The Effect of Autografts from the Inferior and Superior Bulbar Conjunctiva on the Ocular Surface in Primary Pterygium Surgery: A Cytology Study.

Objectives: This study aimed to evaluate the effect of using an inferior or superior conjunctival autograft in primary pterygium surgery on the postoperative ocular surface. Materials and Methods: Forty eyes of 40 patients who underwent pterygium surgery with autograft were included in the study. Cytological cell counts were performed on samples taken from the bulbar conjunctiva by impression cytology before and 1 year after the operation. Schirmer 1 test score, lissamine green conjunctival staining score, tear film break-up time (TBUT), and fluorescein corneal staining scores were evaluated. The pain levels of the patients were evaluated with visual analog scale at postoperative 1 day and 1 week. Results: Corneal and conjunctival staining, TBUT, and Schirmer test results demonstrated significant improvement in all patient groups after surgery, but there was no difference between groups (p>0.05). In both preoperative and postoperative impression cytology, the number of goblet cells in the inferior bulbar conjunctiva was higher than in the superior bulbar conjunctiva (p<0.001), while there was no such difference in epithelial cell or mucin staining. There were no significant cytological changes postoperatively in either group (p>0.05). Conclusion: Pterygium surgery with autografting improved tear function tests regardless of graft location. Goblet cell count was higher in the inferior bulbar conjunctiva than in the superior bulbar conjunctiva in both postoperative and preoperative impression cytology. However, there was no significant difference in postoperative epithelial and goblet cell counts or mucin staining between the groups before and after surgery. We think that using the inferior bulbar conjunctiva is an appropriate choice in cases where the superior conjunctiva cannot be used as a graft or when future glaucoma surgery is possible.

The effect of limbal autograft location at primary pterygium excision on anterior and posterior corneal astigmatism: a comparative prospective study.

PURPOSE: The aim of the study is to evaluate the effect of limbal autograft location on corneal astigmatism in inferior and superior conjunctival autografted pterygium surgery. METHODS: Patients were divided into 2 groups as diagnosed with primary pterygium and planned to receive surgical treatment. Pterygium surgery was performed on 25 patients with superior and 25 patients with inferior limbal autograft who have similar epidemiologic features. Cornea anterior and posterior surface keratometry (K) 1, K2, Kmax, peripheric radius (Rper) (the mean radius of curvature of the 7.0-9.0 mm ring area), refractive astigmatism and axis values, were examined. Corneal irregularity indices were the index of surface variance (ISV), index of vertical asymmetry (IVA, mm), index of height asymmetry (IHA, µm), index of height decentration (IHD, µm). The data were compared pre- and postoperative and the effect of graft location on results was evaluated. RESULTS: K1 which is from the values of the cornea front face has risen after surgery both of superior and inferior groups (p = 0.011). However, no postoperative significant difference was detected in terms of the change. Otherwise, both groups have changed regarding astigmatism and Rper (p < 0.001), but no postoperative significant difference was found in terms of the change. There were not any differences between groups regarding the changes of postoperative back face values. Although there were significant decreases in ISV, IVA, and IHD values in both groups in terms of all corneal surface indices, there was no significant difference between the lower and upper groups in terms of postoperative results (p > 0.05). CONCLUSION: The effects of pterygium surgery with limbal autograft provide significant improvement on corneal astigmatism. However, we think that the location of the conjunctiva has no effect, but in cases where the bulbar conjunctiva needs to be preserved or cannot be used, the choice of the lower bulbar conjunctiva can achieve successful results.

The relationship between histopathological features and surgical success in primary acquired punctal stenosis.

