The outcomes of intravitreal C3F8 gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy.

PURPOSE: To share the anatomical results and visual outcomes of intravitreal gas tamponade combined with laser photocoagulation treatment for optic disc pit maculopathy (ODPM). METHODS: Intravitreal gas tamponade combined with laser photocoagulation treatment was performed on six consecutive patients with ODPM. A 0.3 mL of 100% perfluoropropane (C3F8) gas was injected intravitreally. The patients were then asked to maintain prone position until the C3F8 gas disappeared. Laser photocoagulation was performed the day after the procedure. The outcomes were determined by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA). RESULTS: In the present study, visual improvement and reduction in serous macular detachment were observed in 83% of the ODPM patients. Complete retinal reattachment was achieved in 66% of the ODPM patients. In one patient, no regression was observed after the repeated treatment, and pars plana vitrectomy was performed. The final BCVA improved in five eyes and unchanged in one eye. No postoperative complications were observed during the follow-up period in any patient. CONCLUSIONS: Intravitreal C3F8 gas tamponade combined with laser photocoagulation procedure is an effective, minimally invasive, and cost-effective treatment method for ODPM.

Abnormal quantitative pupillary light responses following COVID-19.

PURPOSE: To characterize alterations in pupillary light reflex responses in subjects following coronavirus disease 2019 (COVID-19), especially those with long-COVID. METHODS: Thirty-five subjects with previous COVID-19 and 30 healthy control participants were enrolled in this cross-sectional comparative study. An infrared dynamic pupillometry system (MonPack One; Metrovision, France) was used to quantify pupillary light responses. The National Institute for Health and Care Excellence (NICE) long-COVID questionnaire was used to identify persisting symptoms at least 4 weeks after acute COVID-19. RESULTS: The median time after the diagnosis of acute COVID-19 was 4.0 (2.0-5.0) months. There was an increase in the latency of pupil contraction (P = 0.001) and a reduction in the duration of pupil contraction (P = 0.039) in post-COVID-19 subjects compared to healthy controls. No significant differences were observed in the initial pupil diameter, amplitude and velocity of pupil contraction or latency, velocity and duration of pupil dilation. Long-COVID was present in 25/35 (71%) subjects and their duration of pupil contraction was reduced compared to subjects without long-COVID (P = 0.009). The NICE long-COVID questionnaire total score (ρ = - 0.507; P = 0.002) and neurological score (ρ = - 0.412; P = 0.014) correlated with the duration of pupil contraction and the total score correlated with the latency of dilation (ρ = - 0.352; P = 0.038). CONCLUSION: Dynamic pupillometry reveals significant alterations in contractile pupillary light responses, indicative of parasympathetic dysfunction after COVID-19.

Subclinical inner retinal layer thickness changes in the fellow eyes of patients with unilateral central retinal artery occlusion: a pilot study.

PURPOSE: To investigate microstructural changes in the macular inner retinal layers over time in the fellow eyes of patients with unilateral central retinal artery occlusion (CRAO). METHODS: Spectral-domain optical coherence tomography scans of 16 patients with CRAO were performed at initial examination (1st day), at 1st month, at 3rd month, at 6th month, and the central macular thickness (CMT) and inner retinal layer thicknesses in the fellow eyes of the patients were compared between each visit. The thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) were calculated in 9 quadrants according to the definition by the Early Treatment Diabetic Retinopathy Study. RESULTS: CMT decreased over a 6-month period, but the difference was insignificant among visits (p = 0.072). Also, there were no significant differences in the thicknesses of RNFL and GCL among visits (p > 0.05 for all quadrants). But there was thinning in the parafoveal superior and perifoveal superior quadrants of the IPL (p = 0.007, p = 0.01) and in the parafoveal temporal quadrant of the INL (p = 0.033) within 6 months of follow-up in the fellow eyes of the patients with CRAO. CONCLUSION: This study demonstrated subclinical alterations of the macular inner retinal layers over time in the fellow eyes of CRAO patients.

