Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment / O impacto do descolamento macular seroso na recuperação visual no tratamento de oclusões de veias retinianas

ABSTRACT Purpose: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. Methods: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. Results: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. Conclusions: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

RESUMO Objetivo: Avaliar o efeito do descolamento macular seroso observado durante oclusões de veias retinianas nos resultados do tratamento. Métodos: Um total de 117 olhos de 115 pacientes que foram tratados com injeções intravítreas para edema macular secundário à oclusão de veia retiniana foram revistos retrospectivamente. A acuidade visual, tomografia de coerência óptica e os resultados da angiofluoresceinografia foram avaliados de acordo com a presença ou ausência de descolamento macular seroso. Resultados: No grupo com oclusão de um ramo da veia retiniana, foi detectado um aumento estatisticamente significativo na acuidade visual média em comparação com o valor inicial em cada consulta de acompanhamento do descolamento macular seroso, enquanto que o aumento na acuidade visual média só foi significativo nas consultas aos 3 e 6 meses na presença de descolamento macular seroso. No grupo com oclusão da veia central da retina, houve um aumento na acuidade visual média em comparação com a acuidade inicial em cada consulta na ausência de descolamento macular seroso, enquanto a acuidade visual média diminuiu em comparação com a acuidade inicial em todas as consultas, exceto na consulta aos 3 meses. O defeito da zona elipsoide era mais proeminente na presença de descolamento macular seroso nos olhos com oclusão de um ramo da veia retiniana, enquanto que não havia diferença significativa na zona elipsoide com a presença ou ausência de descolamento macular seroso em olhos com oclusão central da veia retiniana. Conclusões: No grupo com edema macular devido à oclusão de veias retinianas, o aumento médio inicial da acuidade visual observado no primeiro ano foi mantido nos casos sem descolamento macular seroso, mas não naqueles com presença de descolamento macular seroso. O descolamento macular seroso pode ser um fator negativo em olhos com oclusão de veias retinianas.

Novel predictor of pulmonary arterial hypertension: Monocyte to HDL cholesterol ratio.

Monocyte to HDL cholesterol ratio (MHR), lymphocyte to monocyte ratio (LMR), and neutrophil to lymphocyte ratio (NLR) have been proposed as novel systemic inflammatory markers. The aim of this study was to explore the association between MHR, LMR and NLR with pulmonary arterial hypertension (PAH). The study is a single-center, retrospective Cross-sectional study. The study group consisted of 73 patients with PAH and the control group 77 participants without cardiac pathology as determined by echocardiography. On admission, blood sampling to calculate MHR, LMR, NLR, and detailed clinical data were obtained. According to the Pearson test, systolic pulmonary artery pressure (PAP) value Higher MHR, NLR and lower LMR that indicates an enhanced inflammation were significantly increased in patients with PAH when compared with controls. Compared to many other inflammatory markers, these markers are widely available. positively correlated with the MHR and NLR (r:.35, P < .001 and r:.33, P < .001, respectively), but negatively correlated with LMR (r: -.26, P = .001). After multivariate logistic regression analysis, MHR, LMR, and NLR remained as significant predictors of PAH (OR: 2.651, 95% CI: 1.227-5.755, P = .007; OR: 0.647, 95% CI:0.450-0.931, P = .005; OR: 1.350, 95% CI: 1.054-1.650 P = .030, respectively).

A comparison of postoperative complications following cardiac implantable electronic device procedures in patients treated with antithrombotic drugs.

