Phacoemulsification and Core Vitrectomy in Fuchs' Heterochromic Uveitis.

OBJECTIVE: To evaluate the efficacy of phacoemulsification combined with posterior capsulorhexis, core vitrectomy and ciliary sulcus intraocular lens (IOL) implantation in patients with Fuchs' heterochromic uveitis (FHU). MATERIALS AND METHODS: A total of 18 eyes of 18 patients with FHU underwent cataract surgery were included in the study. 18 eyes with FHU underwent posterior capsulorhexis, core vitrectomy and poly (methyl methacrylate) (PMMA) IOL implantation in the ciliary sulcus. Subjects were chosen for this procedure based on an intraoperative vitreous haziness assessment, performed by indirect ophthalmoscopy. Patients with +2 or more vitreous haziness qualified for this procedure. RESULTS: Of the 83 eyes with FHU that underwent cataract surgery, 18 eyes (21.6%) of 18 patients were employed in the study. There were 11 (61.1%) men and 7 (38.9%) women in the study; ages ranged from 23 to 47, with a mean of 32.06 years. Follow-up ranged from 8 months to 49 months. There were no intraoperative complications except for peripheral iris bleeding in 7 eyes. There was no severe intraocular inflammation in any patient postoperatively. All patients had 0.05 or better logMAR visual acuity after corneal suture removal. Glaucoma developed in 2 patients. For the short term period, the main vision threatening problem was suture-induced astigmatism. CONCLUSION: Cataract surgery combined with posterior capsulorhexis, core vitrectomy and IOL implantation in the ciliary sulcus is safe and leads to good visual outcome due to the removal of the hazy vitreous in patients with FHU.

Measurement of Choroidal Thickness Following Caffeine Intake in Healthy Subjects.

PURPOSE: The aim of this study is to investigate the effect of 200 mg caffeine on subfoveal choroidal thickness (CT) in the macular area as measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in healthy subjects. MATERIALS AND METHODS: Fifty healthy individuals (study group) and 50 healthy individuals (control group) were enrolled in study. In the study group, participants received a 200 mg caffeine capsule and the control group consisted of subjects who received plasebo capsule. The subfoveal CT was measured by EDI-OCT before the caffeine intake and at 30 min, 1 h, 2 h, 3 h, 4 h and 6 h following caffeine intake. RESULTS: SFCT after caffeine intake was significantly decreased at 30 min, 1 h, 2 h, 3 h and 4 h compared to the baseline measurement, while the difference between baseline and 6 h was not statistically significant in the study group. There were no significant differences between the baseline and the other measurement times in the control group (p > 0.05). CONCLUSION: The thinning of CT begins about 30 min after the oral ingestion of 200 mg of caffeine and lasts for about four hours.

The ocular surface side effects of an anti-psychotic drug, clozapine.

PURPOSE: The purpose of this study is to investigate the effects of long-term clozapine usage on tear film stability and corneal topographic parameters. MATERIAL AND METHODS: The study was conducted between March 2014 and November 2014. Thirty patients who were diagnosed of schizophrenia and have been under clozapine treatment for 2.73 ± 0.73 years (range 2-4 years) were involved in this study (group 1). Thirty healthy subjects (group 2) who have statistically similar demographic features compared with the group 1, were involved as a control group. Full ophthalmologic examination with biomicroscopy and indirect ophthalmoscopy was applied. Corneal topographic parameters were measured using the Pentacam HR and Schirmer test was done. Statistical analysis of the subjects was evaluated by using SPSS (for Windows version 16.0; SPSS Inc., Chicago, IL) program. RESULTS: K1 value was measured as 43.39 ± 0.17 D (43-43.50 D) and K2 value was measured as 43.39 ± 0.06 D (43.30-43.50 D) in groups 1 and 2, respectively. In groups 1 and 2, K2 values were noted as 43.86 ± 0.27 D (43.50-44.50 D) and 43.72 ± 0.18 D (43.50-44.00 D), respectively. Central corneal thickness was found to be 523.93 ± 15.66 µm (495-554 µm) and 550.13 ± 1.03 µm (520-580 µm) in groups 1 and 2, respectively. Corneal apex thickness was 525.86 ± 15.75 µm (497-556 µm) in group 1 and 551.60 ± 14.99 µm (521-581 µm) in group 2. The corneal thickness of thinnest location was 520.93 ± 15.60 µm (492-551 µm) and 548.06 ± 15.17 µm (518-578 µm) in groups 1 and 2, respectively. Corneal volume was determined as 58.13 ± 3.46 mm(3) (52-64 mm(3)) in group 1 and 60.73 ± 3.76 mm(3) (54-66 mm(3)) in group 2. The Schirmer test showed thickness of 3.33 ± 0.72 mm (2-4 mm) and 13.60 ± 1.59 mm (11-16 mm) in groups 1 and 2, respectively. The mean fluorescein break-up time was 5.40 ± 1.50 s (3-8 s) and 12.46 ± 1.40 s (10-14 s) in groups 1 and 2, respectively. There was a statistically significant difference in the Schirmer test, fluorescein break-up time, central corneal thickness, corneal apex, and the thinnest corneal location thickness between the two groups. CONCLUSION: Clozapine may induce dry eye syndrome and thus may lead to morphological alterations in corneal parameters through its anticholinergic and antidopaminergic activities. Because of these corneal alterations, one should be aware of evaluating patients having diseases like glaucoma or preoperative selection of corneal refractive surgery candidates.

