Expression of placental growth factor, neuropilin-1, and neuropilin-2 in primary pterygium tissue.

PURPOSE: The aim of this study was to evaluate the expression of placental growth factor (PLGF), neuropilin-1 (NP-1), and neuropilin-2 (NP-2) molecules in primary pterygium tissue compared with normal conjunctival tissue. METHODS: The records of 42 patients who underwent excision surgery with autografts for primary pterygium (pterygium group) and 20 patients who underwent conjunctival nevus excision surgery (control group) in the same period were reviewed retrospectively. The samples obtained from the pterygium tissues in the pterygium group and the clean conjunctival tissues adjacent to the nevus in the control group were collected from the archive. Immunohistochemical stains of the primary antibodies-1/100 diluted PLGF, NP-1, and NP-2 (Abcam Cambridge Science Park, UK)-were applied to all groups. Staining intensities and the percentage of positive cells in epithelial, endothelial, stromal, and inflammatory cells were analyzed by an experienced pathologist. RESULTS: The positivity rates of PLGF and NP-2 expression in epithelial, endothelial, stromal, and inflammatory cells were found to be higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively; NP-2: p < 0.001 for all). Staining intensities for PLGF and NP-2 were higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively; NP-2: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). However, no significant differences were found in any cell type in terms of NP-1 expression positivity rates (p = 0.730, p = 0.121, p = 0.524, and p = 0.624, respectively) or staining intensity (p = 0.716, p = 0.147, p = 0.147, and p = 0.780, respectively). CONCLUSION: PLGF and NP-2 levels were found to be higher in pterygium tissue, while there was no difference in NP-1. These results indicate the possible roles of NP-2 and PLGF in primary pterygium.

Corneal innervation changes in Alzheimer's: implications for sensory dysfunction.

PURPOSE: To compare, between Alzheimer's disease (AD) patients and healthy individuals, corneal subbasal nerve plexus (CSNP) parameters and corneal sensitivities. METHODS: Twenty-two patients who were followed up with Alzheimer's disease (Alzheimer's group) and 18 age- and gender-matched healthy individuals (control group) were included in this cross-sectional study. CSNP parameters, including nerve fiber length (NFL), nerve fiber density (NFD), and nerve branch density (NBD), were evaluated using in vivo confocal microscopy. Corneal sensitivity was evaluated using a Cochet-Bonnet esthesiometer. The results were compared between the two groups. RESULTS: In the Alzheimer's group, NFL was 12.2 (2.4) mm/mm2, NFD was 12.5 [3.1] fibers/mm2, and NBD was 29.7 [9.37] branches/mm2. In the control group, NFL was 16.5 (2.0) mm/mm2, NFD was 25.0 [3.13] fibers/mm2, and NBD was 37.5 [10.9] branches/mm2. All three parameters were significantly lower in the Alzheimer's group compared to the control group (p < 0.001, p < 0.001, and p = 0.001, respectively). Similarly, corneal sensitivity was significantly lower in the Alzheimer's group (55.0 [5.0] mm) compared to the control group (60.0 [5.0] mm) (p < 0.001). CONCLUSION: We determined that, in AD, corneal sensitivity decreases significantly, in parallel with the decrease in corneal nerves. Changes in the corneal nerve plexus and a decrease in corneal sensitivity may be used in the early diagnosis and follow-up of AD. In addition, ocular surface problems secondary to these changes should also be kept in mind.

Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology.

PURPOSE: To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity. METHODS: One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups. RESULTS: The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001). CONCLUSION: In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.

Impact of unilateral trigeminal neuralgia on bilateral ocular surface alterations.

