Long-term evaluation of posterior corneal surface parameters after accelerated corneal cross-linking with a comparison with uncross-linked keratoconic eyes.

PURPOSE: To evaluate the 36 months changes in posterior corneal surface parameters in keratoconic eyes after accelerated corneal cross-linking and to compare the data with uncross-linked progressive and non-progressive keratoconic eyes. METHODS: Thirty five cross-linked, 30 uncross-linked progressive, and 30 uncross-linked non-progressive keratoconic eyes were included. Maximum keratometry (Kmax), thinnest pachymetry, minimum radius of curvature back (Rminback), asphericity back, posterior elevation and corneal densitometry, back corneal higher order aberrations (HOAs), back surface deviation (Db), final D, posterior radius of curvature (PRC) and 'B' unit values were recorded at baseline and at the 12, 24, 36 months follow-up. Data were analyzed with repeated measures ANOVA and paired t-tests. RESULTS: Kmax and thinnest pachymetry were significantly changed in the cross-linked and progressive uncross-linked groups. Rminback, asphericity back, and HOAs did not change in either group. Total posterior corneal densitometry improved; posterior elevation, Db and B unit worsened in the cross-linked group and did not change in the uncross-linked groups. PRC and final D worsened in the cross-linked and progressive uncross-linked groups, and did not change in the non-progressive group. CONCLUSION: Despite a decreased Kmax, the posterior corneal surface parameters, posterior elevation values were determined to have significantly worsened in the cross-linked group and this increase was higher than in progressive uncross-linked eyes.

Tear function and ocular surface changes following corneal collagen cross-linking treatment in keratoconus patients: 18-month results.

PURPOSE: To investigate the long-term effects that CXL has on the tear function and ocular surface in keratoconus. METHODS: Twenty-one consecutive patients (24 eyes) with progressive keratoconus scheduled for CXL were included. All patients underwent the following procedures: conjunctival impression cytology analysis, ocular surface disease index (OSDI) score, tear osmolarity test, Schirmer test, tear film breakup time (TBUT), ophthalmic surface fluorescein (Fl) staining, and topographical corneal evaluation before as well as 3 and 18 months after accelerated CXL. RESULTS: There was no change in the median OSDI score, tear osmolarity test, Schirmer test, and the Fl staining score after CXL. The median TBUT increased from 9.00 s at baseline to 12.00 s at 18 months postoperative (P < 0.001). The cytological features of the temporal and superior bulbar conjunctiva deteriorated at 3 months post-CXL (P < 0.001). An improvement in impression cytology analysis of the temporal conjunctiva was noted at 18-month follow-up (P < 0.001). Significant improvements in the median maximum keratometry and mean keratometry (K-mean) readings were also noted 18 months after CXL (P < 0.001). The changes in the K-mean correlated significantly with the changes in TBUT levels at 18-month follow-up as compared to baseline (r = - 0.688, P < 0.001). CONCLUSIONS: The improvement in TBUT, conjunctival squamous metaplasia, and the goblet cell density indicates a favorable effect of CXL on the ocular surface and tear film in keratoconus, presumably due to the reduced corneal irregularity after CXL.

Longitudinal Evaluation of the Progression of Keratoconus Using a Novel Progression Display.

OBJECTIVES: To evaluate the longitudinal tomographic changes and to compare the discriminatory potential of a novel progression display between progressive and nonprogressive keratoconic eyes. METHODS: Retrospective evaluation was made of 81 eyes of 81 patients with keratoconus who had undergone Scheimpflug measurements at least twice with an interval of 12 months or longer between each measurement. The progressive group was defined as 36 eyes, which showed progression according to the definition of the global consensus on keratoconus and ectatic diseases when 2 of the 3 criteria were met, and the other 45 eyes were considered the nonprogressive group. The main outcome measures from progression display were "A" for anterior radius of curvature, "B" for posterior radius of curvature, "C" for thinnest pachymetry, "D" for distance visual acuity; Kmax; Q-value front and back; index of surface variance (ISV), vertical asymmetry, height asymmetry, and height decentration; overall deviation of normality (final D); average pachymetric progression index; and maximum Ambrósio relational thickness. RESULTS: The rate of change per year of A, B, C, thinnest pachymetry, Kmax, final D, and ISV was significantly different between groups (P≤0.01 for all values). It was determined that yearly change rates greater than 0.12 for A, 0.14 for B, 10.04 µm for thinnest pachymetry, 0.68 D for Kmax, 0.15 for final D, and 2.11 for ISV might indicate progression in keratoconus management. CONCLUSIONS: Belin progression display parameters may be useful in discriminating progressive from nonprogressive keratoconic eyes.