Evaluation of cardiovascular biomarkers in patients with age-related wet macular degeneration.

AIM: To evaluate levels of homocysteine, asymmetric dimethylarginine (ADMA), and nitric oxide (NO), as well as activity of endothelial NO synthase (eNOS), in patients with age-related macular degeneration (AMD). METHODS: The levels of homocysteine, ADMA, and NO and activity of eNOS in patients who were diagnosed with wet AMD by fundus fluorescein angiography (n=30) were compared to a control group with no retinal pathology (n=30). RESULTS: Levels of homocysteine and ADMA were found to be significantly higher in the wet AMD group than in the control group (P<0.001), whereas NO levels and eNOS activity were higher in the control group (P<0.001). In the wet AMD group, we detected a 2.64- and 0.33-fold increase in the levels of ADMA and homocysteine, respectively, and a 0.49- and 2.41-fold decrease in the eNOS activity and NO level, respectively. CONCLUSION: Elevated levels of homocysteine and ADMA were observed in patients with wet AMD. Increased ADMA may be responsible for the diminished eNOS activity found in these patients, which in turn contributes to the decrease in NO levels, which likely plays a role in the pathogenesis of AMD.

Nd: YAG laser posterior capsulotomy rates in myopic eyes after implantation of capsular tension ring.

BACKGROUND: The aim f this study was to evaluate the effect of capsular tension ring implantation during cataract surgery on the incidence of neodymium: YAG (Nd: YAG) laser posterior capsulotomy in myopic (axial length [AL] ≥25.00 mm) eyes. MATERIAL/METHODS In this retrospective study, the records of the cases of 117 myopic patients who underwent cataract surgery between January 2004 and January 2011 were reviewed. A total of 153 eyes with an axial length of 25 mm or higher were included in the study with consideration of exclusion criteria mentioned below. Eyes were grouped by presence or lack of capsular tension ring (CTR+ and CTR-, respectively). RESULTS: The study included 153 eyes from 107 myopic patients. Hydrophilic acrylic IOL and capsular tension ring (CTR) were implanted in 78 eyes (CTR+ group), and 75 eyes received only the hydrophilic acrylic IOL (CTR- group). Six eyes (7.6%) in CTR+ and 16 eyes (21.3%) in CTR- required Nd: YAG laser capsulotomy within 7 years. The difference between the 2 groups was statistically significant (p=0.021). CONCLUSIONS: Because CTRs significantly decrease subsequent need for Nd: YAG laser posterior capsulotomy in myopic patients, are very inexpensive, and provide other benefits, our data suggest that the use of CTRs in myopic eyes undergoing cataract surgery with an hydrophilic acrylic IOL implantation is advantageous and should be standard practice.

Topical anesthesia for cataract surgery: the patients' perspective.

Purpose. To evaluate the analgesic efficacy of 0.5% propacaine hydrochloride as topical anesthesia during phacoemulsification surgery. Methods. Intraoperative pain intensity was assessed using a 5-category verbal rating scale during each of three surgical stages. Pain scores from each surgical stage and total pain scores were compared for the factors of patient age, gender, cataract laterality, and type. Results. In comparison of cataract type subgroups, the mean total pain scores and mean stage 2 pain scores in both white mature cataract (WMC) and corticonuclear plus posterior subcapsular cataract (CN + PSC) groups were significantly higher than in the PSC-only (PSC) group (P < 0.05). Conclusion. Phacoemulsification with topical anesthesia is not a completely painless procedure. Pain intensity varies with cataract type and stage of surgery.

Traumatic wound dehiscence after penetrating keratoplasty.

BACKGROUND: We aimed to evaluate the risk factors, clinical features and outcomes of surgery for traumatic wound dehiscence (TWD) following penetrating keratoplasty (PK). METHODS: Twenty-six patients with TWD following PK were evaluated retrospectively in terms of factors related to the trauma, types of reconstructive surgery, final graft clarity, and visual acuity. RESULTS: There were 26 patients with a mean age of 40.7±19.6 years. In 12 (46.1%) patients, the better eye was affected by the trauma. The most frequent type of trauma was blunt trauma by various objects (9). In all cases, the dehiscence was at the graft host junction. The mean extent of detachment was 135.4°±57.6°. Crystalline or intraocular lens damage was present in 42.3% of cases. Median follow-up time after the reconstructive surgery was 36 months. The graft remained clear in 13 (50%) patients, whereas graft insufficiency/graft rejection developed in 13 (50%) patients. Final visual acuity was over 20/200 in 13 (50%) patients. CONCLUSION: TWD may occur at any time after PK, most frequently within the first postoperative year. Low visual acuity in the other eye seems to be a major risk factor. In patients without major complications such as posterior segment damage, visual outcomes and graft survival can be favorable.