Subfoveal choroidal thickness change following pars plana vitrectomy with silicone oil endotamponade for rhegmatogenous retinal detachment.

PURPOSE: To report changes in subfoveal choroidal thickness (SFCT) using spectral-domain optical coherence tomography following pars plana vitrectomy (PPV) with silicone oil (SiO) endotamponade injection and subsequent removal. METHODS: In this prospective study, 24 eyes of 24 patients with macula-off rhegmatogenous retinal detachment (RD) were included. These patients underwent PPV with SiO injection removal. SFCT measurements were taken 2 weeks and 3 months after PPV and SiO injection and 1 month after SiO removal. The contralateral eyes served as controls. RESULTS: Mean SFCT values of the operated eyes were 294.1 ± 70.5 µm and 282.9 ± 80.6 µm 2 weeks and 3 months after PPV and 264.2 ± 63.3 µm 1 month after SiO removal. There was no significant change in SFCT between first and second measurements (p = 0.96). SFCT decrease was statistically significant when first and last measurements were compared (p = 0.03). SFCT percent change was correlated with duration of SiO in the eye and was not correlated with amount of endolaser photocoagulation performed during surgery. SFCT values of the fellow eyes were 317.1 ± 84.8 µm, 313.7 ± 79.8 µm and 306.1 ± 69.1 µm, at 2 weeks and 3 months after PPV and 1 month after SiO removal, respectively. There was no significant difference between the measurements of the control eyes taken at different time intervals (p = 0.430, p = 0.085, respectively). CONCLUSION: SFCT seems to decrease after the removal of the SiO which indicates that choroidal parameters should be taken into account during or after surgery for rhegmatogenous RD.

Influence of cyclopentolate hydrochloride on corneal biomechanical properties in healthy individuals.

OBJECTIVE: This observational study aims to investigate the effects of cyclopentolate hydrochloride (1%) on corneal biomechanical properties, with the ocular response analyzer (ORA), in healthy individuals. METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements of 36 (15 female and 21 male) healthy individuals, before and after 45 min of 1% cyclopentolate hydrochloride instillation, were performed by the ORA. RESULTS: The mean CH and IOPcc measurements of the eyes were 10.63±1.17 mm Hg and 15.15±2.69 mm Hg, precycloplegia, and 11.09±1.32 mm Hg and 14.16±2.77 mm Hg, postcycloplegia, respectively. The differences between the precycloplegia and postcycloplegia in both measurements were statistically significant (P=0.031, P=0.016, respectively; paired t test). The mean CRF and mean IOPg measurements of the eyes were 10.40±1.16 mm Hg and 14.83±2.56 mm Hg, precycloplegia, and 10.61±1.33 mm Hg and 14.25±2.65 mm Hg, postcycloplegia, respectively. The differences between the precycloplegia and postcycloplegia measurements of the eyes were insignificant (P=0.264 and P=0.100, respectively; paired t test). CONCLUSIONS: A 1% cyclopentolate hydrochloride instillation leads to significant changes in the CH values and IOPcc measurements. This should be taken into account during the evaluation of refractive surgery candidates and in clinical conditions where ORA measurements are considered in the diagnosis and follow-up.

Normative data assessment of age-related changes in macular and optic nerve head vessel density using optical coherence tomography angiography.