Could corneal densitometry be used as a diagnostic and screening tool for ocular involvement in patients with gout?

PURPOSE: To evaluate the corneal and tear film characteristics in patients with gout and compare these data with those of healthy subjects and to investigate the correlation of corneal densitometry with uric acid value and duration of disease. METHODS: Forty-one eyes of 41 patients with gout (group 1) and 40 eyes of 40 healthy subjects (group 2) were included in this study. Detailed ophthalmologic examinations were performed on all participants. Corneal tomographic analyses were performed with the Pentacam HR Scheimpflug imaging system (Oculus, Wetzlar, Germany). Maximum keratometry (Kmax), central corneal thickness (CCT), corneal volume (CV), and corneal densitometric values were compared between groups. Tear function tests including Schirmer, tear breakup time, and fluorescein staining were performed and compared between groups. RESULTS: Groups were similar in terms of age and gender. Kmax, CCT, and CV values were similar between groups. The outcomes of tear function tests were similar between groups. Corneal densitometric values for the 0-2 and 2-6 mm zones of the anterior and center layers were significantly higher in group 1 compared to group 2. This densitometric increase was positively correlated with uric acid levels and gout duration. CONCLUSIONS: Corneal densitometry values of the 0-2 and 2-6 mm zones of the anterior and central layers were higher in patients with gout than those of the control subjects, and the densitometric values increased as uric acid level and disease duration increased.

Shifting of the Line of Sight in Tilted Disk Syndrome.

OBJECTIVES: To investigate the shifting of the line of sight (LoS) and the refractive, topographic, and aberrometric parameters that may be associated with the shifting of the LoS in eyes with tilted disk syndrome (TDS). METHODS: Eighty left eyes of 80 subjects with TDS (Study Group) and 70 left eyes of 70 subjects with myopia and astigmatism (Control Group) were included in this study. Line-of-sight coordinates on the horizontal (x) and vertical (y) axes, refractive, topographic, and aberrometric parameters were evaluated. All parameters were compared between groups, and correlations were analyzed for the study group. RESULTS: In the study group, the LoS significantly shifted to the superotemporal direction compared with the control group (P=0.022 and P=0.008 respectively). The shift on y-axis was correlated with mean cylindrical refractive error (r=-0.283, P=0.011), total root mean square (RMS) (r=0.321, P=0.004), higher-order aberration RMS (r=0.300, P=0.007), vertical coma (r=0.430, P<0.001), and vertical trefoil values (r=-0.455, P<0.001). CONCLUSIONS: Results demonstrated a superotemporal shifting of the LoS in eyes with TDS. As eyes with TDS have an important place among candidates for refractive and multifocal intraocular lens implantation surgeries, this shift must be accounted for to prevent decentralization and provide satisfactory outcomes.

A novel marker in acute central serous chorioretinopathy: thiol/disulfide homeostasis.

PURPOSE: The aim of this study was to compare dynamic thiol/disulfide homeostatic status in acute central serous chorioretinopathy (CSCR) patients by using a novel and automated assay determining dynamic thiol/disulfide homeostasis. METHODS: Fifty-one patients with acute CSCR (study group) and 65 healthy individuals (control group) were enrolled in this study. Diagnosis of acute CSCR was made clinically and using spectral-domain RTVue OCT (optical coherence tomography) (Optovue, Fremont, CA). Fluorescein angiography confirmed the diagnosis of acute CSCR in all subjects. Total thiol, native thiol, disulfide amount, and native thiol/disulfide ratio (TDR) were calculated in the blood samples. RESULTS: Mean total thiol, native thiol, and native TDR values were lower in patients with acute CSCR (364.2 ± 14.1, 326.4 ± 13.2, 17.14 ± 1.9, respectively) than in healthy eyes (441.2 ± 16.3, 398.5 ± 16.4, 22.70 ± 2.15, respectively; mean total thiol, p = 0.017; native thiol, p = 0.011; native TDR, p = 0.031). CONCLUSIONS: Total thiol, native thiol, and native TDR were significantly lower statistically in patients with acute CSCR when compared with healthy controls.