PURPOSE: To investigate the pathophysiology of punctal stenosis based on histopathological features, and to assess the correlation between histopathological findings and treatment outcomes in primary punctal stenosis. METHODS: A total of 43 eyes of 34 consecutive patients with primary punctal stenosis were included in this prospective study. Punctum specimens obtained by rectangular three-snip punctoplasty (TSP) were examined based on the multilayered structure of the epithelium and subepithelial histopathology. The correlation between the histopathological findings and treatment outcomes was evaluated. RESULTS: A total of 61.8% of the patients were female and had an average age of 62.4 (41-81) years. Based on the histopathological examination, all 43 puncta consisted of non-keratinized stratified squamous epithelia. Subepithelial pathology demonstrated inflammation in 10 puncta (23.3%), fibrosis in 19 puncta (44.2%) and both inflammation and fibrosis in 11 puncta (25.6%). There was a moderate relationship between the presence of subepithelial fibrosis and symptom duration (r = 0.4, p = 0.03). The surgical success was 88.4% at the mean of 12.4 ± 3.5 months follow-up. The surgical success was clinically lower in the puncta with exhibited fibrosis, although it was not statistically significant (p = 0.6). CONCLUSION: Although the findings for almost all punctum specimens were consistent with fibrosis, inflammation or both, subepithelial fibrosis was detected as the most common histopathological feature. Clinically lower surgical success rates in puncta exhibiting fibrosis may be associated with a longer duration of symptoms and excessive postoperative healing response.

The Effects of Daily Digital Device Use on the Ocular Surface in Healthy Children.

SIGNIFICANCE: Digital device usage among children has increased significantly in recent years. Prolonged screen exposure can have adverse effects on the eye, especially on the ocular surface. PURPOSE: We aimed to evaluate the duration of screen exposure and its effect on the ocular surface in healthy children aged 10 to 18 years. METHODS: This cross-sectional observational study included 200 healthy children. Screen exposure times of the children were ascertained, and the effect of screen exposure on the ocular surface was evaluated using tear breakup time, kerato-epitheliopathy (Oxford) score, and Schirmer test. The Ocular Surface Disease Index (OSDI) was used to assess subjective dry eye symptoms. Findings for subjects with a daily screen exposure time of fewer than 2 hours were compared with those reporting more than 2 hours of screen time. Statistical evaluation included the Shapiro-Wilk test, Student t test, and Pearson correlation analysis. RESULTS: The mean ± standard deviation (SD) age was 14 ± 2.6 years, and 88.5% of the participants used mobile phones or computers every day. The mean ± SD tear breakup time was 10.3 ± 4.1 seconds, and the Schirmer test score was 15.6 ± 4.7 mm. The Oxford score was 0.4 ± 1, and no corneal staining was detected in 83.5% of the subjects. The mean ± SD OSDI score was 23.5 ± 17.8, and 67.5% of subjects had a mild-to-severe ocular surface disease. When daily screen exposure times less than and greater than 2 hours were compared, there was no statistically significant difference between the two groups in tear breakup time, Schirmer test, Oxford score, and OSDI score. Whereas there was a statistically significant weak positive correlation (r = 0.307, P = .001) between OSDI score and screen exposure time, there was no correlation between tear breakup time, Schirmer test, and Oxford score and screen exposure time. CONCLUSIONS: Screen exposure in healthy children may cause ocular surface symptoms without causing changes in ocular surface findings.

The effect of smoking on corneal densitometry and endothelial cell morphology.

PURPOSE: We investigated corneal endothelial morphology and corneal densitometry in smokers and compared our results with findings observed in non-smokers. MATERIALS AND METHODS: This cross-sectional observational study included 100 participants (50 smokers, 50 non-smokers) aged 18-80 years in whom corneal endothelial morphology was analysed using a non-contact Tomey EM-4000 specular microscope (Tomey Corporation, Japan). The Pentacam HR system was used to measure corneal densitometry spatially in three concentric zones (from the centre to the periphery) and at three different corneal depths (from the anterior to the posterior aspects). Endothelial morphology findings and corneal densitometry values were recorded in all participants, and these results were compared between smokers and non-smokers. RESULTS: Endothelial morphology and corneal densitometry analysis showed significantly lower endothelial cell counts (Num) in smokers (228 cells/mm2 vs. 246 cells/mm2, p = 0.02) in addition to increased maximum cell area (Max) values (986.5 µm2 vs. 935 µm2, p = 0.04). We observed no statistically significant intergroup difference in corneal densitometry values (p > 0.05 for each zone); however, we observed a moderately positive correlation between densitometry values in the 6-10 mm concentric zone and between the all total corneal zones and number of pack-years in smokers. CONCLUSIONS: Our study highlights that among the morphometric corneal endothelial variables analysed in this study, only the Num value was significantly correlated with smoking. We observed no statistically significant intergroup difference in corneal densitometry values in this study; however, a positive correlation was observed between the number of pack-years and corneal densitometry findings. Therefore, as the pack-years increase, the increase in corneal densitometry values may indicate a decrease in corneal clarity, considering the possible contribution of secondary factors such as age.