OBJECTIVE: To investigate macular and optic nerve head vessel density in healthy individuals using optical coherence tomography angiography (OCTA), and determine their relationship with age. METHOD: This retrospective study included 153 eyes of 153 individuals aged between 20 and 80 years, who had no systemic diseases, optic disk, or retinal pathologies. The retinal (6 × 6 mm) and optic disk (4.5 × 4.5 mm) OCTA images were evaluated for superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillary plexus (RPCP) vessel density, foveal avascular zone (FAZ) area, and choriocapillaris flow area and compared among 5 age groups. RESULTS: The SCP vessel density was significantly associated with age for the whole image (P = 0.001), parafovea (P = 0.038), and perifovea (P/ce:italic>= 0.001). The DCP vessel density significantly varied with age in the whole image (P = 0.004), parafovea (P = 0.001), and perifovea (P = 0.002). The SCP and DCP vessel densities were significantly lower in the older age groups, and more prominently so after 50 years of age. The FAZ area increased with age; however, this finding was not statistically significant (P = 0.660). The choriocapillaris flow area decreased with age (P = 0.002). The RPCP vessel density in the inside disk significantly decreased with age (P = 0.038). CONCLUSION: Age should be taken into consideration when using OCTA in the diagnosis and follow-up of retinal and optic nerve diseases. It is believed that the results here in can be used as a reference baseline for future studies.

Assessment of pupillary light reflex using dynamic pupillometry in laser-treated eyes with retinal vein occlusion.

PURPOSE: This study aims to evaluate the pupillary light reflex measured with dynamic pupillometry in patients who underwent retinal laser photocoagulation due to unilateral retinal vein occlusion (RVO). METHODS: A total of 48 patients with unilateral RVO were included in the study. Thirty-four patients had undergone retinal laser photocoagulation while the remaining 14 patients that did not undergo laser treatment were observed for control purposes. Of the laser-treated eyes, 14 eyes (41.2%) had central RVO (CRVO) and 20 eyes (58.8%) had branch RVO (BRVO). Among the 14 patients with RVO without laser treatment, nine eyes (64.3%) had CRVO and five eyes (35.7%) had BRVO. Pupillary light reflexes were assessed with dynamic pupillometry (MonPackOne®; Metrovision, France). The parameters of the eyes with RVO were compared with that of fellow healthy eyes. RESULTS: Mean patient age was 65.8 ± 10.4 years and median time after photocoagulation was 25.5 months. Eyes that received laser photocoagulation had lower pupil contraction amplitude (p = 0.037), prolonged contraction latency (p = 0.027), slower contraction velocity (p = 0.043), and slower dilation velocity (p < 0.001) compared to healthy fellow eyes. Subgroup analysis revealed that eyes with CRVO had lower contraction amplitude (p = 0.013) and slower dilation velocity (p = 0.003), and eyes with BRVO had slower dilation velocity (p = 0.003). Non-laser-treated eyes with RVO revealed no significant difference in any of the pupillary light reflex parameters compared to fellow eyes. CONCLUSION: Laser-treated eyes with RVO demonstrated changes in pupillary light reflex parameters including reduced contraction amplitude, prolonged contraction latency, and slower contraction and dilation velocities measured with dynamic pupillometry.

Assessment of Monocyte/HDL Ratio in Branch Retinal Vein Occlusion.

Purpose: The purpose of this article was to evaluate monocyte count and high-density lipoprotein (HDL) cholesterol levels and their ratio (monocyte/HDL ratio [MHR]) in patients with branch retinal vein occlusion (BRVO).Materials and Methods: A total of 50 participants were included in the study. Participants were divided into two groups: Twenty-five patients diagnosed with BRVO and 25 participants as the control group. Ocular examination findings and hematologic parameters were accessed from the file records and database, retrospectively.Results: The mean MHR was significantly higher in BRVO group compared to the control group (13.4 ± 5.2 vs. 8.1 ± 2.2, p < 0.001). In receiver operating characteristics analysis, the area under the curve for MHR was 0.862, and an MHR of >9.5 predicted BRVO with a sensitivity of 76% and specificity of 70.8%.Conclusion: The present study showed that elevated MHR is significantly associated with BRVO. Therefore, MHR may be a useful marker for the emergence of BRVO.

Effect of serum cytokines and VEGF levels on diabetic retinopathy and macular thickness.

