psoriasis not receiving systemic treatment and 41 healthy volunteers. Spectral domain optical coherence tomography was used for retinal and choroidal thickness measurements. The mean RNFL, quadrant RNFL (superior, inferior, nasal, temporal), and CRT values were recorded. The choroidal thickness measurements were taken from the subfoveal area, towards the temporal and nasal directions from the fovea at distances of 500, 1000, and 1500 µm. RESULTS: The RNFL was determined to be thinner in the superior quadrant (p=0.025), and the CT was thicker at all the measurement points (p < 0.05) in the patients with psoriasis. The CRT values were similar in both groups (p > 0.05). No correlation was determined between the parameters measured and disease duration or severity. CONCLUSIONS: Thinning of the RNFL and increased CT may be a sign of choroidal microvascular changes and ganglion cell damage due to psoriasis.

Evaluation of central corneal epithelial thickness with anterior segment OCT in patients with type 2 diabetes mellitus.

BACKGROUND: This study aimed to evaluate the central corneal thickness (CCT) and central corneal epithelial thickness (CCET) in patients with Type 2 diabetes mellitus (DM), and the effect of the duration of diabetes, the degree of diabetic retinopathy (DR), and HbA1c level. METHODS: CCT and CCET values of 72 patients diagnosed with type 2 DM and 72 healthy individuals were measured by anterior segment optical coherence tomography. The eye tear function was evaluated with the Tear Break-up Time test (TBUT) and the Schirmer test. From the results of fundus examination, the diabetic patients were grouped as those without DR, non-proliferative DR, and proliferative DR. The disease duration and the HbA1c levels were recorded. RESULTS: In the diabetic patients, the mean CCT was determined to be thicker (p = 0.025), the CCET was thinner (p = 0.003), and the TBUT and Schirmer values were lower (p <0.001, p <0.001, respectively). The duration of diabetes and the HbA1c level was not found to have any statistically significant effect on these parameters (p >0.05). The presence of retinopathy had no significant effect on CCT, TBUT, and Schirmer values. The CCET was determined to be thinner in patients with retinopathy (p <0.001). CONCLUSIONS: As the corneal epithelial thickness is reduced in patients with advanced diabetic retinopathy, corneal epithelial pathologies can be seen more often. Therefore, early and effective treatment can be started by taking into consideration the complications which may develop associated with the corneal epithelium following surgical procedures, especially those applied to the cornea.

A rare cause of pediatric oculomotor nerve palsy: neurobrucellosis.

Neurobrucellosis is a significant complication of brucella, which is seen more rarely in children than in adults. As there are no specific symptoms, it may be confused with several diseases which involve the nervous system. Although various cranial nerves can be affected in neurobrucellosis, oculomotor nerve involvement is extremely rare. The case is here presented of a 13-year-old patient who presented at the polyclinic with complaints of double vision and left eyelid droop. The diagnosis of neurobrucellosis was made from the determination of brucella antigens in the serum and cerebrospinal fluid, and following treatment, the patient recovered without sequelae. The aim of this case presentation was to emphasise that a reason for oculomotor nerve palsy in the paediatric age group, especially in regions where brucella is endemic, could be neurobrucellosis.

Automated Diabetic Retinopathy Detection Using Horizontal and Vertical Patch Division-Based Pre-Trained DenseNET with Digital Fundus Images.

