In Vivo Confocal Microscopy Findings After Anterior Stromal Puncture in the Treatment of Recurrent Corneal Erosion Syndrome.

Objectives: The objectives of the study are to show up the healing processes after anterior stromal puncture (ASP) in the cornea using in vivo confocal microscopy (IVCM) and to investigate the efficacy of ASP in the treatment of recurrent corneal erosion (RCE). Methods: This is a prospective, non-randomized, consecutive series. Twenty-three eyes of 19 patients diagnosed with RCE were evaluated between March 2020 and January 2022. Outcome measures included age, sex, laterality, etiology of RCE, duration and recurrence of symptoms, additional treatments required, and complications. IVCM was performed on the same day, at 1st week, 1st, and 6th month. Results: Mean age was 41.5±11.3 years, 63.2% of patients were female and 65.2% of eyes had unilateral involvement. Corneal trauma (56.5%) was the most common cause. Mean follow-up was 21.1 months (range 8-33). At the final follow-up, 69.5% of eyes were symptom free, 17.4% required a second ASP, and 13% needed a third ASP. At the 1st week, the epithelium became intact. An increase in activated keratocytes and dendritic cells (DCs) with beading of nerve fibers was observed. At 1st month, DCs and activated keratocytes were still present. At the 6th month, a scar was left. The superficial and basal epithelial cell formation and subbasal corneal nerve plexus returned to normal. Conclusion: IVCM has a superiority in visualizing cornea at cellular level. After ASP which is a safe, practical, and cost-effective treatment option in paracentral or peripherally located RCE, IVCM may help the surgeon to better observe and understand the post-healing processes and explain the recurrences.

Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes.

PURPOSE: Postoperative refraction in modern mi-croincision cataract surgery gained extra importance in patients with the previous laser-assisted in situ keratomileusis (LASIK) surgery. The surgically induced astigmatic changes in those eyes may differ not only in magnitude but also in direction compared to virgin corneas. This study aimed to compare the surgically induced astigmatic changes after microscopic cataract surgery between post-LASIK corneas and virgin eyes. METHODS: Cases that underwent microincision cataract surgery in eyes with and without previous LASIK surgery were reviewed. The demographics, the axial length at cataract surgery, the central corneal thickness, spheric and cylindric values, keratometry readings, and postoperative posterior corneal astigmatism were retrospectively evaluated. A modified Alpins method was used for astigmatic vector analysis, and baseline astigmatism, surgically induced astigmatism, difference vector, flattening effect, and torque were assessed. RESULTS: A total of 42 eyes from 24 subjects was evaluated. Group I consisted of 14 eyes with the previous LASIK, and Group II included 28 eyes without any refractive surgery. Preoperative mean central corneal thickness in Group I was significantly thinner (p=0.012). There was no significant difference in baseline astigmatism between the groups regarding magnitude and power vectors. After microincision cataract surgery, there were no significant differences in mean spheric and cylindric values and mean keratometry readings (all p>0.05). However, surgically induced astigmatism and difference vector were significantly higher on J45 vector component in post-LASIK eyes and microincision cataract surgery steepening effect on post-LASIK corneas was significantly higher than those in virgin eyes (p=0.001, p=0.002 and p=0.018, respectively). CONCLUSIONS: Cataract surgery has steepened the corneas in both groups with a significantly higher steepening effect in post-LASIK eyes. Certainly, corneal topography cataract surgery is particularly helpful to provide more precise surgically induced astigmatism interpretations.

Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes / Comparação de alterações astigmáticas induzidas cirurgicamente após cirurgia de catarata em córneas ceratomileusis in situ pós-Laser versus olhos virgens

ABSTRACT Purpose: Postoperative refraction in modern mi­croincision cataract surgery gained extra importance in patients with the previous laser-assisted in situ keratomileusis (LASIK) surgery. The surgically induced astigmatic changes in those eyes may differ not only in magnitude but also in direction compared to virgin corneas. This study aimed to compare the surgically induced astigmatic changes after microscopic cataract surgery between post-LASIK corneas and virgin eyes. Methods: Cases that underwent microincision cataract surgery in eyes with and without previous LASIK surgery were reviewed. The demographics, the axial length at cataract surgery, the central corneal thickness, spheric and cylindric values, keratometry readings, and postoperative posterior corneal astigmatism were retrospectively evaluated. A modified Alpins method was used for astigmatic vector analysis, and baseline astigmatism, surgically induced astigmatism, difference vector, flattening effect, and torque were assessed. Results: A total of 42 eyes from 24 subjects was evaluated. Group I consisted of 14 eyes with the previous LASIK, and Group II included 28 eyes without any refractive surgery. Preoperative mean central corneal thickness in Group I was significantly thinner (p=0.012). There was no significant difference in baseline astigmatism between the groups regarding magnitude and power vectors. After microincision cataract surgery, there were no significant differences in mean spheric and cylindric values and mean keratometry readings (all p>0.05). However, surgically induced astigmatism and difference vector were significantly higher on J45 vector component in post-LASIK eyes and microincision cataract surgery steepening effect on post-LASIK corneas was significantly higher than those in virgin eyes (p=0.001, p=0.002 and p=0.018, respectively). Conclusions: Cataract surgery has steepened the corneas in both groups with a significantly higher steepening effect in post-LASIK eyes. Certainly, corneal topography cataract surgery is particularly helpful to provide more precise surgically induced astigmatism interpretations.

RESUMO Objetivo: A refração pós-operatória na cirurgia mo­derna de catarata por microincisão ganha ainda mais importância em pacientes com cirurgia prévia de ceratomileuse in situ assistida por laser (LASIK). As alterações astigmáticas induzidas cirurgicamente nesses olhos podem diferir não apenas em magnitude, mas também em direção em comparação com córneas virgens. O objetivo deste estudo foi comparar as alterações astigmáticas induzidas cirurgicamente após cirurgia de catarata por microincisão entre córneas pós-LASIK e olhos virgens. Métodos: Foi revisada uma série de casos de cirurgia de catarata por microincisão em olhos com e sem cirurgia LASIK anterior. Os dados demográficos, o comprimento axial no momento da cirurgia de catarata, a espessura central da córnea, os valores esféricos e cilíndricos, as leituras da ceratometria e o astigmatismo corneano posterior pós-operatório foram avaliados retrospectivamente. O método Alpins modificado foi usado para análise vetorial astigmática e foram avaliados o astigmatismo basal, o astigmatismo induzido cirurgicamente, o vetor de diferença, o efeito de achatamento e o torque. Resultados: Ao todo, 42 olhos de 24 indivíduos foram avaliados. O Grupo I consistiu em 14 olhos com LASIK prévio; o Grupo II incluiu 28 olhos sem qualquer cirurgia refrativa. A média da espessura corneana central pré-operatória no Grupo I foi significativamente mais fina (p=0,012). Não houve diferença significativa no astigmatismo basal entre os grupos em termos de magnitude e vetores de potência. Após a cirurgia de catarata por microincisão, não houve diferenças significativas nos valores médios esféricos, cilíndricos e leituras médias de ceratometria (todos com p>0,05). No entanto, o astigmatismo induzido cirurgicamente e o vetor de diferença foram significativamente maiores no componente do vetor J45 em olhos pós-LASIK, e o efeito de aumento da inclinação pela cirurgia de catarata por microincisão nas córneas pós-LASIK foi significativo em comparação com olhos virgens (p=0,001, p=0,002 e p=0,018, respectivamente). Conclusões: A cirurgia de catarata aumentou a inclinação das córneas em ambos os grupos, sendo esse aumento significativamente maior nos olhos pós-LASIK. Certamente, a topografia da córnea antes da cirurgia de catarata é particularmente útil para fornecer interpretações mais precisas do astigmatismo induzido cirurgicamente.

Developing a Measure to Quantify Ocular Pain Postoperatively: The Adaptation of the Ocular Pain Assessment Survey.

Purpose: Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods: We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results: We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion: Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.