PURPOSE: To investigate the role of serum inflammatory cytokines and vascular endothelial growth factor (VEGF) in diabetic retinopathy (DR) and evaluate their relationship with macular thickness measurements obtained with optical coherence tomography (OCT). METHODS: The study enrolled 28 healthy subjects (Group 1), 31 patients without DR (Group 2), 49 patients with nonproliferative DR (Group 3), and 46 patients with proliferative DR (Group 4). Macular profile was assessed with Stratus OCT-3 and the serum concentrations of VEGF and interleukin-1 alpha (IL-1 alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), macrophage inflammatory protein (MIP-1 alpha), monocyte chemoattractant protein (MCP-1), and epidermal growth factor (EGF) were measured using multiplex bead immunoassay. RESULTS: The median value of the visual acuity was 20/20 (Groups 1 and 2), and 20/100 (Group 3), and 20/125 (Group 4). The median value of central subfield macular thickness was estimated as 165.50 microm in Group 1, 202.5 microm in Group 2, 318 microm in Group 3, and 310 microm in Group 4. The median serum VEGF level, which was 98.20 pg/ml in Group 1, demonstrated a progressive rise to 125.37 pg/ml in Group 2, to 153.07 pg/ml in Group 3, and to 149.12 pg/ml in Group 4. Statistical significance was found between all groups (p<0.05) except between Groups 3 and 4 (p=0.87). The median levels of IL-1 alpha and IL-6 were zero in all groups. The median serum levels of IL-8, IL-10, MIP-1 alpha, and EGF revealed a wide range within each group but no statistical significance between the groups (p>0.05). The median serum levels of IL-8, IL-10, MIP-1 alpha, and EGF revealed a wide range within each group, however, no statistically significant relationship was found between the groups (p>0.05). The median values of the serum MCP-1 concentrations presented a statistically significant rise with the progression of DR (p=0.02). No correlation was found between macular thickness and serum cytokine and VEGF levels (p>0.05). CONCLUSIONS: Increased serum levels of VEGF and MCP-1 may act as a key regulator of DR and provide a potential tool for risk assessment in diabetic patients. Further studies that evaluate both vitreous and serum levels in various stages of DR are needed to provide a better understanding of the interaction between systemic and local inflammatory and angiogenic factors.

Screening for retinopathy of prematurity in a tertiary care newborn unit in Turkey: frequency, outcomes, and risk factor analysis.

PURPOSE: To report the frequency, risk factors, and outcomes of screening for retinopathy of prematurity (ROP). METHODS: Data of neonates with a gestational age of 34 weeks or less were analyzed and the predictors on the development of ROP were determined by using logistic regression analysis. RESULTS: Of the 318 neonates, the frequency of ROP was 37.1% for any stage and 7.2% for stage 3 or greater. Treatment was needed in 16.1% of neonates with ROP. No treatment was required in neonates with a gestational age of greater than 32 weeks. Oxygen therapy, sepsis, gestational age of 32 weeks or less, and birth weight of less than 1,250 g were determined as the independent risk factors. CONCLUSIONS: Although frequency of ROP in Turkey is similar to that in the United States, the rate of severe ROP necessitating treatment seems to be higher in Turkey. Neonates with a gestational age of 32 weeks or less, a birth weight of less than 1,250 g, sepsis, and oxygen therapy may have a greater risk of developing ROP and screening should be intensified in the presence of these risk factors.

Treatment of Mooren's ulcer with topical administration of interferon alfa 2a.