BACKGROUND: The incidence of postoperative complications following cardiac implantable electronic device (CIED) procedures in patients treated with antithrombotic drugs has not been studied sufficiently. Here we present a comparison of complications after CIED implantations. METHODS: Using an observational study design, the study included 1807 patients with a taking antiplatelet drugs (n: 1601), nonvitamin K anticoagulants (NOAC) (n: 136), and warfarin (n: 70) undergoing CIED surgery. Primary endpoint was accepted as cumulative events including composite of clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to device system. Secondary outcomes included each compenent of cumulative events. Multivariable analysis was performed to identify predictors of cumulative events. RESULTS: The overall cumulative event rate was 3.7% (67 of 1807). Cumulative events occured 3.1% (50 of 1601) in the antiplatelet, 5.1% (7 of 136) NOAC, and 14.3% (10 of 70) warfarin groups (p < 0.001). CSH occurred in 2 of 70 patients (2.9%) in the warfarin group, as compared with 5 of 1601 (0.3%) in the antiplatelet group (p: 0.032). However, no significant differences were found between NOAC and warfarin groups in terms of CSH (0.7% vs. 2.9% respectively, p: 0.267). Warfarin treatment was an independent predictor of cumulative events and increased 2.9-fold the risk of cumulative events. Major surgical complications were rare and did not differ significantly between the study groups. CONCLUSIONS: The incidence and severity of complications may be lower in patients treated with periprocedurally antiplatelet or NOAC therapy when compared with warfarin therapy. Further randomized control studies are required to confirm our findings.

Impact of serous macular detachment on visual recovery in retinal vein occlusion treatment.

PURPOSE: The aim of this study was to evaluate the effect of serous macular detachment observed during retinal vein occlusion on treatment results. METHODS: A total of 117 eyes from 115 patients who had been treated with intravitreal injections for macular edema secondary to retinal vein occlusion were retrospectively reviewed. Visual acuity, optical coherence tomography, and fundus fluorescein angiography findings were evaluated according to the status of serous macular detachment. RESULTS: In the branch retinal vein occlusion group, a statistically significant increase was detected in the mean visual acuity compared to the baseline value at each visit in the absence of serous macular detachment, whereas the increase in the mean visual acuity was significant only at the 3- and 6-month visits in the presence of serous macular detachment. In the central retinal vein occlusion group, there was an increase in the mean visual acuity compared to the baseline value at every visit in the absence of serous macular detachment, whereas the mean visual acuity decreased compared to the baseline value at every visit except at the 3-month visit in the presence of serous macular detachment. The ellipsoid zone defect was more prominent in the presence of serous macular detachment in eyes with branch retinal vein occlusion, whereas there was no significant difference in the ellipsoid zone in the absence or presence of serous macular detachment in eyes with central retinal vein occlusion. CONCLUSIONS: In the group with macular edema due to retinal vein occlusion, the initial mean visual acuity increase observed in the first year was maintained in cases without serous macular detachment but not in those with serous macular detachment. Serous macular detachment could be a negative factor in eyes with retinal vein occlusion.

Comparison of the effects of the McGRATH MAC, C-MAC, and Macintosh laryngoscopes on the intraocular pressures of non-ophthalmic patients: A prospective, randomised, clinical trial.

INTRODUCTION: In this prospective, randomised study, we compared the effects of the Macintosh, McGRATH MAC, and C-MAC laryngoscopes on intraocular pressure (IOP) and haemodynamics of non-ophthalmic patients during endotracheal intubation. METHODS: One hundred and twenty adult patients undergoing non-ophthalmic surgeries performed in the supine position under general anaesthesia requiring orotracheal intubation were included in this study. The patients were separated randomly and prospectively into 3 groups: Macintosh group (n = 40), McGRATH MAC group (n = 40), and C-MAC group (n = 40). Mean arterial pressure (MAP), heart rate (HR) and IOP of left and right eye were measured at specified times. RESULTS: There were no significant differences with regard to patients characteristics. After intubation, the HR increased significantly in the Macintosh group when compared to the other groups (p = 0.001) and the MAP increased significantly in the Macintosh group when compared to the McGRATH MAC group (p = 0.001) and the C-MAC group (p < 0.001). The IOP values increased in the Macintosh group when compared to the McGRATH MAC group (p < 0.001) and the C-MAC group (p < 0.001) after intubation. Additionally, there was a significant difference between the McGRATH MAC group and C-MAC group in the IOP values of the eyes after intubation (p < 0.001). According to the evaluation within the groups, there were significant differences in all of the groups at all times when compared with the baseline values (p < 0.001). CONCLUSIONS: In this study, we concluded that the C-MAC VL may be preferable when compared to the Macintosh and McGRATH MAC laryngoscopes for use in ophthalmic patients in whom a rise in the IOP is undesirable.