The Effect of Anterior Segment Depth on the Accuracy of 7 Different Intraocular Lens Calculation Formulas.

Objectives: To evaluate the effect of anterior segment depth (ASD; sum of anterior chamber depth and lens thickness) on the accuracy of 7 intraocular lens formulas calculated in patients with axial length (AL) between 22.5 and 24.5 mm. Materials and Methods: In this retrospective study, patients who underwent cataract surgery were divided into three groups based on their ASD measurements (Group I: ASD <7.30 mm, Group II: ASD between 7.30-7.90 mm, Group III: ASD >7.90 mm). The mean predictive error (MPE), mean absolute error (MAE), and median absolute error (MedAE) values of each group were compared. The effect of ASD on the predictive error (PE) of each lens formula was additionally tested in subgroups based on mean keratometry (K) values (Subgroup I: K <42.0 D, Subgroup II: K between 42.0-44.5 D, Subgroup III: K >44.5 D). Results: The study included 184 eyes of 184 patients. In Group I, all formulas except Olsen OLCR and Barrett II had clinically myopic MPEs. In Group II, the MPEs of all lens formulas except Barrett II were statistically non-different from zero (p>0.05). In Group III, the MPEs of all lens formulas were found to be statistically hyperopic. In Group III, all formulas except Olsen OLCR were significantly shifted to more hyperopic results when compared with Groups I and II (p<0.05). ASD was positively correlated with the PEs of the SRK/T, Holladay I, Hoffer Q, Barrett II, Hill-RBF, and Haigis formulas. In cases with mean K greater than 42.0 D, ASD was similarly correlated with PE for all formulas except Olsen OLCR. Conclusion: In eyes with AL between 22.5 and 24.5 mm, the predictions of lens formulas were significantly hyperopic in cases with greater ASD.

Comparison of Postoperative Corneal Astigmatism Induced by Two Different Corneal Incisions during Microincisional Cataract Surgery.

Objectives: Clear corneal incision (CCI) architecture in modern microincision cataract surgery (MICS) plays an undeniable role in postoperative refraction. The goal of this study was to evaluate the effect of hinge incision prior to two-step CCI on postoperative refractive astigmatism after cataract surgery and to demonstrate the schematic presentation of these postoperative astigmatic changes via double-angle polar plots. Methods: This study involved a consecutive case series of patients who had MICS. The first incision was performed as a two-step CCI, whereas the second was made as a hinge incision prior to 2-step CCI. The preoperative corneal and postoperative refractive astigmatism and surgically induced astigmatism (SIA) were calculated by vectorial analysis. Hotelling's T2 test was performed to compare the centroid values of preoperative and postoperative corneal astigmatism. Results: A total of 63 eyes from 57 subjects were evaluated. Group I consisted of 27 eyes with the two-step CCI, and Group II included 36 eyes with the hinge incision prior to two-step CCI. No significant difference was found between the groups in terms of age, sex, axial length, keratometry readings, implanted intraocular lens power, and postoperative spherical equivalent. The centroids of corneal astigmatism postoperatively increased to 0.21 D at 87.6°±0.61 with no significance in Group I (p=0.525) and to 0.70 D at 90.6°±0.47 with significance in Group II (p=0.032). The difference in postoperative centroids between the two groups was also significantly different (p=0.043). Finally, the centroids of SIA were 0.12 D at 85.5°±0.50 and 0.22 D at 91.1°±0.49 for Group I and Group II, respectively, with no significance. Conclusion: A hinge incision did not have an unfavorable effect on postoperative refractive astigmatism; therefore, it may be preferred for controlled entrance to the anterior chamber.

Investigation of Mitophagy Biomarkers in Corneal Epithelium of Keratoconus Patients.