OBJECTIVE: To report an apparently beneficial effect of topical interferon alfa 2a (IFNalpha2a) as a single therapeutic agent in the treatment of Mooren's ulcer. DESIGN: Two case reports. PARTICIPANTS: Two consecutive patients with unilateral Mooren's ulcer diagnosed at the cornea service of Gulhane Military Medical Academy from December 2004 to December 2005 were studied retrospectively. INTERVENTION: Patients with a clinical diagnosis of Mooren's ulcer were treated with topical IFNalpha2a until their lesions resolved. MAIN OUTCOME MEASURES: A review of medical records was performed to assess the duration and response to treatment with topical IFNalpha2a drops, defined by clinical resolution of Mooren's ulcer. RESULTS: Symptoms and signs in 2 eyes improved during the first week of treatment, and reepithelialization was achieved at 7 and 10 days. Visual acuity levels reached 20/25 and 20/30 within 1 month of treatment. No recurrences were observed during 1 year and 6 months of follow up. CONCLUSIONS: Topical IFNalpha2a as a single therapeutic agent was an effective alternative in the treatment of our 2 patients with Mooren's ulcer. It offers the benefits of topical therapy and avoided surgical or other interventions that may lead to stem cell deficiency. Larger controlled studies are necessary to confirm the long-term efficacy and safety of this treatment.

Essential hypertension and hypermetropia: is there really an association?

AIM: To investigate the relationship between hypermetropia and systemic hypertension. METHODS: The study was performed on 2 groups of participants (a total of 1,162 participants). Group 1 comprised 370 patients with arterial hypertension and 205 age- and sex-matched normotensive subjects. Hypertension was defined as systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg. Spherical equivalents between -0.50 and +0.50 dpt were regarded as emmetropia. Keratometry, anterior chamber depth (ACD) and axial length (AL) were measured with IOL Master (Zeiss, USA). Group 2 comprised 124 myopic, 206 emmetropic and 257 hypermetropic subjects. Differences for mean spherical equivalent, keratometry, ACD and AL measurements between hypertensive patients and control subjects (group 1) were compared using independent-sample t test and Mann-Whitney U test, and distributions of refractions were compared with the chi(2) test. Distributions of hypertensive and normotensive subjects (group 2) among myopic, emmetropic and hypermetropic subjects were compared with the chi(2) test. RESULTS: Mean spherical equivalents of the patients with hypertension and of control subjects were -0.03 +/- 1.63 and 0.22 +/- 1.82 dpt, respectively (p = 0.182). The differences for keratometric values, ACD and AL were not significant (p = 0.151, 0.692 and 0.548, respectively). There was also no significant difference (p = 0.143) for hypertension ratios among myopic (66.1%), emmetropic (57.8%) and hypermetropic (55.6%) subjects. CONCLUSION: There is no association between systemic arterial hypertension and hypermetropia.

Linear corneal epithelial keratitis with a horseshoe pattern.

PURPOSE: To report the treatment and follow-up of a linear epithelial keratitis with a horseshoe pattern. METHODS: A 21-year-old Turkish soldier, who presented with epithelial keratitis with a horseshoe pattern that did not respond to immunosuppressive and multiple anti-microbial treatment, was studied clinically. RESULTS: No microorganism was identified with different stains, cultures, and herpes simplex virus-polymerase chain reaction. The impression cytology revealed prominent polymorphonuclear leukocyte infiltration at the keratitis line. The keratitis did not respond to different antimicrobial treatment or local and systemic corticosteroids. After a fourth scraping was perfomed deeply with a disc-knife, the lesion healed and did not recur in six months. CONCLUSION: Linear epitheliitis of cornea with a horseshoe pattern was not found to be associated with any microorganism or systemic disease.

Effects of panretinal laser photocoagulation on the corneal nerve plexus and retinal nerve fiber layer in retinal vein occlusion.