Chiari 1 malformation with optic disc drusen.

A 32 year old female patient with CM 1 diagnosis was referred for the management of papilledema. Ophthalmologic examination revealed normal visual acuity (20/20 in both eyes), normal optic nerve function tests and normal slit-lamp biomicroscopic findings. Fundoscopy revealed bilateral irregular optic nerve heads with blurred margins. B scan ultrasonography (USG) and Spectral domain optical coherence tomography were performed and bilateral optic nerve heads were diagnosed as ODD. We concluded that the pseudopapilledema must be taken into account before making papilledema diagnosis in patients with CM 1 to protect the patients from redundant interventional procedures.

Optic Nerve Head Elastometry in Both Eyes of Patients with Unilateral Non-arteritic Anterior Ischaemic Optic Neuropathy - May It Be a Novel Aspect of the Pathogenesis?

In this prospective study, the biomechanical properties of optic nerve head (ONH) and cornea in both eyes of patients with non-arteritic anterior ischaemic optic neuropathy and healthy control eyes were investigated. ONH elastometry was measured with real-time elastography, and corneal elastometry was measured with ocular response analyser. Elastometry of cornea and ONH was lower in both eyes of patients with unilateral non-arteritic ischaemic optic neuropathy than in healthy control eyes. The role of these biomechanical differences in the pathogenesis of non-arteritic ischaemic optic neuropathy should be investigated further.

Are optic nerve heads of patients with helicobacter pylori infection more susceptible to glaucomatous damage?

BACKGROUND: To compare retinal nerve fiber layer thicknesses (RNFLT) of patients with or without Helicobacter pylori infection and to reveal the possible RNFLT changes after H. pylori eradication. MATERIALS AND METHODS: Sixty-five eyes of 65 patients that tested positive for H. pylori (Group 1) and 48 eyes of 48 patients that tested negative for H. pylori (Group 2) were included. RNFLT analyses were performed with spectral-domain (SD) optical coherence tomography (OCT) in a total of five regions: the superior, inferior, nasal, and temporal quadrants and the average. Then, a comparison was made between groups. After H. pylori eradication in 38 patients, RNFLTs were compared with both pre-eradication values and Group 2. RESULTS: The groups were similar in terms of age and gender. Temporal quadrant RNFLT was thinner in Group 1 than in Group 2 (P=.02). After H. pylori eradication, RNFLTs did not differ from pre-eradication values in Group 1 (P>.05 for all), whereas temporal quadrant RNFLT after H. pylori eradication was thinner compared to Group 2 (P=.03). CONCLUSIONS: H. pylori may cause the localized defects on RNFL that are the early signs of glaucoma.

Tear Function and Ocular Surface Alterations After Accelerated Corneal Collagen Cross-Linking in Progressive Keratoconus.

OBJECTIVE: To investigate the alterations in the ocular surface and tear film parameters 3 months after accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients. METHODS: Twenty-six patients (33 eyes total) with progressive KC were enrolled in this study. All patients were subjected to ophthalmic surface examination, such as OSDI (ocular surface disease index) scoring, the osmolarity tear test, Schirmer test, tear film breakup time (TBUT) analysis, rose bengal (RB) and fluorescein (Fl) ocular surface staining, and conjunctival impression cytology (IC) analysis, respectively. These tests were performed at baseline and 3 months after A-CXL. Nelson's grading system was used to evaluate the cell morphology and goblet cell density. RESULTS: No statistically significant differences in the levels of tear osmolarity, TBUT, Schirmer test, OSDI scoring, and Fl and RB staining between pretreatment and 3 months postoperatively were observed (all P values >0.05). A statistically significant increase in superior (P=0.005) and temporal (P=0.006) IC grading was seen at the postoperative third month compared to pretreatment. CONCLUSIONS: Only metaplastic changes and a reduction in the density of the goblet cells were seen in conjunctival IC, which is probably because of the toxicity of ultraviolet-A 3 months after A-CXL. However, these results do not lead to deterioration in TBUT. In this study, A-CXL has no adverse effect on ocular surface and tear function, which are important for visual quality.