Evaluation of Corneal Densitometry and Endothelial Layer in Soft Contact Lens Users.

SIGNIFICANCE: Soft contact lens wear may lead to physiological changes in the cornea. Corneal densitometry is a new software tool that may detect these physiological changes by monitoring their effects on corneal transparency. PURPOSE: This study aimed to assess corneal densitometry values and corneal endothelium in patients using soft contact lenses. METHODS: The study included 36 eyes of 36 subjects with soft contact lens use (group 1) and 36 eyes of 36 healthy control subjects (group 2). Anterior segment parameters and corneal densitometry of all subjects were evaluated using Scheimpflug corneal topography (Pentacam; Oculus Inc., Wetzlar, Germany). A total corneal area of 12 mm was divided into four annular zones (0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm) and into three regions as anterior, central, and posterior for densitometry examination. Cell density, cell distribution, and cell morphology (quadrangular, pentagonal, hexagonal, and other cell percentages) of the endothelial layer were examined in both groups using specular microscopy (Nidek CEM 530; Nidek Co., Gamagori, Aichi, Japan). RESULTS: In group 1, the mean duration of contact lens wear was 4.45 ± 2.15 years. The anterior segment parameters were not significantly different between the two groups (P > .05). The anterior 0- to 2- and 2- to 6-mm corneal densitometry values were significantly higher in group 1 compared with group 2 (23.2 ± 4.7 for group 1 and 17.3 ± 5.6 for group 2 [P = .03]; 22.4 ± 6.4 for group 1 and 17.8 ± 1.4 for group 2 [P = .03], respectively). There were no significant differences between the groups for corneal densitometry values between 6 and 12 mm, or for cell density, cell distribution, and cell morphology (P > .05). CONCLUSIONS: Although the cornea remains transparent in soft contact lens wearers, corneal densitometry may increase in the 0- to 6-mm annular zone of the anterior region.

Association Between Dry Eye Disease and Newly Diagnosed Obsessive-Compulsive Disorder.

PURPOSE: The purpose of this study was to evaluate the association between dry eye disease and patients with newly diagnosed obsessive-compulsive disorder (OCD). METHODS: Thirty treatment-naive patients with OCD and 30 healthy controls were included in this prospective study. The Ocular Surface Disease Index, tear breakup time, Schirmer I test, corneal and conjunctival staining grade (Oxford scale), and neutrophil-to-leucocyte ratio values were obtained for all participants. RESULTS: The comparison of the patients with OCD and healthy controls showed significantly higher values in Ocular Surface Disease Index (34.8 vs. 20.8, P = 0.001), corneal Oxford scoring (0.9 vs. 0.6, P = 0.02), and conjunctival Oxford scoring (0.8 vs. 0.5, P = 0.04), with consistently lower values in the Schirmer I test (15.7 vs. 18.8, P = 0.043) and tear breakup time (9.1 vs. 12.9, P = 0.001). The mean neutrophil-to-leucocyte ratio values were significantly higher in the OCD group compared with the controls (2.4 ± 0.9 vs. 1.6 ± 0.4, respectively; P = 0.001). CONCLUSIONS: Our study showed a relation between dry eye disease and patients with newly diagnosed OCD who were not using any psychiatric drug. Our findings suggest that inflammation, which plays an important role in the pathogenesis of both diseases, may be responsible for this relationship.

