The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis.

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population.

PURPOSE: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. METHODS: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. RESULTS: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. CONCLUSIONS: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

Macula pigment optical densitometry changes in hydroxychloroquine use.

PURPOSE: To investigate the association between hydroxychloroquine (HCQ) use and macular pigment optic densitometry (MPOD) abnormalities. MATERIALS AND METHODS: Fifty patients that have been receiving HCQ treatment and forty-eight control subjects were randomly selected from patients with no visual impairment with similar age and gender. All participants underwent detailed ophthalmologic examination including fundus photography, fundus autofluorescence, optic coherence tomography, and visual field analysis. Macular pigment optical density (MPOD) was measured by fundus reflectometry using one-wavelength reflection method. Patients with ongoing HCQ treatment formed the HCQ group and healthy subjects formed the control group. RESULTS: Mean age was 50.9 ± 7.9 and 47.9 ± 9.4 years in the HCQ and controls groups respectively (p = 0.098) Between the groups, there is no significant difference in central foveal thickness and mean deviation and pattern standard deviation in the visual field analysis. Parafoveal hyper fluorescence lesions were detected in 5 (%10) patients. Choroidal thickness was significantly decreased in the HCQ group (p = 0.001). Maximum and mean MPOD outcomes were significantly lower in the HCQ group (p = 0.005, p = 0.003, respectively). Between the groups, there was no difference in mean MPOD volume and MPOD area. CONCLUSIONS: Patients with HCQ use have reduced MPOD. Further studies are required investigating the sensitivity and specificity of MPOD in detecting initial retinal changes in patients with HCQ use.

Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients.

PURPOSE: To use optic coherence tomography (OCT) to evaluate idiopathic intracranial hypertension (IIH) patients with subclinical segmental optic atrophy despite being under apparently effective treatment. METHODS: IIH patients underwent an OCT examination including the peripapillary retina never fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, focal loss volume (FLV) and global loss volume (GLV) of the GCC, and total macular thickness measurements at presentation and at 3, 6, 9, and 12 months after the diagnosis. The obtained data were compared with healthy subjects. Subjects with and without subclinical segmental atrophy at the 12th month were compared according to the demographics, clinical findings, and the OCT parameters recorded at the beginning of the disease. RESULTS: Both eyes of 56 patients with papilledema due to IIH and 50 age- and sex-matched control subjects were included in this prospective case-control study. Regression of papilledema with regional axon loss on the peripapillary RNFL thickness map was found in 37 (33%) eyes in the IIH group. IIH patients with segmental atrophy had the following characteristics when compared to those without segmental atrophy at the beginning of the disease: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, thinner GCC layer, greater FLV and GLV loss, and severe visual field loss. CONCLUSIONS: Axonal loss occurred in the patients despite apparent treatment. It would be appropriate to follow-up with aggressive medical treatment those patients who present with the following characteristics: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, and thinner GCC.

The effects of adjuvant hormonotherapy on tear functions in patients with breast cancer.

PURPOSE: Aromatase inhibitors (anastrozole, letrozole) and selective estrogen receptor modulators (tamoxifen) are widely used as adjuvant hormonal therapy in women with hormone receptor-positive breast cancer. We aimed to evaluate the effects of oral adjuvant hormonotherapy on tear functions in patients with breast cancer. METHODS: In this case-control study, we enrolled eligible patients with breast cancer who were receiving regular medical selective estrogen receptor modulator (tamoxifen, n:50), aromatase inhibitors (anastrozole, letrozole, n:50) and gender-matched healthy controls (n:50). Tear functions were measured and compared by the Schirmer test, fluorescein breakup time, corneal staining evaluated by Oxford grading scale and Ocular Surface Disease Index scores. RESULTS: Mean age was 49.95 (± 9.2), 51.52 (± 7.2) and 51.91 (± 10.3) in tamoxifen, aromatase inhibitors groups and controls (p = 0.426). Mean duration of BC diagnosis (p = 0.536) and drug use (p = 0.417) was not significant between two groups. Ocular Surface Disease Index scores were lower (p < 0.001), and fluorescein breakup time measurements were higher (p < 0.001) in controls. Schirmer test scores were higher in controls than aromatase inhibitors group (p < 0.001). According to the scores of all measurements, the differences between aromatase inhibitors and tamoxifen groups were statistically significant (p < 0.001). CONCLUSIONS: Our results demonstrated a high difference in all parameters in patients receiving aromatase inhibitors compared to tamoxifen group and controls. Aromatase inhibitors, which reduce estrogen levels in the blood, might affect the tear functions more than tamoxifen, which affects as antiestrogenic on estrogen receptors.