Monocyte to high-density lipoprotein cholesterol and lymphocyte to monocyte ratios are predictors of in-hospital and long-term mortality in patients with acute coronary syndrome.

OBJECTIVE: We aimed to determine the relationship between LMR and MHR and in-hospital and long-term mortality in patients with ACS. METHODS: We retrospectively collected patients with ACS undergoing coronary angiography between January 2012 and December 2013. RESULTS: In total, 825 patients with a mean age of 62.4 ± 12.9 years (71.3% male) were enrolled in the study. Patients were divided into three tertiles based on MHR levels and LMR levels. In-hospital mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [30 (10.9%) vs 8 (2.9%) and 14 (5.1%); P < .001, P = .009, respectively]. Five-year mortality of the patients was significantly higher amongst patients in the upper MHR tertile when compared with the lower and middle MHR tertile groups [84 (30.5%) vs 48 (17.5%) and 57 (20.7%); P < .001, P = .005, respectively]. In-hospital mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [25 (9.1%) vs 10 (3.6%) and 17 (6.2%); P = .007, P = .130, respectively]. Five -year mortality of the patients was significantly higher amongst patients in the lower LMR tertile when compared with the upper and middle LMR tertile groups [77 (28.0%) vs 47 (17.1%) and 65 (23.6%); P = .001, P = .142, respectively]. CONCLUSION: We have shown that high MHR and low LMR were significant and independent predictors of in-hospital and long-term mortality in patients with ACS.

Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome.

In patients with unstable angina pectoris (UAP) or non-ST elevation myocardial infarction (NSTEMI), long-term mortality remains high despite improvements in the diagnosis and treatment. In this study, we investigated whether serum albumin level is a useful predictor of long-term mortality in patients with UAP/NSTEMI. Consecutive patients (n = 403) who were hospitalized with a diagnosis of UAP/NSTEMI were included in the study. Patients were divided into 2 groups based on the presence of hypoalbuminemia and the relationship between hypoalbuminemia and mortality was analyzed. Hypoalbuminemia was detected in 34% of the patients. The median follow-up period was 35 months (up to 45 months). Long-term mortality rate was 32% in the hypoalbuminemia group and 8.6% in the group with normal serum albumin levels (P < .001). On multivariate analysis, hypoalbuminemia, decreased left ventricular ejection fraction, and increased age were found to be independent predictors of mortality (P < .05). The cutoff value of 3.10 g/dL for serum albumin predicted mortality with a sensitivity of 74% and specificity of 67% (receiver-operating characteristic area under curve: 0.753, 95% CI: 0.685-0.822). All-cause long-term mortality rates were significantly increased in patients with hypoalbuminemia. On-admission albumin level was an independent predictor of mortality in patients with UAP/NSTEMI.

Platelet-to-lymphocyte ratio is a predictor of long-term mortality in patients with acute coronary syndrome.

INTRODUCTION: Atherosclerosis is a chronic inflammatory process and inflammation is an important component of acute coronary syndrome (ACS). Platelet-to-lymphocyte ratio (PLR) is a useful parameter showing the degree of the inflammatory response. AIM: To explore the association between PLR and long-term mortality in patients with ACS. MATERIAL AND METHODS: A total of 538 patients who had a diagnosis of ACS between January 2012 and August 2013 were followed up to 60 months. On admission, blood sampling to calculate PLR and detailed clinical data were obtained. RESULTS: In total, 538 patients with a mean age of 61.5 ±13.1 years (69% male) were enrolled in the study. Median follow-up was 79 months (IQR: 74-83 months). Patients were divided into 3 tertiles based on PLR levels. Five-year mortality of the patients was significantly higher among patients in the upper PLR tertile when compared with the lower and middle PLR tertile groups (55 (30.7%) vs. 27 (15.0%) and 34 (19.0%); p < 0.001, p = 0.010 respectively). In the Cox regression analysis, a high level of PLR was an independent predictor of 5-year mortality (OR = 1.005, 95% CI: 1.001-1.008, p = 0.004). Kaplan-Meier analysis according to the long-term mortality-free survival revealed the higher occurrence of mortality in the third PLR tertile group compared to the first (p < 0.001) and second tertiles (p = 0.009). CONCLUSIONS: PLR, which is an easily calculated and universally available marker, may be useful in long-term risk classification of patients presenting with ACS.