Biomechanical evaluation of cornea in patients with ankylosing spondylitis.

PURPOSE: The aim of this study was to evaluate the corneal biomechanical parameters in patients with ankylosing spondylitis (AS) and to compare them with the healthy subjects. METHODS: Sixty patients with AS (study group) and 60 healthy subjects (control group) were enrolled in this prospective study. The study group was further classified as active (n:30) and inactive (n:30). After detailed ophthalmological examination including intraocular pressure (IOP) measurement with Goldmann applanation tonometer (IOPGAT), corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Reichert Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured with the Spectral-Domain Optical Coherence Tomography (SD-OCT). RESULTS: The study group's mean CH, CCT, IOPg, and IOPGAT values were lower than the control group (p < 0.05 for all variables). The mean CH, CRF, CCT, IOPg, and IOPGAT values were higher in active patients when compared to the inactive ones (p < 0.001, p < 0.001, p = 0.013, p = 0.021, and p = 0.002, respectively). CONCLUSIONS: AS patients have lower CCT, CH, IOPg, and IOPGAT when compared with healthy subjects. In the active stage of AS, patients present with higher levels of corneal biomechanical parameters with thicker corneas. IOPcc is a more accurate measurement than IOPGAT or IOPg in AS patients.

Evaluation of ocular microvascular characteristics in smokers and patients with chronic obstructive pulmonary disease using an optical coherence tomography angiography.

PURPOSE: To investigate retinal microvascular changes in patients with chronic obstructive pulmonary disease (COPD) using optical coherence tomography angiography (OCTA) and to compare these values with those of smokers and healthy non-smokers. METHODS: This study was performed on 38 eyes of 38 patients with COPD, 30 eyes of 30 smokers, and 31 eyes of 31 healthy non-smokers. Foveal avascular zone (FAZ) area, superficial (SCP) and deep (DCP) capillary plexus (whole image, fovea, parafovea, and perifovea) and radial peripapillary capillary (RPC) vessel densities (whole image, peripapillary, and inside disc) were evaluated via OCTA device (Optovue, Fremont, CA, USA). The forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio and FEV1 values of patients with COPD were recorded. RESULTS: There were statistically similar values in smoking pack-years between the smoker and COPD groups (p = 0.059). Entire SCP and DCP vessel densities were significantly different among the all groups (p < 0.05); for these parameters, the control group had the highest and the COPD group had the lowest vessel density values. Significantly decreased RPC vessel densities in all regions were detected in the COPD group compared with the other groups. Multiple regression analysis showed significant positive correlations between the FEV1 and the SCP, DCP, and RPC vessel densities (for all, p < 0.05). CONCLUSIONS: This study detected lower vessel densities in patients with COPD than in smokers and healthy controls and reported decreased vessel density measurements with increasing COPD severity. COPD patients with or without a history of smoking may benefit from higher prioritization in terms of ophthalmic screening to prevent ocular complications.

Long-term Effects of Uncomplicated Traumatic Hyphema on Corneal and Lenticular Clarity.

PURPOSE: To evaluate the long-term effects of uncomplicated traumatic hyphema on endothelial morphology, anterior segment structure, and corneal and lenticular densitometry. METHODS: In this retrospective comparative study, eyes with a history of uncomplicated traumatic hyphema were compared with the healthy contralateral unaffected eyes. The corneal endothelial cell properties were captured using specular microscopy. Anterior segment analysis, corneal densitometry (12-mm corneal diameter), and lens densitometry measurements were performed using the Pentacam imaging system. RESULTS: Measurements were obtained at a mean follow-up of 49.5 ± 15.8 months after injury. The average endothelial cell density was significantly lower in the study group than in the control group (2,506.6 ± 294.0 cells/mm² vs. 2,665.7 ± 195.0 cells/mm², p = 0.020). There was no difference between the groups in respect of polymegathism and pleomorphism (p = 0.061 and p = 0.558, respectively). All the investigated corneal tomographic and angle parameters were similar in both groups (all p > 0.05). The corneal densitometry values in all concentric zones and layers showed no statistically significant difference between the groups (p > 0.05 for all). The lens zone 1 densitometry value was significantly higher in the study group than in the control group (9.6% ± 1.1% vs. 8.9% ± 1.2%, p = 0.031). No difference was observed in zone 2 and 3 (p = 0.170 and p = 0.322, respectively). The degree of hyphema was not correlated with endothelial cell and lenticular clarity loss (p = 0.087 and p = 0.294, respectively). CONCLUSIONS: Even if traumatic hyphema is not complicated, long-term outcomes indicate endothelial cell loss and increased lenticular density.