Diabetic retinopathy (DR) is a common complication of diabetes that can lead to progressive vision loss. Regular surveillance with fundal photography, early diagnosis, and prompt intervention are paramount to reducing the incidence of DR-induced vision loss. However, manual interpretation of fundal photographs is subject to human error. In this study, a new method based on horizontal and vertical patch division was proposed for the automated classification of DR images on fundal photographs. The novel sides of this study are given as follows. We proposed a new non-fixed-size patch division model to obtain high classification results and collected a new fundus image dataset. Moreover, two datasets are used to test the model: a newly collected three-class (normal, non-proliferative DR, and proliferative DR) dataset comprising 2355 DR images and the established open-access five-class Asia Pacific Tele-Ophthalmology Society (APTOS) 2019 dataset comprising 3662 images. Two analysis scenarios, Case 1 and Case 2, with three (normal, non-proliferative DR, and proliferative DR) and five classes (normal, mild DR, moderate DR, severe DR, and proliferative DR), respectively, were derived from the APTOS 2019 dataset. These datasets and these cases have been used to demonstrate the general classification performance of our proposal. By applying transfer learning, the last fully connected and global average pooling layers of the DenseNet201 architecture were used to extract deep features from input DR images and each of the eight subdivided horizontal and vertical patches. The most discriminative features are then selected using neighborhood component analysis. These were fed as input to a standard shallow cubic support vector machine for classification. Our new DR dataset obtained 94.06% and 91.55% accuracy values for three-class classification with 80:20 hold-out validation and 10-fold cross-validation, respectively. As can be seen from steps of the proposed model, a new patch-based deep-feature engineering model has been proposed. The proposed deep-feature engineering model is a cognitive model, since it uses efficient methods in each phase. Similar excellent results were seen for three-class classification with the Case 1 dataset. In addition, the model attained 87.43% and 84.90% five-class classification accuracy rates using 80:20 hold-out validation and 10-fold cross-validation, respectively, on the Case 2 dataset, which outperformed prior DR classification studies based on the five-class APTOS 2019 dataset. Our model attained about >2% classification results compared to others. These findings demonstrate the accuracy and robustness of the proposed model for classification of DR images.

Serum Cystatin C Concentrations in Patients with Graves' Ophthalmopathy.

PURPOSE: To evaluate the concentration of serum cystatin C (CysC) in patients with Graves' ophthalmopathy (GO) and the usability of the serum CysC concentrations in the follow-up of the disease. METHODS: Thirty patients with GO and 30 healthy age-matched volunteers were included in this cross-sectional study. GO was diagnosed based on the European Group on Graves' Orbitopathy consensus. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and CysC concentrations were measured in the participants. The serum CysC concentrations were compared between patients with GO and controls. Patients with GO were subdivided into hyperthyroid and euthyroid patients, and their serum CysC concentrations were compared. In addition, the CysC concentrations in hyperthyroid and euthyroid patients with GO were compared separately with those of healthy subjects. Kruskal-Wallis test and Student's t-test were used for statistical evaluation. RESULTS: The mean serum CysC concentrations in GO patients and controls were 1.04 ± 0.36 and 0.74 ± 0.09 mg/L, respectively. There was a statistically significant difference in the serum CysC concentrations between patients with GO and control subjects (p < 0.001). Fifteen patients had hyperthyroid status, and 15 patients had euthyroid status. The mean serum CysC concentrations in hyperthyroid and euthyroid patients with GO were 1.35 ± 0.22 and 0.72 ± 0.13 mg/L, respectively. Serum CysC concentrations were significantly higher in hyperthyroid patients than in euthyroid patients (p = 0.001). In addition, hyperthyroid patients had significantly higher serum CysC concentrations than healthy subjects. Among patients with GO, 21 and nine had mild and moderate-to-severe GO, respectively. Active and inactive GO were observed in eight and 22 patients, respectively. CONCLUSIONS: The serum CysC concentrations in hyperthyroid patients were higher than those in healthy subjects. Moreover, hyperthyroid patients had higher serum CysC concentrations than euthyroid patients. Further studies with a larger sample size are needed to confirm these results.

Evaluation of Central Macula, Retinal Nerve Fiber Layer, and Ganglion Cell Complex Thickness in Congenital Color Vision Deficiency.