PURPOSE: The pathological mechanisms of keratoconus (KC) have not been elucidated yet. Mitophagy is an important mechanism that eliminates damaged mitochondria under oxidative stress, and it could be one of the leading pathological causes of KC. This study aimed to find out the role of mitophagy in the keratoconic corneal epithelium. METHODS: The corneal epithelia were collected from the 103 progressive KC patients and the 46 control subjects. The real-time quantitative PCR was performed for PTEN-putative kinase-1 (PINK1), PARKIN, p62, and BNIP3 gene expressions in 31 KC and 9 control subjects. Western blot analyses were performed to investigate the protein expressions of PINK1, PARKIN, LC3B, ATG5, and BECLIN in the remaining 109 corneal epithelium samples from 72 patients and 37 control subjects. RESULTS: mRNA and protein expressions of PINK1 decreased significantly in the corneal epithelium of KC patients compared to the control subjects. No significant change was found in mRNA levels of PARKIN, p62, and BNIP3 in KC patients. The protein expression of PARKIN, LC3B, ATG5, and Beclin did not significantly differ between KC patients and control subjects. Gene expression levels of mitophagy biomarkers were not affected by the KC grade. CONCLUSIONS: PINK1/PARKIN-dependent mitophagy is affected in the keratoconic corneal epithelium. We found significant decreases in both mRNA and protein expressions of PINK1 in the keratoconic corneal epithelium. However, we did not observe any other significant change in mitophagy markers. Mitochondrial stress-related mitophagy pathways could be interrupted by the decreased levels of PINK1 in the keratoconic corneal epithelium, but solely PINK1 dysregulation is not likely to induce KC pathogenesis.

Peripapillary Choroidal Vasculature in Pediatric Eyes with Type 1 Diabetes Mellitus.

Objectives: Choroidal vasculature change in children with diabetes mellitus is not investigated enough although it could reflect clinical outcome. Methods: Pediatric Type 1 diabetes mellitus (T1DM) patients and healthy controls were retrospectively evaluated. Peripapillary retinal nerve fiber layer optical coherence tomography (OCT) images of the right eyes were analyzed. Choroidal parameters including total choroidal area, luminal area, stromal area, and choroidal vascularity index were measured through image binarization. Results: Twenty eyes of 20 patients were compared with 46 eyes of 46 healthy controls. Mean total choroidal area, luminal area, and stromal area were 1.59±0.35, 1.10±0.24, and 0.50±0.13 mm2 in patients' eyes and 1.52±0.49, 1.05±0.34, and 0.47±0.17 mm2 in healthy eyes. No difference was found in choroidal vascularity indices between patients and healthy eyes (68.8±3.9% vs. 69.4±4.4%, p=0.521). Temporal choroidal vascularity index was significantly higher than its nasal counterpart in healthy eyes (71.8±5.0% vs. 68.6±4.9%, p<0.001) which was not significant in patients' eyes (70.7±4.0% vs. 68.9±5.1%, p=0.067). Temporal quadrant had the highest choroidal vascularity index score among all quadrants in healthy controls (all p<0.05), whereas no choroidal vascularity index difference between quadrants was detected in patients (p=0.75). Conclusion: Peripapillary choroidal vasculature has shown subtle sectoral changes which did not reflect the overall peripapillary OCT section in pediatric T1DM patients when compared with healthy controls.

Survey of the Impact of the COVID-19 Pandemic on Ophthalmology Clinical Practice in Turkey

Objectives: To investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and Methods: A questionnaire consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants' demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: Nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: Ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic.

Choroidal vascularity index in pseudoexfoliative glaucoma.

PURPOSE: To evaluate choroidal vascular involvement in pseudoexfoliative glaucoma (PEXG) by applying the choroidal vascularity index (CVI) to optic coherence tomography (OCT) images. METHODS: Seventy-eight eyes from 40 subjects were included the study. Group 1 included healthy eyes (n = 20), group 2 eyes with PEX (n = 16), and group 3 eyes with PEXG (n = 42). OCT imaging of macular and peripapillary regions and retinal nerve fiber layer (RNFL) analyses were performed. CVI was calculated using ImageJ software. RESULTS: The mean age was 64.89 ± 5.8, 71.2 ± 7.8, and 68.24 ± 7.4 years in groups 1, 2, and 3, respectively (p = 0.046). There were no significant differences between the groups in terms of sex (p = 0.777). In macula, mean CVI rates were 66.97 ± 1.9%, 64.23 ± 1.2%, and 64.63 ± 1.6%, and in the peripapillary areas, mean CVI rates were 67.04 ± 1.5%, 65.20 ± 1.5%, and 64.14 ± 2.1% in groups 1, 2, and 3, respectively (group 1 vs. group 2 and 3, p = 0.000; group 2 vs. group 3, p > 0.05). The decrease in average RNFL thickness was statistically significant in group 3 compared to groups 1 and 2. CONCLUSION: CVI could be used to assess choroidal vascular changes in ocular diseases. CVI was found to be reduced in PEX and PEXG, indicating an ocular vascular involvement in pseudoexfoliative process.