Evaluation of the radial peripapillary capillary density in unilateral branch retinal vein occlusion and the unaffected fellow eyes.

Background: Given that unilateral branch retinal vein occlusion (BRVO) and glaucoma share common systemic vascular risk factors, the fellow eyes of patients with BRVO may be at increased risk of glaucoma. Objectives: To analyze the radial peripapillary capillary density (RPCD) in eyes with unilateral BRVO and their unaffected fellow eyes using optical coherence tomography angiography (OCTA). Design: Cross-sectional, prospective study. Methods: The study included 120 eyes of 80 patients: 40 affected eyes of BRVO, 40 fellow eyes of BRVO, and 40 control eyes. The RPCD, retinal nerve fiber layer thickness (RNFLT) were analyzed using OCTA. Results: RPCDs in the whole image, peripapillary region, all the hemispheres, and quadrants were statistically lower in the affected eyes than in both the fellow and control eyes (p < 0.05 for all). RPCD values in the whole image and the peripapillary region were significantly lower in the fellow eyes than in the control eyes (p = 0.013, and p = 0.021, respectively). RNFLTs in the peripapillary region, inferior hemisphere and inferior quadrant were significantly lower in the affected eyes than in the control eyes (p < 0.05 for all). No significant differences were detected between the fellow eyes and the control eyes in term of RNFLT values in any regions (p > 0.05 for all). Conclusion: Lower RPCD values despite similar RNFLT values were observed in the fellow eyes of patients with unilateral BRVO compared with healthy controls. These results may indicate the shared vascular mechanisms and risk factors that account for the development of BRVO and glaucoma.

Comparison of radial peripapillary capillary density results of individuals with and without Helicobacter pylori infection.

PURPOSE: To evaluate the radial peripapillary capillary density using optical coherence tomography angiography in patients with and without Helicobacter pylori infection. METHODS: This prospective, cross-sectional study comprised 52 patients (52 eyes: Group 1) and 38 patients (38 eyes: Group 2) with and without H. pylori infections, respectively. The radial peripapillary capillary density and retinal nerve fiber layer thickness in 4 equal quadrants and 2 equal hemispheres in the peripapillary region were calculated using optical coherence tomography angiography. The optic nerve head parameters of the patients were also assessed. RESULTS: The groups were similar in terms of age, gender, and the optic nerve head parameters. The radial peripapillary capillary densities in the superior hemisphere and quadrant were significantly lower in Group 1 than in Group 2 (p=0.039 and p=0.028, respectively) and were positively correlated with the superior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). Similarly, the radial peripapillary capillary densities in the inferior hemisphere and quadrant were also significantly lower in Group 1 compared to Group 2 (p=0.03 and p=0.017, respectively) and were positively correlated with the inferior hemisphere's retinal nerve fiber layer thickness (p<0.001 and p<0.001, respectively). The retinal nerve fiber layer thickness in the nasal and temporal quadrants were significantly decreased in Group 1 when compared to Group 2 (p=0.013 and p=0.022) and were positively correlated with the corresponding radial peripapillary capillary densities of the 2 quadrants (p=0.002 and p=0.022). CONCLUSION: The decreased radial peripapillary capillary density in the H. pylori-positive patients suggests that H. pylori may play a role in the etiopathogenesis of glaucoma.

Retinal Microcirculation Alterations in Microalbuminuric Diabetic Patients With and Without Retinopathy.