OBJECTIVES: This study was designed to evaluate the thickness of the central macula, the retinal nerve fiber layer (RNFL), and the ganglion cell complex (GCC) in individuals with congenital red-green color vision deficiency (CVD) using spectral-domain optical coherence tomography (SD-OCT). METHODS: This study included 22 males with a red-green CVD (Group 1) and 22 males with normal color vision (Group 2). The Ishihara test was used to determine CVD. SD-OCT was used to evaluate the central macula, RNFL, and GCC measurements of all of the study participants. The quantitative data of the 2 groups were compared. The Kruskal-Wallis test was used for the statistical analysis and a p value <0.05 was considered significant. RESULTS: The mean central macula thickness observed in Group 1 and 2 was 255.00±25.50 µm and 248.95±24.70 µm, respectively. The mean RNFL thickness of Group 1 and 2 was 110.66±14.70 µm and 109.49±9.90 µm, respectively, and the mean GCC thickness of Group 1 and 2 was 97.70±10.80 µm and 97.56±5.10 µm, respectively. There were no significant differences between the groups in the assessment of the central macula, RNFL, or GCC thickness (p=0.20, p=0.34, p=0.37). CONCLUSION: The results of this study suggested that congenital red-green CVD does not affect the thickness of the central macula, RNFL, or GCC. To the best of our knowledge, this is the first study to evaluate the thickness of the GCC in individuals with congenital red-green CVD.

Pediatric Canaliculitis: A Case Report

Canaliculitis is a rare disease that relapses when not properly diagnosed and treated. It usually occurs in middle-age and advanced age. It is extremely rare in children and infants. A healthy 12-year-old girl presented with lower eyelid swelling and watery discharge in her right eye. During the last 2 years, the patient had been examined several times for the same complaints but there was no improvement despite treatment. Examination showed that the lower punctum had a pouting punctum appearance, and applying pressure to the lacrimal sac area resulted in purulent discharge. Lavage showed that the lacrimal passage was patent. In light of these clinical findings, the patient was diagnosed with canaliculitis. Punctoplasty with surgical curettage of the dacryoliths were performed. After the surgical procedure, a topical antibiotic was prescribed. Histopathological examination of the dacryoliths revealed that the infective cause was Actinomyces. No recurrence or complications were observed during 12 months follow-up.

Decorin, Tenascin C, Total Antioxidant, and Total Oxidant Level Changes in Patients with Pseudoexfoliation Syndrome.

PURPOSE: Pseudoexfoliation syndrome (PEX) is an eye disease that develops under the influence of regional population differences, genetic factors, age, and environmental factors and is characterized by visualization of a gray-white fibrogranular substance in the lens anterior capsule and/or pupil margin during anterior segment examination. The underlying biochemical mechanisms of the disease have not yet been fully elucidated. Therefore, this study was designed to show the changes in aqueous humor and blood serum levels of matrix metalloproteinases (decorin and tenascin C), total antioxidants (TAS), and total oxidants (TOS) in both cataract patients who have unilateral PEX material and cataract patients who do not have unilateral PEX material. METHODS: Biological samples were simultaneously collected from 22 cataract patients who had unilateral pseudoexfoliation (PEX patients) and 22 cataract patients who did not have unilateral pseudoexfoliation (control patients). From the collected biological samples, decorin (DEC) and tenascin C (TN-C) were measured with the enzyme-linked immunosorbent assay (ELISA) method, and TAS and TOS were measured with an autoanalyzer. RESULTS: When decorin, tenascin C, and TOS values of PEX patients were compared with those of control patients, there was a statistically significant increase in all three parameters. Conversely, TAS values showed a statistically significant decrease in PEX patients compared to controls. DEC, TN-C, TAS values, and TOS values were significantly higher in aqueous fluid than in blood in both the PEX patient and control groups. CONCLUSIONS: We suggest that parameters such as DEC, TN-C, TAS, and TOS play a role in the etiopathology of pseudoexfoliation syndrome. Thus, bringing these increased levels of extracellular proteins and TOS and decreased levels of TAS back to within physiological limits can mediate the reorganization of the blood-aqueous fluid barrier and slow the progression of pseudoexfoliation syndrome.