Optical coherence tomographic comparison of naive macular edema due to ischemic and nonischemic retinal vein occlusion.

PURPOSE: To examine the macular microstructure in macular edema (ME) due to retinal vein occlusion (RVO) in terms of ischemic or nonischemic type to determine whether and how ischemia affects macular microstructure. METHODS: This retrospective, nonrandomized study included 75 newly diagnosed RVO cases (group 1: 55 nonischemic RVO cases and group 2: 20 ischemic RVO cases) with evidence of center-involving ME without any treatment. Quantitative measures on spectral-domain optical coherence tomography images were performed. Central subfield thickness (CST) was collected in the central 1 mm from the thickness map. The following items were evaluated in a 3-mm-wide area (perifoveal ETDRS circle) centered on the fovea: disorganization of the retinal inner layers (DRIL), disrupted external limiting membrane (ELM) and ellipsoid zone disruption (EZD). The microstructural changes were measured manually. RESULTS: Baseline characteristics, such as age, sex, study eye, and RVO risk factors, were similar between the groups (P > 0.05). CST was 554.15 ± 191.45 µm for group 1 and 769.90 ± 290.00 µm for group 2 (P: 0.001). The extent of DRIL was 1864.09 ± 941.70 µm and 2447.25 ± 492.59 µm for groups 1 and 2, respectively (P: 0.010). The disrupted ELM length was 1700 (0-3000) µm for group 1 and 2725 (300-3000) µm for group 2 (P: 0.027). The EZD length was 1453.09 ± 870.38 µm for group 1 and 1846.00 ± 926.54 µm for group 2 (P: 0.093). CONCLUSIONS: Ischemic RVOs cause greater macular edema and greater disruption in the macular microstructure compared to nonischemic RVOs, especially in terms of DRIL and ELM.

Estimation of angle kappa and pupil barycentre configuration in myopic tilted disc syndrome.

BACKGROUND: To evaluate the angle kappa and pupil barycentre configuration in patients with myopic tilted disc syndrome (TDS). METHODS: Thirty-five eyes of 35 patients with TDS were included in the study. Thirty-five eyes of 35 age- and sex-matched healthy subjects were enrolled in the control group. All measurements were performed with the Lenstar LS 900. Angle kappa was calculated according to Pythagorean theorem using the x and y co-ordinates of the pupil centre. Pupil dx and pupil dy values (pupil dx: x co-ordinate of pupil centre relative to corneal apex, pupil dy: y co-ordinate of pupil centre relative to corneal apex) were used to evaluate the pupil barycentre configuration. Central corneal thickness, white to white (cornea diameter), pupil diameter, anterior chamber depth, lens thickness, and axial length were also measured. RESULTS: The calculated mean angle kappa distance was 0.27 ± 0.15 mm in the TDS group and 0.29 ± 0.23 mm in the control group (p = 0.42). The mean pupil dx was -0.01 ± 0.24 mm in the TDS group and -0.17 ± 0.14 mm in the control group (p = 0.006). The mean pupil dy was -0.02 ± 0.13 mm in the TDS group and -0.05 ± 0.22 mm in the control group (p = 0.65). CONCLUSIONS: The pupil barycentre in TDS cases was statistically significantly closer to the corneal vertex on the horizontal plane compared to the control group. However, there was no statistically significant differences in terms of angle kappa and pupil dy values between the groups. According to our results, refractive surgery can be performed safely with respect to complications related to decentration of ablation zone and decentration of multifocal intraocular lenses in these groups of patients.

Corneal endothelial changes in long-term cannabinoid users.