Retinal nerve fibre layer, ganglion cell layer and choroid thinning in migraine with aura.

BACKGROUND: The aim of this study was to investigate the thickness of the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and choroid thickness (CT) in patients who have migraines, with and without aura, using spectral optical coherence tomography (OCT). METHODS: Forty-five patients who had migraines without aura (Group 1), 45 patients who had migraines with aura (Group 2), and 30 healthy participants (control group) were included in the study. Spectral OCT was used to measure the RNFL, GCL and CT values for all patients. RESULTS: The mean age of Group 1, Group 2, and the control group was 34.6 ± 4.3, 32.8 ± 4.9, and 31.8 ± 4.6 years, respectively. The mean attack frequency was 3.6/month in Group 1 and 3.7/month in Group 2. The mean age among the groups (p = 0.27) and number of attacks in migraine patients (p = 0.73) were not significantly different. There was significant thinning in the RNFL and GCL in Group 2 (p < 0.05, p < 0.001 respectively), while there were no significant differences in RNFL and GCL measurements between Group 1 and the control group (p > 0.05). All groups were significantly different from one another with respect to CT, with the most thinning observed in Group 2 (p < 0.001). When all migraine patients (without grouping) were compared with the control group, there were significant differences on all parameters: RNFL thickness, GCC thickness and CT (p < 0.05). CONCLUSIONS: RNFL and GCL were significantly thinner in the migraine patients with aura as compared with both the migraine patients without aura and the control subjects. In migraine, both with aura and without aura, patients' choroid thinning should be considered when evaluating ophthalmological findings.

Occupational exposure to lead decreases macular, choroidal, and retinal nerve fiber layer thickness in industrial battery workers.

PURPOSE: To evaluate the toxic effects of chronic lead (Pb) exposure on retinal nerve fiber layer thickness (RNFLT), macular thickness (MT) and choroidal thickness (CT) in battery industry workers. MATERIALS AND METHODS: Male factory workers (n = 50) and healthy non-employees (n = 20) participated in the study. Group 1 (n = 22) comprised lead workers; Group 2 (n = 16), box makers; Group 3 (n = 12), assistant personnel; and Group 4 (n = 20), healthy non-employees. All participants were given Best-Corrected Visual Acuity (BCVA) tests, full ophthalmologic examinations, and Spectral Domain Optical Coherence Tomography (SD-OCT) of the optic nerve head, RNFL, macula, and choroid. Blood lead levels (BLL) in venous blood samples were determined. The duration of exposure to lead varied, and is expressed in months. RESULTS: Average (mean ± SD) ages of participants were 27.55 ± 4.00, 28.69 ± 3.48, 32.00 ± 3.38, and 29.85 ± 5.48 yrs (Groups 1-4, respectively). BLL were 46.2 ± 2.32, 29.31 ± 3.30, 16.9 ± 1.9, and 2.85 ± 0.98 µg/dL (Groups 1-4, respectively). Durations of exposure to lead were 43.86 ± 10.81, 42.81 ± 4.86, and 49.42 ± 6.14 mo (Groups 1-3, respectively). OCT averages for RNFL were 101.68 ± 5.32, 119.50 ± 13.47, 127.67 ± 8.92, and 130.9 ± 6.63 µm (Groups 1-4, respectively). Although RNFLTs of Group 1 were significantly less than those of for Groups 2-4, and, RNFLTs of Groups 2 and 3 were significantly less than that of Group 4, there were no significant differences between Group 2 and 3. MTs were 94.50 ± 6.78, 105.63 ± 5.43, 111.50 ± 6.74 and 147.95 ± 6.67 µm, (Groups 1-4, respectively). CTs were 176.41 ± 15.39, 222.19 ± 17.79, 239.17 ± 15.64, and 251.50 ± 10.98 µm (Groups 1-4, respectively). Both MTs and CTs displayed significant differences among the four groups. CONCLUSIONS: Ocular changes in individuals who are chronically exposed to lead include decrease in RNFT, MT, and CT, and thus these parameters should be evaluated during ophthalmologic examination of individuals working in lead-based industries.

Peripapillary Retinal Nerve Fibre Layer Thinning Secondary to Nutritional Folic Acid Deficiency.

Folic acid has a fundamental role in central nervous system (CNS) function at all ages, especially the methionine synthase-mediated conversion of homocysteine to methionine, which is essential for nucleotide synthesis and genomic and non-genomic methylation. Folic acid and vitamin B12 may have roles in the prevention of disorders of CNS development, mood disorders, and dementias, including Alzheimer disease and vascular dementia in elderly people. The authors examined the peripapillary retinal nerve fibre layer thickness (RNFLT) in patients with nutritional folic acid deficiency using optical coherence tomography (OCT). Patients were divided into two groups according to blood folic acid levels: blood folic acid <7 nmol/L as Group 1 and >7 nmol/L as Group 2. Peripapillary RNFL measurements were performed. There were significant positive correlations between serum folate levels and RNFLT in all quadrants (p < 0.05), except for the temportal quadrant (p = 0.41).