Effects of diabetes duration and HgA1C level on corneal endothelial morphology.

OBJECTIVE: The aim of this study is to investigate the effects of the HbA1c level and the duration of diabetes mellitus on the corneal endothelium morphology and to compare between healthy individuals and diabetes mellitus patients with non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. MATERIAL AND METHODS: Ninety patients who applied to the Health Sciences University Ulucanlar Eye Training and Research Hospital between January 2016 and January 2017 were included in this prospective randomized study. In the study, 45 diabetes mellitus patients and 45 healthy individuals were evaluated. The diabetes patients were compared in terms of HbA1c level, diabetes mellitus duration, corneal endothelial cell density, coefficient of variation, standard deviation, and hexagonality with healthy control group. RESULTS: A statistically significant difference was found in the endothelial cell densitometer, coefficient of variation, and standard deviation measurements between the diabetes mellitus patients and the control (healthy) group. But, there was no statistically significant difference between 6A (hexagonality) and central corneal thickness measurements. There was a negative correlation between HbA1c levels and diabetes mellitus times and endothelial cell densitometer values in the patients with diabetes mellitus diagnosis and standard deviation values in the positive direction. There was a statistically significant difference between diabetes mellitus patients with the diagnosis of non-proliferative diabetic retinopathy and proliferative diabetic retinopathy in the endothelial cell densitometer and standard deviation values. But there was not any statistically significant difference between coefficient of variation, 6A, and central corneal thickness values. CONCLUSION: The endothelial cell densitometer in diabetes mellitus patients with retinopathy is lower than that in healthy individuals. There is a negative correlation between retinopathy severity and corneal endothelial cell density. Diabetes affects negatively not only vascular tissues but also avascular cornea.

Adjunctive Punctal Re-Dilation for Early Postoperative Cicatrization after One-Snip Punctoplasty.

OBJECTIVES: This was an assessment of one-snip punctoplasty outcomes in patients for whom adjunctive punctal re-dilatation was performed in-office for early postoperative cicatricial changes. METHODS: A retrospective analysis was conducted of patients who underwent one-snip punctoplasty between March 2019 and February 2020 due to acquired punctal stenosis. Patients were followed up on the first, third, and seventh postoperative day, then weekly for the remainder of the first month, every 2 weeks over the next month, and then monthly. Punctal re-dilatation was performed if patients showed early clinical signs of re-stenosis. Demographic details, the number and timing of re-dilatation procedures, the timing of re-stenosis, and anatomical and functional success rates were analyzed. RESULTS: The medical records of 148 eyes of 86 patients were evaluated. A re-dilation procedure was performed in a total of 57 (38.5%) puncta showing signs of early cicatrization. The first punctal re-dilatation was performed at a mean of 17.2±11.3 days (range: 3-57 days). Re-stenosis was observed in 25 puncta (16.9%) at a mean of 5.6±3.1 weeks (range: 2-16 weeks). The anatomical success rate was 83.1% and the functional success rate was 79.1%. There were no significant differences in the anatomical and functional success rates between the patients who did and did not need adjunctive re-dilatation. CONCLUSION: In-office punctal re-dilatation may improve functional and anatomical success rates after one-snip punctoplasty by preventing recurrent punctal cicatrization.

An objective evaluation of crystalline lens density using Scheimpflug lens densitometry in different uveitis entities.