PURPOSE: To investigate the effect of microalbuminuria (MA) on superficial vessel density (SVD), deep vessel density (DVD), and choriocapillaris vessel density (CVD) in type-2 diabetic patients. METHODS: Twenty patients without diabetic retinopathy (DR) and MA (group 1), 20 patients without DR but with MA (group 2) and 30 patients with mild DR and MA (group 3) were enrolled in this prospective and cross-sectional study. SVD, DVD, and CVD of all patients were screened with optical coherence tomography angiography (OCTA). The relationships between these values and age, diabetes duration and metabolic parameters were also evaluated. RESULTS: The whole macular SVD value was 50.15 ± 4.52 in group 1 and 47.81 ± 4.12 in group 2 (p = .04). The whole macular DVD value was 47.66 ± 2.76 in group 1, 44.37 ± 3.39 in group 3 (p = .02). Parafoveal DVD value was 52.58 ± 3.47 in group 1, 51.84 ± 2.23 in group 2, and 49.23 ± 3.38 in group 3 (p G1&3 = .001, p G2&3 = .02). Perifoveal DVD value was 47.92 ± 3.30 in group 1, 43.96 ± 4.19 in group 2, and 42.85 ± 2.98 in group 3 (p G1&2 = .02 and p G1&3 < .001). There were inverse correlations between diabetes duration, urea, creatinine, albumin, urinary sodium and some DVD values (p < .05, for all). Also, there were inverse correlations between parafoveal and perifoveal DVD values and MA (p = .002 and p = .031). Additionally, inverse correlations were determined between diabetes duration, creatinine, urea, serum Na and some CVD values (p < .05 for all).Conclusion: Decreased SVD and DVD values measured by OCTA in type-2 diabetic patients, whether they have mild DR or not, may be associated with MA causing early retinal microvascular changes.

Comparative Evaluation of Central Corneal Thickness in Cross-Linked Keratoconic Eyes.

PURPOSE: To compare the central corneal thickness (CCT) measurements measured by using the Pentacam Scheimpflug system with the CCT measured using ultrasound pachymetry (UP) and to compare the compatibility between the methods in normal, keratoconic, and cross-linked keratoconic corneas. METHODS: The study included 50 eyes of 50 patients with keratoconus (keratoconus group), 50 eyes of 50 patients with progressive keratoconus who underwent corneal cross-linking treatment (CCL group), and 50 eyes of 50 healthy subjects (control group). Patients in the keratoconus and CCL groups were further classified into mild (mean keratometry [Km] ≤ 47 D) and moderate keratoconus subgroups (47.0 < Km < 52.0 D). CCT values were noted from the Pentacam Scheimpflug and UP. RESULTS: The difference between the Pentacam and UP values was largest in the CCL group (-20.9 0.21.5 µm), followed by the keratoconus and control groups (-10.6 0.20.3 and 0.4 0.6.8 µm). The Pentacam and UP measurements were not comparable in the keratoconus and CCL groups (P = 0.001 and P < 0.001), whereas they were comparable in the control group (P = 0.62). In subgroup analysis, the 2 methods were comparable in the mild keratoconus subgroup (P = 0.12) and not comparable in the moderate keratoconus subgroup and in both mild and moderate subgroups of the CCL group (P = 0.001, P < 0.001 and P < 0.001). CONCLUSIONS: Pentacam Scheimpflug tomography and UP can be used interchangeably in normal and mild keratoconic eyes, but not in moderate keratoconic and cross-linked keratoconic eyes. Pachymetry measurements from Scheimpflug must be interpreted with extreme caution with different methods before planning an invasive procedure in these eyes.

Topometric and Tomographic Evaluation of Subclinical Keratoconus.