Unilateral Painful Red Eye with Corneal Cysts Assessed with Corneal Confocal Microscopy: A Case Mimicking Acanthamoeba Keratitis.

A 28-year-old woman with a history of trauma to her right eye 2 months prior reported experiencing a stinging sensation and tearing in the morning since the injury occurred and the need to occasionally use an eye patch. Three days before presentation she had been prescribed a therapeutic contact lens (CL) with the diagnosis of a corneal epithelial defect. She described significant pain despite the CL. There was a corneal lesion with haze at the base surrounded by corneal edema. Corneal confocal images revealed hyperreflective cystic lesions that suggested Acanthamoeba keratitis (AK). However, the lesion healed within 10 days and the results of cultures taken before the initiation of treatment proved to be negative. The history of trauma and CL wear, the presence of severe pain, corneal findings, and the confocal microscopy detection of cysts led to a suspicion of AK in a differential diagnosis, but the final diagnosis was recurrent epithelial erosion based on the negative culture results, quick response to treatment, and the possibility of similar confocal findings in a healing epithelium. Since AK may cause loss of vision, suspicion should require that samples be obtained for microbiological study and close follow-up of the clinical course until a final diagnosis can be achieved.

Evaluation of optic nerve head changes with optic coherence tomography in patients with idiopathic intracranial hypertension.

In the case of mild papilledema, fundoscopy findings may sometimes be insufficient, leading to false and misleading indices in the diagnosis of early-stage idiopathic intracranial hypertension (IIH). This study aims to evaluate these patients through optic coherence tomography (OCT). The study included 54 individuals diagnosed with IIH and 48 healthy individuals in the control group. All patients underwent neurological and ophthalmologic examinations. Opening pressure values of patients' cerebrospinal fluid (CSF) were recorded. We measured the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex, cup volume, and the optical disc area, as well as the neuroretinal rim in both groups. A total of 108 eyes from the patient group and 96 eyes from the control group were evaluated. It was found that the mean value of the RNFL thickness of the IIH patients was greater than the control group in the following eight segments: superior nasal, superior temporal, inferior nasal, inferior temporal, nasal superior, nasal inferior, temporal superior, and temporal inferior (p < 0.01 for all). In contrast to the control group, the disc and rim area values of the patient group were higher (p < 0.01), while the cup volume was smaller (p < 0.01) than in the control group. In the patient group, a positive correlation was observed between the papilledema grade and the RNFL thickness (r = 0.64, p < 0.01), CSF opening pressure (r = 0.59, p < 0.01), disc area (r = 0.68, p < 0.01), and rim area (r = 0.70, p < 0.01). Furthermore, RNFL thickness, CSF opening pressure (r = 0.61, p < 0.01), disc area (r = 0.71, p < 0.01), and rim area (r = 0.71, p < 0.01) values were determined to be positively correlated to each other. OCT is believed to contribute to the diagnosis of IIH, by providing reliable data on optical cup volume, optical disc and rim area, and a greater RNFL thickness.

Idiopathic intracranial hypertension without headache: A case report and literature review.

This study reports the case of a 23-year-old man with idiopathic intracranial hypertension (IIH) who presented with blurred vision and diplopia, without accompanying headache. Although headache is the most common symptom associated with IIH, occasionally, it may not be observed clinically. This situation is more frequently observed in males, young adults, children, and in patients with low body mass index. This case highlights a crucial aspect; patients who present with serious visual symptoms without headache must be treated aggressively because vision loss will develop rapidly.