OBJECTIVE: To evaluate ocular surface alterations in both eyes of patients with unilateral trigeminal neuralgia (TN) compared with controls. BACKGROUND: Corneal nerves mainly originate from the trigeminal nerve, and neurosensory abnormalities are important factors in ocular surface alterations and dry eye etiopathogenesis. METHODS: Twenty-four patients with idiopathic unilateral TN and 24 healthy controls with similar sex and age distributions were included in this cross-sectional study conducted from February 15 to September 15, 2021. The eyes on the affected sides of the patients with TN were treated as Group 1, their contralateral eyes as Group 2, and the right eyes of the controls as Group 3. All participants were evaluated for tear film and ocular surface using the Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and conjunctival impression cytology grading. RESULTS: The mean (SD) ages of the patients with TN (17 of 24 females, 70.8%) and controls (15 of 24 females, 62.5%) were 49.7 (11.7) and 48.5 (9. 6) years, respectively. The median [25th, 75th percentile] Schirmer 1 test results in Groups 1, 2, and 3 were 5.0 [4.0, 14.0], 7.0 [3.2, 11.7], and 10.0 [6.0, 15.7] mm, respectively, with no statistically significant differences between Groups 1 and 2 (p = 0.697), Groups 1 and 3 (p = 0.133), or Groups 2 and 3 (p = 0.129). The median TBUT scores in Groups 1, 2, and 3 were 7.0 [5.0, 10.0], 8.0 [5.2, 10.0], and 12.5 [8.0, 13.0] s, respectively, showing reduced times for both Groups 1 and 2 versus Group 3 (median difference = -3.0 [95% CI: -5.0, -1.0], p = 0.001, and median difference = -3.0 [95% CI: -5.0, -2.0], p = 0.001, respectively). Conjunctival impression cytology grades were significantly higher in Groups 1 and 2 versus Group 3 (median difference = 2.0 [95% CI: 1.0, 2.0], p < 0.001, and median difference = 1.0 [95% CI: 1.0, 2.0], p < 0.001, respectively). The median OSDI score in TN patients (30.2 [25.0, 34.9]) was significantly higher than in the controls (8.3 [0.0, 18.7]), with a median difference of 20.8 (95% CI: 14.7, 27.1), p < 0.001. CONCLUSION: Even if pain is unilateral in patients with TN, there are significant abnormalities in conjunctival cytology and tear functions in both eyes. There seem to be various pathophysiological mechanisms of TN that affect the bilateral ocular surface and lead to significant alterations.

The ocular surface findings in alopecia areata patients: clinical parameters and impression cytology.

PURPOSE: The objective of this study was to examine the effects of alopecia areata (AA) on the ocular surface and conjunctival cytology. METHODS: A total of 48 subjects were included in the present study. Twenty-three subjects were assigned to group 1 as the patient group, and 25 healthy individuals were included in group 2 as the control group. The ocular surface examination was performed, and the right eyes of all participants were included in the analysis. Both groups underwent the following tests for evaluation of ocular surface: tear break-up time (TBUT), Schirmer I test, Ocular Surface Disease Index (OSDI), and conjunctival impression cytology (CIC). Results obtained from the tests were then analyzed and compared between the groups. RESULTS: The mean TBUT value was significantly lower in Group 1 compared to Group 2 (4.96 ± 3.4 vs 10.52 ± 4.8 s) (p < 0.001). There was no significant difference between Group 1 and Group 2 in terms of the mean Schirmer I test score (p = 0.129). The mean OSDI score was higher in Group 1 compared to Group 2 (15.48 ± 10.4 vs 9.61 ± 13.4), but the difference between both groups was not statistically significant (p = 0.1). The mean CIC score was statistically significantly higher in Group 1 than in Group 2 (1.65 ± 0.7 vs 0.52 ± 0.5) (p < 0.001). CONCLUSION: The results of this study showed that AA was correlated with significant disturbances in conjunctival cytology and the tear function.

Conjunctival impression cytology and tear film parameters in patients with multiple sclerosis.

PURPOSE: To evaluate conjunctival impression cytology (CIC) findings and tear film parameters in patients with multiple sclerosis (MS) compared with controls. METHODS: Thirty-three patients with MS (MS group) and 33 age- and sex-matched healthy subjects (control group) were included in this cross-sectional comparative study. CIC grades, tear break-up time (TBUT), Schirmer 1 test results, and Ocular Surface Disease Index (OSDI) scores were compared between the two groups, and correlations between CIC grade, TBUT, Schirmer 1 test result, OSDI score, Expanded Disability Status Scale score, and disease duration were analyzed. RESULTS: Mean CIC grade was higher in the MS group than in the control group (1.48 ± 0.71 and 0.39 ± 0.56, respectively; p < 0.001). In the MS group, CIC of the 14 participants (42.4%) was grade 2-3. In the control group, CIC of the only one participant (3.3%) was grade 2, and none of them was grade 3. TBUT (8.12 ± 3.16, 13.06 ± 4.23 s in MS and control groups, respectively; p < 0.001) and Schirmer 1 test results (8.45 ± 5.75, 17.36 ± 10.89 mm in MS and control groups, respectively; p < 0.001) were lower, and OSDI score (36.36 ± 19.19, 13.70 ± 15.36 in MS and control groups, respectively; p < 0.001) was higher in the MS group compared to the control group. CONCLUSION: In patients with MS, objective findings of dry eye, subjective symptoms related to dry eye, and CIC abnormalities, including high grades of conjunctival squamous metaplasia and goblet cell loss, are more common. Patients with MS should be monitored for ocular surface alterations and dry eye disease.