PURPOSE: To determine the effects of panretinal photocoagulation (PRP) on corneal sub-basal nerve plexus (SBNP) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with unilateral central retinal vein occlusion (CRVO) who had previously undergone PRP treatment. METHODS: Sixty-four eyes of 32 patients (19 male, 13 female) with unilateral ischemic type CRVO who had undergone PRP treatment at least 6 months previously were included in this cross-sectional study. The laser scanning in vivo corneal confocal microscope was used to determine corneal SBNP parameters. The peripapillary RNFL thickness was assessed with spectral-domain optical coherence tomography. Data obtained from the PRP-treated eyes were compared with those of the fellow unaffected eyes. RESULTS: The mean age of patients was 63.5 ± 10.7 years (range 45-85 years). The mean nerve fiber density (NFD), nerve branch density, and nerve fiber length (NFL) were significantly lower in PRP-treated eyes compared with fellow eyes (p<0.001 for all). Average peripapillary RNFL thickness was significantly lower in PRP-treated eyes than in fellow eyes (p = 0.007). The NFD and NFL showed a modest but significant positive correlation with average peripapillary RNFL thickness (r = 0.310, p = 0.013 and r = 0.272, p = 0.030, respectively). CONCLUSIONS: Significant reductions in corneal SBNP parameters and average peripapillary RNFL thickness were observed in the eyes of patients receiving PRP for the treatment of ischemic CRVO.

Assessment of Corneal Sensation, Innervation and Retinal Nerve Fiber Layer in Patients Treated with Multiple Intravitreal Ranibizumab Injections.

PURPOSE: To evaluate the effects of repeated intravitreal ranibizumab injections on corneal sensitivity, corneal sub-basal nerve plexus (SBNP) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with neovascular age-related macular degeneration (AMD). METHODS: Sixty-six eyes of 33 patients who had received unilateral repeated intravitreal ranibizumab injections (0.5 mg/0.05 ml) for the treatment of AMD and 25 eyes of 25 healthy subjects were included in the study. Central corneal sensation was measured using the contact Cochet-Bonnet esthesiometer. The laser scanning in vivo corneal confocal microscope was used to determine corneal SBNP parameters. The peripapillary RNFL thickness was assessed with spectral-domain optical coherence tomography. Data obtained from the ranibizumab-injected eyes were compared with those of the fellow non-treated eyes and the eyes of the healthy control subjects. RESULTS: The mean number of ranibizumab injections per eye was 8.9±5.0 (range 3-20). There were no statistically significant differences in the central corneal sensitivity threshold and corneal SBNP parameters between the ranibizumab-injected eyes and the fellow untreated eyes or between those with neovascular AMD and the healthy control group (P>0.05 for all). The average peripapillary RNFL thickness of the treated eyes did not differ significantly to the fellow eyes (P = 0.237), and the eyes of healthy control subjects (P = 0.918). There were no significant correlations between the number of ranibizumab injections and any of the study parameters. CONCLUSIONS: Multiple intravitreal injections of ranibizumab seem to have no harmful effects on corneal sensitivity, innervation and peripapillary RNFL thickness in patients with AMD.

Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract.

PURPOSE: To investigate whether dietary supplementation with IH636 grape seed proanthocyanidin extract (GSPE) prevents selenite-induced cataract. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey. METHODS: Thirty Spraque-Dawley rat litters were put randomly into 3 groups. In group 1 (n = 10), sodium selenite (30 nmol/g body weight) was injected subcutaneously on postpartum day 10. In group 2 (n = 10), sodium selenite (30 nmol/g body weight) was injected on postpartum day 10 and oral GSPE (100 mg/kg body weight) was given for 1 week after sodium selenite injection. Only subcutaneous saline was injected in group 3 (control, n = 10). The development of cataract was assessed for 3 weeks, and its density was graded and photographed with a slitlamp. Removed rat lenses were analyzed for glutathione (GSH) and malondialdehyde (MDA). RESULTS: All of the rats in group 1 had cataract between stage 6 and stage 3. In group 2, only 5 of 10 eyes had cataract between stage 3 and stage 2 and no cataract occurred in the remaining 5 rats. The difference between mean cataract stages in group 1 and group 2 was significant (P<.05). The mean GSH level in group 1 was significantly lower than in group 2 and controls (P<.05). The mean MDA level in group 1 was significantly higher than in group 2 and controls (P<.05). CONCLUSIONS: IH636 grape seed proanthocyanidin extract effectively suppressed cataract formation in rats. Routine consumption of grape seed proanthocyanidin extract in the form of food or dietary supplement may offer a prophylactic measure against onset and progression of cataract.