Comparison of Intravitreal Bevacizumab, Intravitreal Ranibizumab and Laser Photocoagulation for Treatment of Type 1 Retinopathy of Prematurity in Turkish Preterm Children.

PURPOSE: To evaluate effectiveness of treatment modalities, major complications and refractive errors in children who were treated with intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP). METHODS: Premature infants who underwent IVB monotherapy (Group 1), IVR monotherapy (Group 2) or LP (Group 3) for type 1 ROP and infants with spontaneously regressed ROP (Group 4) were included for the study. Major complications, recurrence rate, recurrence time, total retinal vascularization time and refractive errors at 18 months of corrected age (CA) were determined. RESULTS: Groups 1, 2, 3 and 4 included 24 eyes of 12 patients, 12 eyes of six patients, 72 eyes of 36 patients and 148 eyes of 74 patients, respectively. Recurrence of the disease occurred in two eyes of one patient in Group 1 at 52 weeks of postmenstrual age (PMA) and two eyes of one patient at 48 weeks of PMA in Group 2. In Group 3, disease did not regress after the first treatment in 10 eyes of five patients. The mean vascularization time in Group 1 was 73 ± 10.1 weeks of PMA and 61.8 ± 6.6 weeks of PMA in Group 2 (p = 0.027). Macular ectopia was seen in two eyes of one patient and exudative retinal detachment (ERD) occurred in two eyes of one patient in Group 3. Mean spherical equivalent was 1.49 ± 3.04 diopters (D) in Group 1, -1.79 ± 2.87D in Group 2, -1.27 ± 2.8 D in Group 3 and 1.52 ± 1.07 D in Group 4 at 18 months of CA. There was no significant difference in astigmatism values in all groups. CONCLUSION: IVB, IVR and LP are options that can successfully treat ROP. Myopia was observed to be the main refractive error in all treatment groups. Vascularization of the retina was completed later in the IVB group than in the IVR group.

The Effect of Demodex Infestation on Blepharitis and the Ocular Symptoms.

OBJECTIVE: This study aimed to determine the frequency of Demodex infestation of eyelashes in patients with and without blepharitis and to determine the effects of Demodex infestation on blepharitis and the ocular symptoms. METHODS: The study included patients with chronic mixed (anterior + posterior) blepharitis who presented to our clinic. Patients with refractive error and no ocular disease were enrolled as the control group. From each participant, a total of 4 eyelashes were removed and were then examined under a light microscope for Demodex infestation. Symptoms, fluorescein tear breakup time, and ocular surface staining pattern were recorded. RESULTS: The prevalence of Demodex infection in the blepharitis group was 67.2%, versus 54.9% in the control group (P=0.18). The incidence of itching in the blepharitis group was significantly higher in the Demodex (+) patients than in the Demodex (-) patients (P<0.001). Fluorescein tear breakup time in the Demodex (+) patients was significantly shorter than in the Demodex (-) patients (P<0.001). There was not a significant difference in the fluorescein staining pattern between the 2 groups (P=0.57). The incidence of advanced stage blepharitis was significantly higher among the Demodex (+) patients (P=0.007). The incidence of cylindrical eyelash dandruff in the blepharitis group was significantly higher in the Demodex (+) patients (P<0.001). There was a significant difference in meibomian gland dysfunction between the 2 groups (P=0.039). CONCLUSION: Demodex infestation must be investigated in patients with advanced stage blepharitis, itching, and shorter than normal fluorescein tear breakup time.

Serum insulin-like growth factor-1 levels in patients with pseudoexfoliation syndrome and glaucoma.