Tear Function Alterations and Conjunctival Impression Cytology Findings in Patients With Gout.

OBJECTIVES: The aim of this study was to evaluate the tear functions and conjunctival impression cytology (CIC) findings of patients with gout and compare them with healthy controls. METHODS: Thirty-four patients with gout (group 1) and 32 age-matched and gender-matched healthy individuals (group 2) were included in this cross-sectional study. Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and CIC grade were evaluated and compared between the groups. RESULTS: There was no significant difference between the groups in gender and age (P=0.923 and P=0.078, respectively). The mean of Schirmer 1 test result was significantly lower in group 1 (9.74±6.03 mm) than that in group 2 (17.16±9.33 mm) (P<0.001). The TBUT was also significantly lower in group 1 (7.00±2.09 seconds) than that in group 2 (12.75±5.25 seconds) (P<0.001). The OSDI score (20.04±12.92) was significantly higher in group 1 than that in group 2 (6.19±10.07) (P<0.001). Although 10 patients (29.4%) in group 1 had the CIC grade of 2 to 3, none of the controls had CIC grade 2 to 3. The mean CIC grade in group 1 (1.15±0.89) was significantly higher than that in group 2 (0.47±0.51) (P<0.001). CONCLUSIONS: The results of this study suggest that ocular surface alterations assessed by CIC and tear function abnormalities are more common in patients with gout.

Ocular-symptoms-related Google Search Trends during the COVID-19 Pandemic in Europe.

PURPOSE: To investigate the correlation between the daily relative search volume (RSV) of keywords related to coronavirus and ocular symptoms, and the numbers of the daily coronavirus disease 2019 (COVID-19) new cases and new deaths in Europe using Google Trends (GT). METHODS: The RSVs of the selected keywords related to coronavirus and ocular symptoms between 24 January and 1 June 2020 in the United Kingdom, Spain, Italy, Germany and Turkey were accessed from GT. The numbers of daily COVID-19 new cases and new deaths in the same time interval in the aforementioned countries were compared with the RSVs of the keywords and terms. RESULTS: The United Kingdom, Spain, Italy, Germany, and Turkey were the most affected countries from the COVID-19 pandemic in Europe. In these countries, statistically significant and strong correlations were found between the daily RSVs of most keywords related to coronavirus and ocular symptoms, and the daily numbers of COVID-19 new cases and new deaths ranging from 0.175 to 0.807. CONCLUSIONS: Ocular symptoms are not the frequent signs of COVID-19, but the ocular surface is a possible route for the transmission of COVID-19. The preliminary outcomes of this study demonstrated that there are significant correlations with the ocular symptoms and COVID-19. The news about the relation of eye and COVID-19 in the mass media may have influenced the Google internet search activity of the public for ocular symptoms.

Assessment of Ocular Surface in Patients With Ankylosing Spondylitis.

PURPOSE: To evaluate the clinical findings and ocular surface changes in patients with ankylosing spondylitis (AS). METHODS: This prospective study involved 45 patients with AS (group 1) and 28 healthy subjects (group 2). Patients in group 1 were in the inactive period. The study subjects underwent a complete ophthalmic examination. The right eyes of the subjects in each group were tested for the study including slit-lamp examination, Schirmer I test, tear break-up time (TBUT), conjunctival impression cytology (CIC), and ocular surface disease index (OSDI). Results between the two groups were compared. RESULTS: The mean Schirmer I test result was found as 12.2±8 mm in group 1 and 20.3±9.9 mm in group 2 (P<0.001), whereas the mean TBUT value was found as 3.8±1.9 sec in group 1 and 10.1±4.8 sec in group 2 (P<0.001). The OSDI scores were significantly higher in group 1 (36.5±19.4) than in group 2 (9.1±12.9, P<0.001). The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001). Notably, none of the patients in group 1 showed grade 0 differentiation, and none of the patients in group 2 showed grade 2 or 3 differentiation. The CIC scores were significantly higher in group 1 (2.12±0.7) than in group 2 (0.57±0.6, P<0.001). CONCLUSION: Ocular surface changes, including squamous metaplasia in the bulbar conjunctiva, can be observed in patients with AS.

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.

Conjunctival Impression Cytology and Dry Eye in Patients With Ulcerative Colitis: A Pilot Study.