AIM: To measure lens densities with a Pentacam HR device in patients with active uveitis. Measurements were taken at the onset of the attack and after the treatment of inflammation. METHODS: The study included 51 eyes with different anterior uveitis aetiologies and a control group of 48 eyes of age- and gender-matched healthy subjects. Lens densitometry measurements were taken with a Scheimpflug camera on a Pentacam HR device. All the examinations and measurements were performed on the first presentation with the onset of the attack and were repeated at 1st and 3rd months after treatment. Lens densitometry measurements were compared with those of the healthy control group and the healthy fellow eyes of the uveitic patients. RESULTS: No statistically significant difference was determined between the groups in respect of age and gender (p > 0.05). At 3 months, Pentacam densitometry of zones 3 value was determined to be significantly high in the uveitic eyes compared to the healthy eyes (p = 0.018). The average lens density value (ALD) at 1 month was statistically significantly higher than the baseline value in the uveitic eyes (p = 0.034). There was no significant change in the ALD value at 3 months compared to the baseline and 1-month values (p = 0.386, p = 0.736, respectively). CONCLUSION: Even if there is no cataract development that can be clinically observed in eyes with anterior uveitis, lens density in zone 3 showed a significant increase at the end of 3 months compared to the baseline value. This change can be evaluated objectively with Scheimpflug imaging.

Applications of different types of gas-permeable contact lenses in keratoconus and their visual results.

PURPOSE: To show applications of different types of gas-permeable contact lenses in patients with keratoconus and to compare visual acuity (VA) results. METHODS: A total of 229 eyes of 133 patients who used different types of rigid gas-permeable contact lenses between April 2003 and April 2010 at the Cornea and Contact Lens Unit of Eye Clinic 2 of the Ministry of Health, Ulucanlar Eye Training and Research Hospital, were included. Visual acuity of patients was classified as uncorrected and corrected with eyeglasses and corrected with contact lenses. The patients were compared in terms of VA, daily contact lens wear time, and complications. RESULTS: A total of 70 out of 133 (52.6%) patients in our study were male, and 63 (47.4%) were female. The mean age was 25.9 ± 7.03 years (12-45). As for the classification of the 229 eyes included in the study, 136 of 229 (59.4%) eyes had moderate keratoconus, 88 (38.4%) had advanced keratoconus, and 5 (2.2%) had severe keratoconus. Following the contact lens application, the VA in all patients increased when compared to uncorrected and corrected with eyeglasses groups and the difference was statistically significant (p<0.005). When a comparison of different types of contact lenses was made, a statistically significant difference was not found (p>0.5) in terms of increase in VA. When patients were evaluated in terms of contact lens wear times, it was observed that Boston Equalens II was preferred by patients wearing lenses 4-8 hours/day. For patients wearing lenses more than 8 hours a day, Rose K lens was used the most. No serious complication was observed in any of the patients that would lead them to stop wearing contact lenses during the follow-up period. There was also no need for keratoplasty in any patient during the follow-up period. CONCLUSIONS: We detected an increase in VA in patients with rigid contact lenses. In addition, some contact lenses were better tolerated by patients and were used for a longer time during the day.

Intracerebral hematoma following lumboperitoneal shunt insertion: a rare case report.

Lumboperitoneal shunting is widely used for the surgical management of pseudotumor cerebri and other pathologies such as communicating hydrocephalus. Although it is a safe method, it could be associated with complications including subarachnoid hemorrhage, subdural and rarely intracerebral hematoma. A 44-year-old female applied to our clinic with complaints of severe headache, retroorbital pain and blurred vision. Lumbar puncture demonstrated cerebrospinal fluid opening pressure of cmH2O. A non-programmable lumboperitoneal shunt with two distal slit valves was inserted due to pseudotumor cerebri. She deteriorated shortly after surgery. Immediate cranial computed tomography scan revealed a right parietal intracerebral hematoma. Development of intracerebral hematoma following lumboperitoneal shunt is a rare complication. We discuss this rare event accompanied by the literature.

Aneurysmal bone cyst of the ethmoid presenting with proptosis and epiphora.

An aneurysmal bone cyst of ethmoid is a rare and distinct clinicopathologic entity. The diagnosis is important in this localization because it requires multidisciplinary approach in its management. We report a case of a 14-year-old woman presenting to our clinic with the complaint of epiphora and proptosis in the right eye, which were the symptomatic findings of aneurysmal bone cyst of ethmoid.