PURPOSE: The aim of this study was at evaluating the effects of long-term cannabis use on the corneal endothelial cells with the specular microscopy. METHODS: The study enrolled 28 eyes of 28 patients diagnosed with cannabinoid use disorder. The cannabinoid group was selected among patients who had been using the substance for three days or more per week over the past one year. Thirty-two eyes of 32 age- and sex-matched healthy individuals enrolled as control group in the study. Corneal endothelial cell density (CD), coefficient of variation (CV) and hexagonal cell ratio (HEX) values were analyzed by specular microscopy. RESULTS: The mean CD was 2900 ± 211 cells/mm2 in the cannabinoid group and 3097 ± 214 cells/mm2 in the control group (p < 0.01). There was a significant decrease in cannabinoid group. The mean CV was 29 ± 7 and 27 ± 4 in the cannabinoid and control groups, respectively (p > 0.05). No significant difference was present between the cannabinoid and the control groups in terms of mean CV value. The mean HEX was 52 ± 5% in the cannabinoid group and 53 ± 10% in the control group (p > 0.05). There was not a significant difference between the cannabinoid and the control groups in terms of mean HEX value. CONCLUSION: A significant decrease in CD was found in cannabinoid users compared the control group.

The influence of corneal collagen cross-linking on anterior chamber in keratoconus.

AIMS: This study aimed to evaluate the effect of the corneal changes following corneal cross-linking (CXL) on the anterior chamber in keratoconus patients. MATERIALS AND METHODS: Forty-five eyes of 32 patients who had been diagnosed with progressive keratoconus and had undergone CXL were included in this retrospective study. The thinnest corneal thickness of the progressive keratoconus patients included in the study was >400 µ. The preoperative (T0), postoperative 6th month (T1), and postoperative 1st year (T2) anterior chamber volume (ACV), anterior chamber angle (ACA), and anterior chamber depth (ACD) scheimpflug imaging values were obtained for each eye. RESULTS: The mean T0 ACV value was 182.79 ± 36.68 mmwhile the T1 value was 201.25 ± 41.73 mm3 and the T2 value was 208.40 ± 42.69 mm3 with a statistically significant difference between the periods (P = 0.001). The mean T0 ACA value was 38.64° ±5.85°, increasing to 41.45° ±4.83° in the T1 and 42.10° ± 4.84° in the T2. The T0 value was significantly lower than the post-CXL values (P = 0.003). The mean ACD value was 3.73 ± 0.29 mm at the T0 and 3.82 ± 0.38 mm at the T1 and 3.84 ± 0.36 mm at the T2. The pre-CXL values were significantly lower than the post-CXL values (P = 0.001). CONCLUSIONS: The improvement of corneal parameters by CXL in keratoconus patients can have a positive effect on anterior chamber parameters as well. This effect becomes marked at the postoperative first 6-month evaluation.

Effects of Molsidomine on Retinopathy and Oxidative Stress Induced by Radiotheraphy in Rat Eyes.

PURPOSE: To determine the role of Molsidomine in preventing radiation-induced retinopathy after head and neck region irradiation of rats with a single radiation dose of 15 Gy. MATERIALS AND METHODS: Male Wistar albino rats were randomly grouped into five as follows: (1) control group rats, which were applied through an intraperitoneal (i.p.) vehicle without radiotherapy (RT); (2) RT group rats received a single dose of 15 Gy irradiation and after daily 0.1 ml vehicle i.p. for 5 consecutive days; (3) molsidomine (MOL) group rats were treated for 5 consecutive days by i.p. with 4 mg/kg/day MOL; (4) irradiation plus MOL group (RT+MOL) rats received irradiation and after 10 days single daily i.p. dose of MOL for 5 consecutive days; and (5) MOL+RT group rats were treated for 5 consecutive days by i.p. with MOL before RT. At the end of the work the rats were sacrificed under high-dose anesthesia on the 16th day and then eye tissues were taken for histopathological, immunohistochemical (caspase-3), and biochemical analyses (superoxide dismutase [SOD], glutathione peroxidase [GSH], and malondialdehyde [MDA]). RESULTS: RT significantly decreased both the content of GSH and the activity of SOD, and significantly increased the production of MDA level in the rat eyes. MOL treatment significantly increased the SOD and GSH levels and significantly decreased the MDA production (p < 0.0001). In addition, RT significantly increased the number of ganglion cells (GCs; p = 0.001), whereas especially pretreatment with MOL improved (p = 0.013). RT led to significant retinopathy formation, and MOL therapy protected the retina from radiation-induced retinopathy (p < 0.0001). CONCLUSIONS: We suggest that MOL is a powerful antioxidant and free radical scavenger that prevents the rat eyes from radiation-induced retinopathy and oxidative stress.