PURPOSE: The aim of this study was to compare signs of dry eye between ulcerative colitis (UC) patients and healthy subjects. METHODS: Fifteen patients with UC (group 1) and 15 healthy subjects (group 2) were enrolled in this study. Tear volume measurement, Schirmer-I test with no anesthetic, tear break-up time, and conjunctival impression cytology (CIC) were evaluated in both groups. RESULTS: Patients with UC showed lower tear volumes when compared with healthy subjects (P<0.05). There was a statistically significant difference in distribution of CIC grades between groups 1 and 2 (P<0.05). Tear break-up time and Schirmer-I measurements were significantly lower in group 1 compared with group 2 (P<0.05). CONCLUSIONS: The results of this study indicate that UC is associated with demonstrable disturbances in tear function and conjunctival cytology.

The Effect of Dehydration and Fasting on Corneal Biomechanical Properties and Intraocular Pressure.

PURPOSE: To evaluate the changes in corneal biomechanical properties and intraocular pressure (IOP) during fasting period in healthy subjects. METHODS: Seventy-two eyes of 72 fasting subjects (study group), and 62 eyes of 62 nonfasting subjects (control group) were enrolled in this prospective study undertaken at a single university hospital. All subjects underwent complete ophthalmologic examination including ocular biomechanical evaluation with ocular response analyzer. Ocular response analyzer measurement was performed on the right eyes of the subjects between 5.00 and 6.00 PM after approximately 14 hr of fasting for the study group and after a nonfasting period for the control group. The corneal hysteresis, corneal resistance factor, mean corneal compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg) values were measured with a patented dynamic bidirectional applanation process. RESULTS: Goldmann-correlated IOP and IOPcc measurements in the study group and the control group were found as 13.8±2.8 mm Hg, 14.6±2.6 mm Hg and 16.3±2.2 mm Hg, 15.7±2.4 mm Hg, respectively. There was statistically significant difference within the two groups in IOPg and IOPcc (P<0.001). In addition, corneal hysteresis and corneal resistance factor significantly decreased in study group compared with control group (P<0.001, P=0.012, respectively). CONCLUSION: Prolonged fasting causes a significant decrease in IOPg, IOPcc, corneal hysteresis, and corneal resistance factor in healthy subjects, altering the biomechanical properties of the cornea.

Traumatic luxation of the globe: A 6-year follow-up.

A 25-year-old man was involved in a motor vehicle accident. The left globe was luxated out of orbit with total optic nerve avulsion. The globe was intact without any penetration and put back into the orbit. Although the patient has no light perception, he is grateful for satisfactory cosmetic results with 6-year follow-up.

Effect of mydriasis induced by topical 0.5% tropicamide instillation on the corneal biomechanical properties in healthy individuals measured by ocular response analyzer.

PURPOSE: This observational study aims to investigate the effects of tropicamide (0.5%) 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 38 (21 female and 17 male) healthy individuals, before and after 30 min of 0.5% tropicamide instillation, were performed by using the ORA. RESULTS: The mean CH, CRF, IOPg and IOPcc measurements of the eyes were 10.2 ± 1.9 mmHg, 10.3 ± 2.1 mmHg, 15.7 ± 3.4 mmHg, 16.4 ± 3.3 mmHg pre-tropicamide, and 10.4 ± 1.7 mmHg, 10.3 ± 2.1 mmHg, 15.3 ± 3.4 mmHg, 15.8 ± 2.7 mmHg post-tropicamide, respectively. The differences between the pre- and post-tropicamide measurements of the eyes were insignificant (p = 0.184, p = 0.659, p = 0.294, p = 0.150, respectively; paired t-test). CONCLUSIONS: A tropicamide instillation does not lead to significant changes in the corneal biomechanical properties. Therefore, it can be used safely in disease, i.e. in the diagnosis and follow-up ORA as it does not cause any change.

Efficacy of intralesional bevacizumab administration in primary pterygium: a quantitative analysis.

OBJECTIVE: To analyze the regression of the pterygium tissue quantitatively after intralesional bevacizumab administration in patients with primary pterygium. METHODS: Thirty-three eyes of 33 patients with primary pterygium who underwent intralesional bevacizumab (1.25 mg per 0.05 mL) administration were included in this prospective study. The ocular irritation, best-corrected visual acuity (BCVA), slit-lamp and funduscopic examinations, corneal astigmatism, the horizontal length, and the thickness of the pterygium were assessed before and after 2 months of treatment. To evaluate the corneal astigmatism and the thickness of the pterygium, the Pentacam comprehensive eye scanner (Pentacam CES; Oculus GmbH) was used. RESULTS: After 2 months of bevacizumab administration, the average BCVA was improved (P=0.003). The average ocular irritation score, horizontal length, and the thickness of the pterygium were statistically significantly decreased (P<0.001, P<0.001, P<0.001, respectively). CONCLUSION: After 2 months of intralesional bevacizumab administration, the average amount of decrease in the horizontal length and thickness of the pterygium was 0.6 mm and 37 µm, respectively. Intralesional bevacizumab administration is useful in the management of primary pterygium without having any local or systemic adverse effects; however, repeated administrations are needed to provide clinically more significant results.