PURPOSE: To investigate the corneal topometric and tomographic findings that can be used in the diagnosis of subclinical keratoconus. METHODS: A retrospective cohort study. The study group was selected from patients with clinically evident keratoconus in one eye and subclinical keratoconus without evident topographic findings in fellow eye. The age-matched control group was selected from patients who were candidates for laser in situ keratomileusis (LASIK) and did not develop ectasia after LASIK surgery at least 1-year follow-up. All subjects underwent topographic, topometric and tomographic (Belin-Ambrósio Enhanced Ectasia Display III) analyses via a Pentacam HR rotating Scheimpflug camera (Oculus, Germany, version 1.20r.98) before LASIK surgery. RESULTS: The study group consisted of 151 patients (69 male and 82 female, mean age of 24.8 ± 7.2 years) and the control group also consisted of 150 patients (70 male and 80 female, mean age of 26.0 ± 6.3 years). There were statistically significant differences in all measured topometric (p˂.05) and tomographic (p˂.001) parameters between the eyes with subclinical keratoconus and those of the control group. In discriminating eyes with subclinical keratoconus from normal eyes, final D showed the highest area under curve value (0.858, sensitivity 85.2%, specificity 66.7%), followed by maximum pachymetric progression index (0.809, sensitivity 81.9%, specificity 69.4%) and average pachymetric progression index (0.796, sensitivity 81.9%, specificity 68.1%) in receiver operating characteristic analysis. CONCLUSION: Topometric and tomographic parameters might be useful for early detection of keratoconus, but the sensitivity and specificity of any parameter are not high enough to be used alone.

Densitometric analysis of cornea in patients with neovascular age-related macular degeneration after intravitreal aflibercept loading dose.

PURPOSE: To evaluate the anatomic changes in the cornea and anterior segment following intravitreal aflibercept loading dose for neovascular age-related macular degeneration. METHODS: The study included 40 eyes of 40 patients with neovascular age-related macular degeneration. Each patient underwent a loading dose of one injection per month for three consecutive doses of aflibercept (0.05 ml/2 mg). Before and after the loading dose, a record was made for each patient of corneal topography, anterior segment, corneal densitometry, and lens densitometry parameters with the Pentacam HR and specular microscopy parameters with a non-contact specular microscope. The data before and after the aflibercept loading dose were compared. RESULTS: Corneal densitometry parameters in the 0- to 2-mm and 2- to 6-mm concentric zones of the posterior layer were significantly higher after the loading dose compared with baseline (p = 0.03, p = 0.04, respectively). Corneal densitometry parameters of the anterior, central, and total corneal layer in the 10- to 12-mm concentric zone were also significantly higher after the loading dose compared with baseline (p = 0.009, p = 0.02, and p = 0.007, respectively). No significant changes were determined in respect of corneal topography, anterior segment, lens densitometry, and specular microscopy parameters (p > 0.05 for all). CONCLUSION: The aflibercept loading dose caused slightly increased densitometric values in some corneal regions while it did not affect the corneal topography, anterior segment, lens densitometry, and specular microscopy parameters.

Effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus.

PURPOSE: To investigate the effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus with no or mild diabetic retinopathy and to investigate the relationship between macular thickness and metabolic parameters. MATERIALS AND METHODS: Fifty eight eyes of 58 patients without diabetic retinopathy (group 1) in microalbuminuria stage, 42 eyes of 42 patients with mild diabetic retinopathy (group 2) in microalbuminuria stage, and 50 eyes of 50 patients without diabetic retinopathy and microalbuminuria (group 3) were included in this study. After detailed ophthalmologic examination, all patients underwent spectral domain-optical coherence tomography measurements. Macular thickness was noted from nine different areas (fovea, four parafoveal, and four perifoveal areas) and compared between groups. The correlations between macular thickness and age, duration of diabetes mellitus, microalbuminuria, serum urea, creatinine, glycosylated hemoglobin (HbAIc), albumin, sodium (Na), and urinary Na were evaluated. RESULTS: The mean age was 53.29 ± 6.49 in group 1, 55.86 ± 6.97 in group 2, and 52.98 ± 5.66 years in group 3 (p = 0.06). The macular thickness values of superior, inferior, and nasal parafoveal areas were significantly different between groups (p = 0.001, p = 0.006, and p = 0.03, respectively). Bonferroni post test revealed that this difference originated from the difference between group 2 and 3 (p < 0.05 for all values). There were significant negative correlations between the macular thickness values of parafoveal areas and serum urea, HbA1c, albumin, microalbuminuria levels (p < 0.05 for all values). CONCLUSION: In this study, a significantly decreased parafoveal macular thickness was measured in patients with mild diabetic retinopathy and microalbuminuria compared to patients without diabetic retinopathy and microalbuminuria.