Insulin-like growth factor-1 (IGF-1) is altered in several neurodegenerative diseases, the association between serum IGF-1 levels and glaucoma has not been evaluated. This study was designed to evaluate whether serum IGF-1 levels are different in patients with Pseudoexfoliation (PEX) with or without glaucoma. The study was conducted with 110 participants aged 65 years or older who were divided into three groups: group 1, patients with PEX syndrome; group 2, patients with PEX glaucoma; and group 3, participants without PEX or glaucoma. All participants underwent full ophthalmological examination and a detailed medical history was recorded. Patients with known neurodegenerative diseases other than PEX glaucoma were excluded. Serum IGF-1 levels were measured by automated chemiluminescent assay. Groups 1, 2, and 3 included 35, 34, and 41 patients, respectively; there were no differences regarding age, gender, or systemic disease status. There were also no statistically significant differences between the groups in terms of IGF-1 levels, which were 91.7 ± 39.1, 101.1 ± 40.2, and 107.2 ± 43.8 ng/ml for groups 1, 2, and 3, respectively (p = 0.276). Serum IGF-1 levels were similar by gender, the presence of systemic disease, status of diabetes mellitus, and laterality of the PEX material. There was no correlation between the cup-to-disk ratios and IGF-1 levels (r = -0.214, p = 0.223). IGF-1 levels in the circulation did not differ in the presence of PEX syndrome with or without glaucoma. This may indicate that the neurodegenerative process is local rather than systemic.

The Acute Effect of Hemodialysis on Choroidal Thickness.

Objective. To determine the effect of hemodialysis (HD) on choroidal thickness (CT). Methods. The right eyes of 41 patients with end-stage renal disease (ESRD) undergoing HD were included. All patients underwent an ophthalmic examination, including CT measurement via optical coherence tomography, intraocular pressure (IOP), blood pressure, and body weight measurement immediately before and after a HD session. Results. Mean subfoveal choroidal thickness (SFCT) after HD decreased significantly from 254.59 ± 84.66 µm to 229.34 ± 77.79 µm (p < 0.001). CT at the temporal and nasal regions also decreased significantly after HD (both p < 0.001). IOP changes after HD were insignificant (p = 0.958). CT difference was insignificant in patients with diabetes mellitus (DM) and without DM before and after HD, respectively (p = 0.285 and p = 0.707). Stepwise multivariate linear regression analysis showed that diastolic blood pressure was the best fitted factor to explain the changes in CT (r = 0.327 and p = 0.040). Conclusion. CT was decreased in the patients with ESRD following a HD session. This study suggested that the changes in CT may be related to the changes in systemic blood pressure.

Vitreous vascular endothelial growth factor concentrations in proliferative diabetic retinopathy versus proliferative vitreoretinopathy.

PURPOSE: To assess vitreous vascular endothelial growth factor (VEGF) concentrations in proliferative diabetic retinopathy (PDR) in comparison to proliferative vitreoretinopathy (PVR). PATIENTS AND METHODS: Vitreous samples were collected from 69 eyes of 69 patients with traumatic lens dislocation (n = 10), grade B PVR with rhegmatogenous retinal detachment (n = 13), grade C PVR with rhegmatogenous retinal detachment (n = 14), PDR with vitreous hemorrhage (n = 18), and PDR with vitreous hemorrhage and tractional retinal detachment (n = 14). Vitreous fluid samples were obtained at vitrectomy, and the levels of VEGF were measured by enzyme-linked immunosorbent assay. RESULTS: The mean vitreous level of VEGF was 15.14 ± 5.22 pg/ml in eyes with grade B PVR, 99.15 ± 38.58 pg/ml in eyes with grade C PVR, 4,534.01 ± 1,193.28 pg/ml in eyes with vitreous hemorrhage secondary to PDR, 5,157.29 ± 969.44 pg/ml in eyes with vitreous hemorrhage and tractional retinal detachment secondary to PDR, and 16.19 ± 5.76 pg/ml in eyes of the control group with traumatic lens dislocation. Vitreous VEGF concentrations were significantly higher in the patients with grade C PVR, PDR with vitreous hemorrhage and PDR with vitreous hemorrhage and tractional retinal detachment in comparison to the control patients (p < 0.05). A significant alteration was not observed in patients with grade B PVR (p = 0.55). CONCLUSIONS: Vitreous VEGF concentrations are increased in PDR and grade C PVR. The high VEGF concentrations could suggest a possible effect of VEGF on advanced PVR.