Serum GDF-15 level in rheumatoid arthritis: relationship with disease activity and subclinical atherosclerosis.

OBJECTIVES: Growth differentiation factor (GDF)-15 was originally identified as a factor secreted by activated macrophages, and plays an important role in cell growth and differentiation. GDF-15 plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate the serum GDF-15 levels and their relationship with disease-related characteristics in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Forty-six patients diagnosed with RA and 36 demographically matched healthy control subjects participated in this study. GDF-15 levels were measured in blood samples from patients and controls. The disease activity score-28 (DAS28) was used to evaluate the disease activity of RA. The quality of life was evaluated using the disease-specific rheumatoid arthritis quality of life (RAQoL) scale. The health assessment questionnaire (HAQ) was used to evaluate the functional status. The degree of joint damage was assessed according to Larsen's method. Atherosclerosis was assessed by a cardiologist with the help of echocardiography according to the carotid intima media thickness (CIMT) method; vascular stiffness was assessed by using the flow mediated dilatation (FMD) method. RESULTS: Serum GDF-15 levels were significantly higher in RA patients when compared to the control subjects (p< 0.05). RA patients were divided into two groups according to the disease activity; while 26 subjects (57%) were in the active group, 20 patients were in the non-active group (43%). Serum GDF-15 levels were significantly higher in the group that was considered to have an active disease. According to Pearson's correlation, serum GDF-15 levels were positively correlated with erythrocyte sedimentation rate (ESR) levels, morning stiffness, DAS28 score, tender joint count, and CIMT (p<0.05). CONCLUSION: GDF-15 may play a role in the pathway of disease activity, joint involvement, and atherosclerosis in patients with rheumatoid arthritis.

Histopathological and ophthalmoscopic evaluation of apocynin on experimental proliferative vitreoretinopathy in rabbit eyes.

The aim of the current study was to evaluate the effect of apocynin (APO) on the development of proliferative vitreoretinopathy (PVR). New Zealand-type male rabbits were randomly grouped into three as follows: (1) Sham group rabbits which were applied intraperitoneal (i.p.) vehicle without PVR; (2) PVR group rabbits where PVR was created and an i.p. vehicle was administered for 21 successive days; (3) PVR + APO group rabbits where PVR was created and i.p. APO was administered for 21 successive days. Fundus examination was conducted with an indirect ophthalmoscope before starting the experiments and at each visit afterwards. At the end of the work, the rabbits were sacrificed under high-dose anesthesia and then eye tissues were taken for histopathological analyses. In the PVR + APO group, histopathologic and ophthalmoscopic examination revealed significant decrease in PVR formation. As the result, it has been observed that APO at least partially inhibits PVR formation.

The Influence of Corneal Collagen Crosslinking on Conjunctival Flora.

PURPOSE: To investigate the influence of corneal collagen crosslinking (CXL) on conjunctival flora. MATERIALS AND METHODS: Included in this study were 42 patients, all of whom were treated with CXL for progressive keratoconus (KC). Conjunctival swab samples were collected under operating-room conditions immediately before and immediately after the procedure. Samples were quickly immersed in Amies Transport Medium (ATM), transferred to the microbiology laboratory, diluted, and inoculated into three areas each of blood agar, chocolate agar, eosin methylene blue (EMB) agar, and Saboraud-Dextrose agar plates. Inoculated plates were incubated at 35°C for 24-48 h. Preliminary species identification of isolated bacterial colonies was based on catalase and oxidase tests, Gram staining, and colony morphology. Definitive identification of isolates was made with Vitek-II fully automated identification kits. RESULTS: Cultures were positive in 24 (57.1%) preoperative and 10 (23.8%) postoperative samples (p ˂ 0.05). Microorganisms isolated from preoperative conjunctival samples included coagulase-negative Staphylococcus (CNS) spp. in 23 (54.8%) samples, S. aureus in three (7.1%), Moraxella spp. in two (4.8%), Streptococcus spp. in three (7.1%), Corynebacterium spp, in one (2.4%), Micrococcus spp. in one (2.4%), and Candida spp. in one (2.4%). Microorganisms isolated from postoperative conjunctival samples included CNS spp. in nine (21.4%) samples, S. aureus in one (2.4%), Corynebacterium spp. in two (4.8%), and Acinetobacter spp. in one (2.4%). CONCLUSIONS: CXL appears to have a significant impact on conjunctiva flora.

Corneal structure in tilted disc syndrome.

PURPOSE:: To evaluate the central corneal thickness (CCT), corneal volume (CV), and anterior and posterior corneal surfaces using the Scheimpflug imaging system in patients diagnosed with tilted disc syndrome (TDS). METHODS:: The study group (Group 1) and the control group (Group 2) comprised 35 eyes of 35 age-, sex-, and refraction-matched cases. All cases underwent a full ophthalmic examination that included cycloplegic refraction, axial ocular length measurement, and Scheimpflug imaging. RESULTS:: The mean age was 34.68 ± 15.48 years in Group 1 and 34.11 ± 12.01 years in Group 2 (p=0.864). The gender distribution was 18 males and 17 females in Group 1 and 16 males and 19 females in Group 2 (p=0.618). All subjects were Caucasian. The spherical equivalent was 3.62 ± 1.75 D in Group 1 and 3.69 ± 1.51 D in Group 2 (p=0.850). There was no significant difference in age, sex, race, or spherical equivalent between groups. There was no significant difference in mean keratometric value and CV3 (the CV in the central 3 mm) between groups (p=0.232 and 0.172, respectively). There were statistically significant differences in CCT, CV5, and CV7 (CV in the central 5 and 7 mm3, respectively) and total CV between groups (p=0.008, 0.003, 0.023, and 0.019, respectively). The values of all parameters were lower in the study group than in the control group. There was also a statistically significant difference in the anterior elevation parameters of the cornea between groups (p<0.05). The mean values of Group 1 were higher than those of Group 2. There were statistically significant differences in the two parameters referring to the posterior elevation of the cornea between the two groups (p<0.05). CONCLUSION:: The results of this study showed that eyes with TDS have thinner CCT, lower CV, and different anterior corneal curvature than normal eyes.

Corneal structure in tilted disc syndrome / Estrutura da córnea na síndrome de disco inclinado

ABSTRACT Purpose: To evaluate the central corneal thickness (CCT), corneal volume (CV), and anterior and posterior corneal surfaces using the Scheimpflug imaging system in patients diagnosed with tilted disc syndrome (TDS). Methods: The study group (Group 1) and the control group (Group 2) comprised 35 eyes of 35 age-, sex-, and refraction-matched cases. All cases underwent a full ophthalmic examination that included cycloplegic refraction, axial ocular length measurement, and Scheimpflug imaging. Results: The mean age was 34.68 ± 15.48 years in Group 1 and 34.11 ± 12.01 years in Group 2 (p=0.864). The gender distribution was 18 males and 17 females in Group 1 and 16 males and 19 females in Group 2 (p=0.618). All subjects were Caucasian. The spherical equivalent was 3.62 ± 1.75 D in Group 1 and 3.69 ± 1.51 D in Group 2 (p=0.850). There was no significant difference in age, sex, race, or spherical equivalent between groups. There was no significant difference in mean keratometric value and CV3 (the CV in the central 3 mm) between groups (p=0.232 and 0.172, respectively). There were statistically significant differences in CCT, CV5, and CV7 (CV in the central 5 and 7 mm3, respectively) and total CV between groups (p=0.008, 0.003, 0.023, and 0.019, respectively). The values of all parameters were lower in the study group than in the control group. There was also a statistically significant difference in the anterior elevation parameters of the cornea between groups (p<0.05). The mean values of Group 1 were higher than those of Group 2. There were statistically significant differences in the two parameters referring to the posterior elevation of the cornea between the two groups (p<0.05). Conclusion: The results of this study showed that eyes with TDS have thinner CCT, lower CV, and different anterior corneal curvature than normal eyes.

RESUMO Objetivo: Avaliar a espessura central da córnea (CCT), o volume de córnea (CV), e a superfície corneana anterior e posterior utilizando sistema de imagem Scheimpflug em pacientes com diagnóstico de síndrome do disco inclinado (TDS). Métodos: O grupo de estudo (grupo 1) e o grupo controle (grupo 2) consistiu de 35 olhos de 35 pacientes pareados por idade, sexo e refração em cada grupo. Todos os casos foram submetidos a um exame oftalmológico completo incluindo refração sob cicloplegia, medida do comprimento axial ocular e avaliação por Scheimpflug. Resultados: A idade média foi de 34,68 ± 15,48 anos no grupo 1 e 34.11 ± 12,01 anos no grupo 2 (p=0,864). A distribuição por sexo foi de 18 homens e 17 mulheres do grupo 1 e 16 homens e 19 mulheres no grupo 2 (p=0,618). Todos os indivíduos eram caucasianos. O equivalente esférico foi 3,62 ± 1,75 D no Grupo 1 e 3,69 ± 1,51 D no Grupo 2 (p=0,850). Não houve diferença significativa entre os dois grupos para idade, sexo, raça e equivalente esférico. Não houve diferença significativa entre os dois grupos para o valor médio ceratométrico e CV3 (o volume da córnea na central 3 mm) (p=0,232, p=0,172, respectivamente). Houve diferença estatisticamente significativa entre os dois grupos para CCT, CV5, CV7 (volume de córnea na região central 5 e 7 mm, respectivamente) e CV total (p=0,008, p=0,003, p=0,023 e p=0,019, respectivamente). Os valores do grupo de estudo foram menores do que o grupo controle para todos os parâmetros. Houve também diferença estatisticamente significativa entre os dois grupos nos parâmetros elevação anterior da córnea (p<0,05). Os valores médios do grupo 1 foram maiores do que o grupo 2. Não houve diferença entre os dois grupos para os dois parâmetros referentes à elevação posterior da córnea (p<0,05). Conclusões: Nosso estudo mostrou que os olhos com TDS apresentam CCT mais fina, menor volume da córnea e alterações na curvatura corneana anterior quando comparados aos olhos normais.

The utility of the TIMI risk index on admission for predicting angiographic no-reflow after primary percutaneous coronary intervention in patients with STEMI.

BACKGROUND/AIM: The thrombolysis in myocardial infarction (TIMI) risk score (TRS), and the TIMI risk index (TRI) have been reported in coronary artery disease patients. We investigated whether admission TRI is associated with no-reflow (NRF) in patients undergoing primary percutaneous coronary intervention (p-PCI). MATERIALS AND METHODS: ST-segment elevation myocardial infarction (STEMI) patients treated with p-PCI were included in the study. TRI was calculated on admission using specified variables. We defined the angiographic NRF phenomenon as a coronary TIMI flow grade of ≤2 after the vessel was recanalized or a TIMI flow grade of 3 together with a final myocardial blush grade (MBG) of <2 in a manner as described in previous studies. RESULTS: A total of 371 patients (aged 62 ± 14 years; 73/27 men to women ratio) who underwent p-PCI were enrolled in the study. In terms of age, NRF patients were older than reflow patients (P < 0.017 for MBG). Killip class III-IV designations were more common in NRF patients (P = 0.029 for MBG). TRI (P = 0.014 for MBG) values were significantly greater in the NRF group. TRI was an independent predictor of NRF according to MBG flow (P = 0.003, B = -0.035, Exp B = 0966, 95% CI, 0.944-0.988). CONCLUSION: Admission TRI may predict the development of NRF phenomenon after p-PCI in patients with acute STEMI.