Unilateral Recurrent Anterior Uveitis as the Presenting Sign of Bladder Carcinoma.

A 79-year-old male patient was followed for unilateral uveitis with 3 attacks in 10 months, despite initial improvement with steroid therapy. The patient had visual acuity (VA) of counting fingers in right eye, hypopyon and vitritis with no chorioretinal lesions. The left eye was normal. The patient was evaluated for intraocular foreign body, intraocular lymphoma and associated systemic disease and malignancy. Computed tomography of the abdomen showed a mass in the bladder. Biopsy confirmed bladder carcinoma. After resection of the mass, intraocular inflammation improved completely and no attack was noted in the follow-up. In his last examination, two years after the operation, VA was light perception; seclusio pupilla and mature cataracts were seen on biomicroscopy. There was no sign of vitritis on ocular ultrasonography. Evidence is discussed that suggests a link and potential etiology between refractory uveitis with hypopyon and bladder carcinoma. This is the first case of unilateral recurrent uveitis with hypopyon as the initial presenting sign of bladder carcinoma.

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution.

PURPOSE: To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution. METHODS: In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up. RESULTS: The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 ± 0.2, 0.48 ± 0.2, 0.57 ± 0.2, and 0.64 ± 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 ± 2.4 diopters (D) preoperatively to -5.0 ± 2.1 D, and mean simulated keratometry decreased from 48.5 ± 2.5 D to 47.8 ± 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 ± 25.6 µm and 430.5 ± 23.9 µm preoperatively to 420.7 ± 31.8 µm and 409.3 ± 28.7 µm at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed. CONCLUSIONS: CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes.

PURPOSE: To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction. METHODS: All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively. RESULTS: In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186). CONCLUSIONS: The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.

Intraoperative corneal thickness monitoring during corneal collagen cross-linking with isotonic riboflavin solution with and without dextran.

PURPOSE: The aim of this study was to analyze and compare corneal thickness changes during corneal collagen cross-linking procedures performed with isoosmolar riboflavin solution with 20% dextran and without dextran in corneal ectatic diseases. METHODS: The patients in this study were analyzed in 2 groups: group 1 receiving riboflavin solution containing 20% dextran and group 2 receiving dextran-free riboflavin solution. Corneal thickness measurements were obtained with ultrasonic pachymetry at 6 different time points: preoperatively and at 0, 15, 30, 45, and 60 minutes after epithelial removal and initiation of ultraviolet A irradiation. RESULTS: Twenty-seven eyes of 27 patients with progressive keratoconus were included in the study. In group 1 (n = 13), the mean preoperative thinnest pachymetric readings were 469.3 ± 8.5 µm, which decreased to 423.8 ± 8.9 µm after deepithelization and further decreased to 385.9 ± 10.9 µm at 15 minutes. The corneal thickness assumed a steady course at the 30-, 45-, and 60-minute measurements (378.9 ± 9.8 µm, 384.5 ± 10.5 µm, and 396.7 ± 9.4 µm, respectively). The initial change was statistically significant (P < 0.01). In group 2 (n = 14), the corneal thickness decreased from 459.4 ± 3.8 µm to 414.7 ± 2.6 µm with deepithelization, after which it increased steadily with the initiation of the dextran-free riboflavin solution. The final measurement in group 2 was 474.1 ± 9.4 µm; the increase at each time point was statistically significant when compared with the previous measurement (P < 0.01). CONCLUSIONS: Using isoosmolar riboflavin solution without dextran causes a steady increase in the corneal thickness during the cross-linking procedure, as opposed to riboflavin with dextran. This result might be beneficial in broadening the spectrum of cross-linking indications in patients with thin corneas.