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.

A Rare Pediatric Case of Neurobrucellosis With Cerebral Salt Wasting.

The central nervous system involvement is a serious complication of brucellosis, which is known as neurobrucellosis, although rare. Here we report a 14-year-old case who developed neurobrucellosis and presented with cerebral salt wasting. As far as we know, our case is the first pediatric case of cerebral salt wasting caused by neurobrucellosis. Clinical manifestations of our patient have completely improved with treatment for Brucella.

Quantitative assessment of the effect of SARS-CoV-2 on the corneal sub-basal nerve plexus of post-COVID-19 patients using in vivo confocal microscopy.

OBJECTIVES: To investigate whether SARS-CoV-2 causes morphological changes in the corneal sub-basal nerve plexus (CSNP) of post-COVID-19 patients using in vivo confocal microscopy (IVCM). METHODS: A total of 70 participants were included in the study and were divided into three groups. Post-COVID-19 patients with neurological manifestations were considered Group 1 (n = 24), and post-COVID-19 patients without neurological manifestations were considered Group 2 (n = 24). Healthy control participants were considered Group 3 (n = 22). The parameters of the CSNP, including nerve fibre density (NFD), nerve branch density (NBD), and nerve fibre length (NFL), were investigated in all participants using IVCM. Additionally, corneal sensitivity was tested by corneal esthesiometry. RESULTS: The mean NFD, NBD, and NFL values of Group 1 (16.12 ± 4.84 fibre/mm2, 27.97 ± 9.62 branch/mm2, and 11.60 ± 2.89 mm/mm2) were significantly lower than those of Group 2 (19.55 ± 3.01 fibre/mm2, 40.44 ± 7.16 branch/mm2, and 15.92 ± 2.08 mm/mm2) and Group 3 (25.24 ± 3.75 fibre/mm2, 44.61 ± 11.80 branch/mm2, and 17.76 ± 3.32 mm/mm2) (p < 0.05 for all). Except the mean NFD value (p < 0.001), there were no significant differences in terms of the mean NBD and NFL values between Group 2 and Group 3 (p = 0.445, p = 0.085). The value of the mean corneal sensitivity was significantly higher in Group 3 (59.09 ± 1.97 mm) compared to Group 1 (55.21 ± 1.02 mm) and Group 2 (55.28 ± 1.18 mm) (p < 0.001, p < 0.001) but there was no significant difference between Group 1 and Group 2 (p = 1.000). CONCLUSION: In post-COVID-19 patients, the mean parameters of CSNP were lower than in the control group. These differences were more pronounced in patients who had neurological manifestations of COVID-19.

Dry eye disease and ocular surface characteristics in patients with keratoconus.

PURPOSE: The purpose of this study is to investigate the ocular surface alterations in patients with mild or severe keratoconus (KC). METHODS: A total of 80 participants were included in the study. The corneal topography was performed on each participant using Pentacam and the grouping was done accordingly. The patients with Kmax ≥52.0 D (severe KC) were considered Group 1 (n = 28), the patients with Kmax ≥47.2 and <52.0 D (mild KC) were considered Group 2 (n = 30). Healthy control participants with Kmax <47.2 D were considered Group 3 (n = 22). Tear breakup time (TBUT), Schirmer-I test, ocular surface disease index (OSDI) questionnaire, and conjunctival impression cytology (CIC) were evaluated among the groups. RESULTS: The mean values of TBUT and Schirmer-I test were significantly lower (P = 0.012, P = 0.012) and the mean scores of OSDI and CIC were significantly higher (P = 0.006, P < 0.001) in Group 1 and Group 2 than in Group 3. The mean values of TBUT and Schirmer-I test were lower and the mean scores of OSDI and CIC were higher in Group 1 than in Group 2 but the differences were insignificant (P > 0.05 for all). CONCLUSION: These results indicated that the tests associated with dry eye disease are correlated with KC. Tear film alterations and goblet cell loss are higher in severe KC.