Analysis of the Peripapillary Choroidal Vascular Characteristics in Papilledema Associated with Pseudotumor Cerebri.

SIGNIFICANCE: Choroidal vascularity index measured by image binarization method from peripapillary optical coherence tomography sections has been found significantly lower in papilledema patients than healthy controls. PURPOSE: The purpose of this study was to compare peripapillary choroidal parameters in papilledema patients with control subjects. METHODS: Peripapillary spectral domain optical coherence tomography scans of 34 patients with papilledema and 34 healthy controls are acquired for the study. Images are binarized with the ImageJ software (National Institutes of Health, Bethesda, MD) to calculate total choroidal area, stromal area, luminal area, and choroidal vascularity index. RESULTS: Total choroidal area, luminal area, and choroidal vascularity were significantly lower in papilledema patients compared with healthy controls on right (1.343 ± 0.286 vs. 1.694 ± 0.344, P < .001; 0.880 ± 0.209 vs. 1.167 ± 0.255, P < .001; 65.28 ± 2.99% vs. 68.68 ± 2.81%, P < .001, respectively) and left eyes (1.376 ± 0.308 vs. 1.647 ± 0.339, P < .001; 0.899 ± 0.231 vs. 1.134 ± 0.237, P < .001; 64.92 ± 3.44 vs. 68.84 ± 3.23, P < .001, respectively). No difference was found between active and remitted stages of papilledema in terms of choroidal parameters. CONCLUSIONS: Peripapillary total choroidal area, luminal area, and choroidal vascularity index are significantly reduced in patients with papilledema. These parameters might be beneficial tools for evaluating choroidal vascularity in papilledema quantitatively and differential diagnosis for optic disc edema.

REPEATABILITY OF CHOROIDAL VASCULARITY INDEX MEASUREMENTS USING DIRECTIONAL OPTICAL COHERENCE TOMOGRAPHY IMAGES.

PURPOSE: To investigate the repeatability of choroidal vascularity index (CVI) measurements in centered and decentered (regarding pupil entry position of the beam) directional subfoveal optical coherence tomography (OCT) scans with (CVI1) and without (CVI2) brightness adjustment. METHODS: Thirty-two eyes of 32 healthy volunteers were included in this prospective study. First, the fovea was evaluated by a single horizontal enhanced depth imaging OCT scan in a centered direction. Then, the same subfoveal horizontal line was scanned in a decentered direction. The agreement between CVIs obtained from these centered and decentered directional OCT scans was investigated using Bland-Altman analysis and intraclass correlation coefficient. RESULTS: Intraclass correlation coefficient between centered and decentered CVI1 was 0.71 (95% CI: 0.48-0.85, P value < 0.001). Intraclass correlation coefficient between centered and decentered CVI2 was 0.73 (95% CI: 0.5-0.86, P value < 0.001). The mean difference between centered and decentered directional measurements for CVI1 and CVI2 were 0.5 and 0.8, respectively. CONCLUSION: There is moderate agreement between CVIs obtained from centered and decentered directional single OCT scans of the same subfoveal area. Studies investigating choroidal vascularity should be standardized by using the same OCT beam direction in all scans.

Keratopigmentation: Is it a Miracle or an Adventure?

OBJECTIVES: This study is an analysis of the cosmetic and functional results of patients who underwent keratopigmentation (KTP). METHODS: Sixteen eyes of 16 patients, 7 females (43.75%) and 9 males (56.25%) were included in the study. Intrastromal and superficial manual KTP were performed under general anesthesia. Patients with no light perception or with only light perception but total corneal opacification, prosthetic contact lens intolerance, or unwillingness to use a contact lens were studied. The main outcomes were postoperative patient's satisfaction, cosmetic results, pigment stabilization and surgical complications. A grading system (0-5 points) was used to assess patient satisfaction and the cosmetic results. RESULTS: The mean age of the patients was 30.5±12.06 years (range: 16-53 years). Black pigment was used in 10 patients (62.5%), a brownish color in 5 patients (31.25%) and a greenish, yellow, blue, and black color pigmentation was used for 1 patient (6.25%). The mean follow-up was 29.31±15.45 months (range: 8-52 months). In 2 of 16 patients, mild to moderate pigment loss was seen 12 months after the surgery and superficial KTP was repeated. Minimal pigment loss was seen in 5 patients, but the cosmetic results were satisfactory and no secondary surgical procedure was required. Pigment leakage underneath the conjunctiva was seen in only 1 patient. Otherwise, there were no complications associated with keratopigmentation. The postoperative mean patient satisfaction score was 4.18±0.75 points (range: 3-5 points). CONCLUSION: KTP is a safe surgical procedure that is easy to learn and perform, does not require expensive materials, and avoids more extensive and invasive reconstructive ocular procedures. Corneal KTP may have a great impact on future ophthalmic surgical practice from both therapeutic and cosmetic perspectives.

Periocular changes in topical bimatoprost and latanoprost use.

BACKGROUND/AIM: To evaluate the periocular changes due to topical bimatoprost and latanoprost use and to investigate their effects on the lacrimal drainage system. MATERIALS AND METHODS: All participants (69 eyes of 43 patients, 52 eyes of 26 controls) were classified into three groups: bimatoprost (0.03%) users, latanoprost (0.005%) users, and healthy controls. Each patient was examined before prostaglandin therapy, and then at the first, third, sixth, and twelfth month of therapy. Palpebral fissure height, upper eyelid crease, and levator function were measured, and lacrimal system drainage irrigation was performed. Periocular hyperpigmentation and upper eyelid sulcus were also examined. RESULTS: No significant change was identified in palpebral fissure height or levator function in any group. However, in upper eyelid crease, among bimatoprost users, a statistically significant increase was observed when compared to the control group (P < 0.001). Patients with skin type II and III, in bimatoprost users, and patients with skin type III, in latanoprost users, had statistically significant hyperpigmentation (P < 0.001) after the third month of therapy. During follow-up, no lacrimal drainage system obstruction was seen. CONCLUSION: Topical bimatoprost therapy causes more periocular changes than latanoprost therapy. Thus, in unilateral cases, patients should be well informed about these probable changes before therapy.

Primary transpupillary thermotherapy of choroidal melanocytic lesions.

PURPOSE: To evaluate the role of primary transpupillary thermotherapy (TTT) in the treatment of choroidal melanocytic lesions. MATERIALS AND METHODS: Retrospective chart review of 24 patients (24 eyes) with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. RESULTS: The mean initial tumor basal diameter was 6.6 (3.0-10.0) mm and the mean initial tumor thickness was 3.0 (1.0-5.0) mm. The mean number of TTT sessions was 2.5 (1-6). The mean decrease in tumor thickness was 1.2 mm (from 3.0 to 1.8 mm) at a mean follow-up of 22.7 (range 3-90) months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients (20.8%)], focal cataract [5 patients (20.8%)], iris atrophy [4 patients (16.6%)] and posterior synechia [4 patients (16.6%)]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness ≤3 mm and juxtapapillary versus nonjuxtapapillary location (Fisher's exact test, P>0.05). Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes (8.3%) were enucleated because of neovascular glaucoma and one eye (4.1%) was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients (87.5%). One patient (4.1%) with extraocular tumor recurrence developed liver metastasis and expired. CONCLUSIONS: Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved.