Optical quality of the cornea after Descemet membrane endothelial keratoplasty surgery: early results from Türkiye.

Background: Descemet membrane endothelial keratoplasty (DMEK) is increasingly favored in the treatment of endothelial dysfunction due to its benefits, which include swift visual rehabilitation and recovery, a relatively low rejection rate, and superior refractive stability. In this study, we examined alterations in corneal clarity among patients who underwent DMEK and correlated these densitometry findings with other optical parameters of corneal topography. Methods: The study incorporated 35 eyes from 35 patients who had previously undergone DMEK surgery for pseudophakic bullous keratopathy at Ankara Bilkent City Hospital. The results from these patients were compared with those from a healthy control group. The preoperative and postoperative optical parameters of the patients were assessed using Pentacam Scheimpflug topography (Oculus). Results: We observed significant decreases in corneal densitometry in the 0-2 mm and 2-6 mm zones of the anterior, posterior, central, and total layers at the sixth month postoperatively compared to the preoperative period (P<0.05). The corneal densitometry values at postoperative month 6 were elevated in all layers and zones relative to the healthy group (P<0.05). The root mean square of higher-order aberrations in postoperative period was elevated significantly (P<0.001). Conclusions: Six months after operation, the optical quality of the cornea following DMEK surgery did not achieve the level of a healthy cornea.

COVID-19 outbreak and increased risk of amblyopia and epidemic myopia: Insights from EUROCOVCAT group.

The most common cause of vision impairment in children is amblyopia. It is defined as impaired visual acuity in one or both eyes that is present with no demonstrable abnormality of the visual pathway and is not immediately resolved by wearing glasses. After the World Health Organization (WHO) recognized COVID-19 as a global pandemic on March 11, 2020, widespread changes and restrictions to social and sanitary practices have presented significant issues in access to eye care during the COVID-19 pandemic. A reduction of more than 80% in pediatric eye care volume up to its total cessation has been observed in different departments. In this scenario, reduced or absent eyesight, due to delay in timely treatment of amblyopic conditions, could create major, long-lasting effects on all aspects of life, including daily personal activities, interacting with the community, school and work opportunities and the ability to access public services. Processes coming out of lockdown should be gradually easing restrictions giving priority to ophthalmology and eye care facilities so that amblyopia does not remain unattended and irreversible as in adults due to lack of timely treatments. If not reversible, this process could lead to a dramatic increase in disability and unsustainable social costs for many governments.

Evolving Techniques and Indications of Descemet Membrane Endothelial Keratoplasty.

Endothelial keratoplasty has replaced traditional penetrating keratoplasty for the treatment of corneal endothelial dysfunction. It offers faster, more predictable, stable visual recovery and low rejection rates while the surgery itself is less invasive. Descemet membrane endothelial keratoplasty (DMEK) is currently the gold standard for the treatment of Fuchs endothelial dystrophy, bullous keratopathy, and corneal edema after cataract surgery. Its favorable long-term outcomes are increasingly reported by large study groups. This review summarizes the current literature on new DMEK techniques, including size and shape modifications, new graft delivery techniques, and surgical pearls for challenging cases like eyes with glaucoma, glaucoma tubes, and failed penetrating keratoplasties.

Clinical outcomes of ocular surface in patients treated with vitamin D oral replacement.

PURPOSE: To analyze the clinical outcomes of the ocular surface in patients with vitamin D deficiency after oral replacement. METHODS: A total of 40 patients with vitamin D deficiency were enrolled in the study. The patients received 50,000 units of oral vitamin D weekly over a period of 8 weeks. After 8 weeks, 1,500-2,000 units/d were administered for 24 weeks. Eyelid margin score, meibomian gland expressibility score, Oxford grading, Schirmer I test, tear breakup time, tear osmolarity, and the Ocular Surface Disease Index score were evaluated at baseline, and at 8, 12, and 24 weeks. RESULTS: The meibomian gland expressibility score, Schirmer I, tear breakup time, tear osmolarity, and Ocular Surface Disease Index score showed improvement 8 weeks after vitamin D supplementation (p<0.05). Compared with the pretreatment values, the eyelid margin score and Oxford grading were decreased at week 12 (p<0.05). CONCLUSION: Vitamin D replacement appears to improve ocular surface in individuals with vitamin D deficiency.

Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up.

PURPOSE: This study was performed to evaluate the outcomes of accelerated corneal cross-linking in keratoconic corneas with thinnest pachymetry values of <400 µm. METHODS: The study included 28 eyes of 24 patients. The uncorrected and best-corrected visual acuities (logMAR), flattest and steepest keratometric readings, central corneal thickness at the thinnest point, corneal higher-order aberrations, and contrast sensitivity were assessed before and at 1, 3, 6, 12, and 24 months after corneal cross-linking. RESULT: The mean best-corrected visual acuity and contrast sensitivity increased (p=0.02, p=0.03, respectively), whereas the mean uncorrected visual acuity did not significantly differ (p>0.05) at 24 months after corneal cross-linking, compared with measurements before corneal cross-linking. Although the mean flattest keratometric reading showed no significant change (p=0.58), the mean steepest keratometric reading was reduced when compared with its value before corneal cross-linking (p=0.001). No change was observed in the mean central corneal thickness at the thinnest point at 24 months after corneal cross-linking, compared with its value before corneal cross-linking (p=0.12). CONCLUSION: Accelerated corneal cross-linking in keratoconic eyes with thin corneas could halt the progression of keratoconus in corneas thinner than 400 µm at 24 months after treatment.

Clinical outcomes of ocular surface in patients treated with vitamin D oral replacement / Resultados clínicos da superfície ocular em pacientes tratados com reposição oral de vitamina D

ABSTRACT Purpose: To analyze the clinical outcomes of the ocular surface in patients with vitamin D deficiency after oral replacement. Methods: A total of 40 patients with vitamin D deficiency were enrolled in the study. The patients received 50,000 units of oral vitamin D weekly over a period of 8 weeks. After 8 weeks, 1,500-2,000 units/d were administered for 24 weeks. Eyelid margin score, meibomian gland expressibility score, Oxford grading, Schirmer I test, tear breakup time, tear osmolarity, and the Ocular Surface Disease Index score were evaluated at baseline, and at 8, 12, and 24 weeks. Results: The meibomian gland expressibility score, Schirmer I, tear breakup time, tear osmolarity, and Ocular Surface Disease Index score showed improvement 8 weeks after vitamin D supplementation (p<0.05). Compared with the pretreatment values, the eyelid margin score and Oxford grading were decreased at week 12 (p<0.05). Conclusion: Vitamin D replacement appears to improve ocular surface in individuals with vitamin D deficiency.

RESUMO Objetivo: Analisar os resultados clínicos da superfície ocular em pacientes com deficiência de vitamina D após reposição oral. Métodos: Foram incluídos no estudo 40 pacientes com deficiência de vitamina D. Os pacientes receberam 50.000 unidades de vitamina D semanalmente por um período de oito semanas. Após esse período, 1.500-2.000 unidades/dia foram administradas por 24 semanas. Escores da margem palpebral, escores de expressibilidade da glândula meibomiana, classificação de Oxford, teste de Schirmer I, tempo de ruptura lacrimal, osmolaridade da lágrima e escore do Índice de Doenças da Superfície Ocular foram avaliados no início e após 8, 12 e 24 semanas. Resultados: O escore de expressibilidade da glândula meibomiana, Schirmer I, tempo de ruptura lacrimal, osmolaridade da lágrima e o Índice de Doenças da Superfície Ocular apresentaram melhoras após 8 semanas de suplementação de vitamina D (p<0,05). Comparado com os valores do pré-tratamento, o escore da margem palpebral e a classificação de Oxford diminuíram na 12ª semana (p<0,05). Conclusão: A reposição de vitamina D parece melhorar a superfície ocular em indivíduos com deficiência de vitamina D.

Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up / Cross-linking corneano acelerado com riboflavina hiposmolar em córneas ceratocônicas finas: 2 anos de acompanhamento

ABSTRACT Purpose: This study was performed to evaluate the outcomes of accelerated corneal cross-linking in keratoconic corneas with thinnest pachymetry values of <400 µm. Methods: The study included 28 eyes of 24 patients. The uncorrected and best-corrected visual acuities (logMAR), flattest and steepest keratometric readings, central corneal thickness at the thinnest point, corneal higher-order aberrations, and contrast sensitivity were assessed before and at 1, 3, 6, 12, and 24 months after corneal cross-linking. Result: The mean best-corrected visual acuity and contrast sensitivity increased (p=0.02, p=0.03, respectively), whereas the mean uncorrected visual acuity did not significantly differ (p>0.05) at 24 months after corneal cross-linking, compared with measurements before corneal cross-linking. Although the mean flattest keratometric reading showed no significant change (p=0.58), the mean steepest keratometric reading was reduced when compared with its value before corneal cross-linking (p=0.001). No change was observed in the mean central corneal thickness at the thinnest point at 24 months after corneal cross-linking, compared with its value before corneal cross-linking (p=0.12). Conclusion: Accelerated corneal cross-linking in keratoconic eyes with thin corneas could halt the progression of keratoconus in corneas thinner than 400 µm at 24 months after treatment.

RESUMO Objetivo: Este estudo foi realizado para avaliar os resultados do cross-linking corneano acelerado em córneas ceratocônicas com os valores mais baixos de paquimetria <400 µm. Métodos: O estudo incluiu 28 olhos de 24 pacientes. As acuidades visuais não corrigidas e melhor corrigidas (logMAR), leituras ceratométricas mais planas e íngremes, espessura corneana central no ponto mais fino, aberrações corneanas de mais alta ordem e a sensibilidade ao contraste foram avaliadas antes e em 1, 3, 6, 12 e 24 meses após a realização do do cross-linking. Resultados: A média da acuidade visual melhor corrigida e a sensibilidade ao contraste aumentaram (p=0,02, p=0,03, respectivamente), enquanto a média da acuidade visual não corrigida não diferiu significativamente (p>0,05) aos 24 meses após o cross-linking, comparada com medidas antes do procedimento. Embora a leitura da média da ceratometria mais plana não tenha apresentado alteração significativa (p=0,58), a leitura ceratométrica mais íngreme diminuiu quando comparada ao seu valor antes do cross-linking (p=0,001). Não foi observada alteração na média da espessura corneana central no ponto mais fino aos 24 meses após o cross-linking em comparação com seu valor antes do procedimento (p=0,12). Conclusão: O cross-linking corneano acelerado nos olhos ceratocônicos com córneas finas pode interromper a progressão do ceratocone nas córneas mais finas que 400 µm 24 meses após o tratamento.

Penetrating keratoplasty in patients with traumatic corneal scarring.

BACKGROUND: To evaluate the results of penetrating keratoplasty (PK) due to trauma-related corneal scarring. METHODS: We evaluated 24 eyes of 24 patients who underwent PK due to trauma-related scarring of the cornea between May 2010 and June 2016. The postoperative visual acuity, graft transparency, and complications were evaluated. RESULTS: The patients were divided into two groups. In group 1, 14 eyes of patients with traumatic corneal scars and retinal detachment underwent PK, pars plana vitrectomy, and intravitreal silicone administration with the help of temporary keratoprosthesis. Group I included five females and nine males with an average age of 39.15+-13.32 (min 8-max 73) years. An intraocular foreign body was removed from five of the eyes. The mean visual acuity was 3.01+-0.013 (3.10-1.00) logMAR after the surgery, 1.36+-0.23 (3.10-0.80) at the postoperative first month, and 1.18+-0.03 (3.10-0.70) at the end of the first year after the removal of keratoplasty sutures. During the follow-up of patients, two eyes (14.2%) lost light sensation, eight eyes (57.1%) developed postoperative glaucoma, nine eyes (64.2%) had graft rejection, and one patient (7.1%) developed keratitis. In one eye (7.1%), the cornea was scraped using ethylenediaminetetraacetic acid due to silicone-related band keratopathy. In group 2, ten eyes with trauma-related corneal scars underwent PK. This group included two females and eight males with an average age of 29.23+-12.03 (11-63) years. The mean visual acuity was 2.98+-0.68 (3.10-1.00) logMAR before the surgery, 0.58+-0.22 (1.80-0.30) at the postoperative first month, and 0.50+-0.17 (1.80-0.10) at the end of the first year. One eye (10%) with iridodialysis developed glaucoma. Rejection was not seen in any of the patients. A statistically significant difference was observed in both groups with regard to visual acuity before operation, at 1 and 12 months after operation, and at 12 months for graft transparency rates (p=0.015, p=0.021, p=0.001, respectively). CONCLUSION: In cases of eye injuries due to trauma, the eyes subjected to combined vitrectomy and PK had poor visual prognosis and high graft rejection rate compared to those subjected to PK as the only treatment.

Association between systemic activity index and dry eye severity in patients with primary Sjögren syndrome / A associação entre o índice de atividade sistêmica e a severidade do olho seco em pacientes com síndrome de Sjögren primária

ABSTRACT Purpose: The aim of the present study was to compare the severity of ocular and systemic findings among patients with primary Sjögren syndrome. Methods: The study followed a prospective controlled design and comprised two groups; the test group included 58 eyes of 58 patients newly diagnosed with primary Sjögren syndrome with poor dry eye test findings and the control group included 45 right eyes of 45 healthy age- and sex-matched individuals. The ocular surface disease index score, tear osmolarity, Schirmer I test without anesthesia, fluorescein tear breakup time, and cornea-conjunctiva staining with lissamine green (van Bijsterveld scoring) were used to examine tear function in the patients via a complete ophthalmological examination. The results were graded and classified on the basis of a Dry Eye WorkShop report and results of the corneal and conjunctival staining test, Schirmer's test, and fluorescein tear breakup time test. Discomfort, severity and frequency of symptoms, visual symptoms, conjunctival injection, eyelid-meibomian gland findings, and corneal-tear signs were interpreted. Disease activity was scored per the EULAR Sjögren's syndrome disease activity index (ESSDAI) via systemic examination and laboratory evaluations, and the EULAR Sjögren's syndrome patient-reported index (ESSPRI) assessed via a survey of patient responses. Results: Mean patient age was 48.15 ± 16.34 years in the primary Sjögren syndrome group and 44.06 ± 9.15 years in the control group. Mean fluorescein tear breakup time was 4.51 ± 2.89s in the primary Sjögren syndrome group and 10.20 ± 2.39 s in the control group. Mean Schirmer I test result was 3.51 ± 3.18 mm/5 min in the primary Sjögren syndrome group and 9.77±2.30 mm/5 min in the control group. Mean ocular surface disease index score was 18.56 ± 16.09 in the primary Sjögren syndrome group, and 19.92 ± 7.16 in the control group. Mean osmolarity was 306.48 ± 19.35 in the primary Sjögren syndrome group, and 292.54 ± 10.67 in the control group. Mean lissamine green staining score was 2.17 ± 2.76 in the primary Sjögren syndrome group, and 0.00 in the control group. Statistically significant differences were found berween the primary Sjögren syndrome group and control group in terms of fluorescein tear breakup time, Schirmer's test, lissamine green staining, and osmolarity tests (p=0.036, p=0.041, p=0.001, and p=0.001 respectively). The Dry Eye WorkShop score was 2.15 ± 0.98, the EULAR Sjögren's syndrome disease activity index score was 11.18 ± 4.05, and the EULAR Sjögren's syndrome patient-reported index score was 5.20±2.63. When potential associations of the Dry Eye Workshop Study scores and osmolarity scores with the Eular Sjögren's syndrome disease activity index scores were evaluated, the results were found to be statistically significant (p=0.001, p=0.001 respectively). Conclusion: The results showed an association between dry eye severity and systemic activity index in primary Sjögren syndrome patients.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a gravidade dos achados oculares e sistêmicos entre pacientes com síndrome de Sjögren primária. Métodos: O estudo seguiu um delineamento prospectivo controlado e compreendeu dois grupos; o grupo de teste incluiu 58 olhos de 58 pacientes recém-diagnosticados com síndrome de Sjögren primária com resultados deficientes no teste de olho seco e o grupo controle incluiu 45 olhos direitos de 45 indivíduos saudáveis pareados idade e sexo. A contagem do índice de doença da superfície ocular, osmolaridade lacrimal, teste de Schirmer I sem anestesia, tempo de ruptura da fluoresceína e coloração córnea-conjuntiva com verde de lissamina (índice de van Bijsterveld) foram utilizados para examinar a função lacrimal dos pacientes através de exame oftalmológico completo. Os resultados foram classificados com base em um relatório da "Dry Eye Workshop" e resultados do teste de coloração da córnea e conjuntiva, teste de Schirmer e teste do tempo de ruptura da fluoresceína. Desconforto, gravidade e frequência dos sintomas, sintomas visuais, injeção conjuntival, achados das glândulas palpebrais e sinais da córnea foram interpretados. A atividade da doença foi avaliada pelo índice de atividade da doença da síndrome de Sjögren EULAR por meio de exame sistêmico e avaliações laboratoriais, e o índice relatado pelo paciente da síndrome de Sjörgen EULAR avaliado através de uma pesquisa das respostas dos pacientes. Resultados: A média de idade dos pacientes foi de 48,15 ± 16,34 anos no grupo da Síndrome de Sjörgen primária e 44,06 ± 9,15 anos no grupo controle. O tempo médio de ruptura da fluoresceína foi de 4,51 ± 2,89 s no grupo síndrome de Sjögren primária e 10,20 ± 2,39 s no grupo controle. O resultado do teste de Schirmer I médio foi de 3,51 ± 3,18 mm/5 min no grupo síndrome de Sjögren primária e de 9,77 ± 2,30 mm/5 min no grupo controle. O índice médio de doença da superfície ocular foi de 18,56 ± 16,09 no grupo síndrome de Sjögren primária e 19,92 ± 7,16 no grupo controle. A osmolaridade média foi 306,48 ± 19,35 no grupo síndrome de Sjögren primária e 292,54 ± 10,67 no grupo controle. O resultado médio de coloração com lissamina verde foi de 2,17 ± 2,76 no grupo síndrome de Sjögren primária e 0,00 no grupo controle. Diferenças es­tatisticamente significativas foram encontradas entre o com sín­­drome de Sjögren primária e o grupo controle em termos de tempo de ruptura da fluoresceína lacrimal, teste de Schirmer I, coloração com lissamina verde e osmolaridade (p=0,036, p=0,041, p=0,001, p=0,001 respectivamente). O índice Estudo do Olho Seco foi de 2,15 ± 0,98, o índice de atividade da doença da síndrome de Sjögren EULAR foi de 11,18 ± 4,05 e a pontuação do índice relatado pelo paciente EULAR Sjögren foi de 5,20 ± 2,63. Quando associações potenciais do Estudo do Olho Seco e o índice da osmolaridade foram comparados a pontuação de índice de atividade da doença da síndrome de Sjögren EULAR, os resultados foram estatisticamente significantes (p=0,001, p=0,001 respectivamente). Conclusão: Os resultados mostraram uma associação entre a gravidade do olho seco e o índice de atividade sistêmica em pacientes com síndrome de Sjögren primária.

Central corneal thickness and corneal volume changes in eyes with and without pseudoexfoliation after uneventful phacoemulsification.

AIM: To investigate the effects of uneventful phacoemulsification on central corneal thickness (CCT) and corneal volume (CV) in pseudoexfoliative eyes during a 3 months postoperative period and compare these changes to eyes without pseudoexfoliation (PEX) syndrome. Another purpose of this study was to compare the CCT measurements done by ultrasound pachymetry (UP) with those done by the Oculus Pentacam. MATERIAL AND METHOD: A total of 42 eyes of 42 consecutive patients with cataracts and PEX syndrome that underwent uneventful phacoemulsification were enrolled in this prospective study. A control group of 42 eyes of 42 patients with cataracts/without PEX was employed for comparison. CV and CCT measurements were obtained preoperatively and at 1 and 3 months postoperatively with the Pentacam. CCT values were also measured with UP. T test and Wilcoxon sign test were used to compare the variables. RESULTS: The mean age of the patients was 72.1 ± 8.3 and 66.6 ± 9.6 years in PEX and non-PEX group, respectively. In both groups, there were no significant differences between preoperative and postoperative CV (Fig. 1), CCT by the Pentacam (Fig. 2) and CCT by UP (Fig. 3) values (p > 0.05). CCT measurements obtained by two devices were also similar, and there were no statistically significant differences (p > 0.05). Changes in CV and CCT remained stabile at 3 months postoperatively. CONCLUSION: Eyes with and without PEX syndrome exhibit similar corneal features before and after phacoemulsification. A surgery in early stages of cataracts in PEX syndrome, not only provides a non-complicated surgery, but also leads to a less damaged cornea similar to eyes without PEX.

The optical coherence tomography angiography findings of rheumatoid arthritis patients taking hydroxychloroquine.

PURPOSE: The aim of this study is to measure retinal vessel density and thickness of the macula by optical coherence tomography angiography in patients with rheumatoid arthritis taking hydroxychloroquine. METHODS: The study included 40 patients with rheumatoid arthritis taking hydroxychloroquine and 20 age-, gender-, and axial length-matched control subjects. Patients were divided into two groups according to the duration of hydroxychloroquine use. Twenty four of the patients were taking hydroxychloroquine for more than 5 years (Group 1), and the rest of 16 were taking hydroxychloroquine for less than 5 years (Group 2). A total of 20 age- and gender-matched volunteers with similar axial length were selected as Group 3. All of the patients underwent optical coherence tomography angiography, and 3 mm × 3 mm scanning mode was chosen for analyzing vascular density and morphological characteristics on the choriocapillaris layer. In addition, Humphrey visual field 10-2 was evaluated in each subject. RESULTS: The temporal deep vascular density was measured as 48.13% ± 8.5% in Group 1, 54.42% ± 10.3% in Group 2, and 60.35% ± 13.1% in Group 3. Deep temporal and deep hemi-inferior vascular density was significantly lower in Group 1 in comparison with Group 3 (p = 0.041 and p = 0.046, respectively). Visual field testing was normal in all patients. CONCLUSION: The optical coherence tomography angiography findings showed that the parafoveal deep temporal and deep hemi-inferior vascular plexus density was reduced in patients taking hydroxychloroquine for more than 5 years despite having normal perimetry. This observation, which can be obtained only through optical coherence tomography angiography, may be relevant to the early findings of hydroxychloroquine toxicity.

Corneal stromal depth of the demarcation line in 'accelerated corneal cross-linking' with different concentrations of riboflavin solutions.

PURPOSE: The aim of this study is to compare the effect of different riboflavin solutions (hypotonic and isotonic) used during accelerated corneal cross-linking (CXL) on the mean depth of the demarcation line (DDL) formed in corneal stroma. METHODS: This prospective, cross-sectional study included 38 eyes of 26 patients. All patients underwent accelerated CXL due to progressive keratoconus. When the corneal epithelium was removed, 17 eyes of 12 patients with corneal thickness < 400 µm were categorized as Group 1, and 21 eyes of 14 patients with corneal thickness > 400 µm as Group 2. Hypotonic riboflavin was applied to Group 1 patients, and isotonic riboflavin to Group 2 patients. Anterior segment optical coherence tomography was performed on all patients by two independent observers at the end of the first and third months. RESULT: Group 1 included 5 male and 7 female patients with an average age of 25.1 ± 8.0 years, whereas Group 2 included 7 male and 7 female patients with an average age of 31.8 ± 10.12 years. At the end of the first month, the mean DDL in Group 1 and Group 2 was 180.32 ± 10.26 and 287.21 ± 15.01 µm, respectively. This difference was statistically significant (p < 0.05). CONCLUSION: Application of different riboflavin solutions was observed to have an effect on measured corneal thickness after saturation and the depth of the demarcation line. The use of hypotonic riboflavin results in swelling of the cornea and more superficial localization of the stromal demarcation line after CXL.

Association between systemic activity index and dry eye severity in patients with primary Sjögren syndrome.

PURPOSE: The aim of the present study was to compare the severity of ocular and systemic findings among patients with primary Sjögren syndrome. METHODS: The study followed a prospective controlled design and comprised two groups; the test group included 58 eyes of 58 patients newly diagnosed with primary Sjögren syndrome with poor dry eye test findings and the control group included 45 right eyes of 45 healthy age- and sex-matched individuals. The ocular surface disease index score, tear osmolarity, Schirmer I test without anesthesia, fluorescein tear breakup time, and cornea-conjunctiva staining with lissamine green (van Bijsterveld scoring) were used to examine tear function in the patients via a complete ophthalmological examination. The results were graded and classified on the basis of a Dry Eye WorkShop report and results of the corneal and conjunctival staining test, Schirmer's test, and fluorescein tear breakup time test. Discomfort, severity and frequency of symptoms, visual symptoms, conjunctival injection, eyelid-meibomian gland findings, and corneal-tear signs were interpreted. Disease activity was scored per the EULAR Sjögren's syndrome disease activity index (ESSDAI) via systemic examination and laboratory evaluations, and the EULAR Sjögren's syndrome patient-reported index (ESSPRI) assessed via a survey of patient responses. RESULTS: Mean patient age was 48.15 ± 16.34 years in the primary Sjögren syndrome group and 44.06 ± 9.15 years in the control group. Mean fluorescein tear breakup time was 4.51 ± 2.89s in the primary Sjögren syndrome group and 10.20 ± 2.39 s in the control group. Mean Schirmer I test result was 3.51 ± 3.18 mm/5 min in the primary Sjögren syndrome group and 9.77±2.30 mm/5 min in the control group. Mean ocular surface disease index score was 18.56 ± 16.09 in the primary Sjögren syndrome group, and 19.92 ± 7.16 in the control group. Mean osmolarity was 306.48 ± 19.35 in the primary Sjögren syndrome group, and 292.54 ± 10.67 in the control group. Mean lissamine green staining score was 2.17 ± 2.76 in the primary Sjögren syndrome group, and 0.00 in the control group. Statistically significant differences were found berween the primary Sjögren syndrome group and control group in terms of fluorescein tear breakup time, Schirmer's test, lissamine green staining, and osmolarity tests (p=0.036, p=0.041, p=0.001, and p=0.001 respectively). The Dry Eye WorkShop score was 2.15 ± 0.98, the EULAR Sjögren's syndrome disease activity index score was 11.18 ± 4.05, and the EULAR Sjögren's syndrome patient-reported index score was 5.20±2.63. When potential associations of the Dry Eye Workshop Study scores and osmolarity scores with the Eular Sjögren's syndrome disease activity index scores were evaluated, the results were found to be statistically significant (p=0.001, p=0.001 respectively). CONCLUSION: The results showed an association between dry eye severity and systemic activity index in primary Sjögren syndrome patients.

Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas / Desempenho visual das lentes esclerais e seu impacto na qualidade de vida de pacientes com córneas irregulares

ABSTRACT Purpose: We aimed to evaluate the visual quality performance of scleral contact lenses in patients with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism, and their impact on quality of life. Methods: We included 40 patients (58 eyes) with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism who were examined between October 2014 and June 2017 and fitted with scleral contact lenses in this study. Before fitting scleral contact lenses, we noted refraction, uncorrected distance visual acuity, spectacle-corrected distance visual acuity, uncorrected contrast sensitivity, and spectacle-corrected contrast sensitivity. We performed corneal topography on and applied a questionnaire that included the National Eye Institute Visual Functioning Questionnaire to all participants. We recorded corrected contrast sensitivity and corrected distance visual acuity on the third month after fitting scleral contact lenses and requested that subjects repeat the National Eye Institute Visual Functioning Questionnaire. Results: The mean age of patients was 28.12 ± 13.19 years. Mean logMAR uncorrected distance visual acuity, spectacle-corrected distance visual acuity, and corrected distance visual acuity with scleral contact lenses were 0.91 ± 0.21 (0.40-1.80), 0.57 ± 0.12 (0.10-1.80), and 0.16 ± 0.02 (0.00-1.30), respectively. We observed significantly higher corrected distance visual acuity with scleral contact lenses compared with uncorrected distance visual acuity and spectacle-corrected distance visual acuity (p<0.05). Mean uncorrected contrast sensitivity, spectacle-corrected contrast sensitivity and CCS with scleral contact lenses were 0.97 ± 0.12 (0.30-1.65), 1.16 ± 0.51 (0.30-1.80), and 1.51 ± 0.25 (0.90-1.80), respectively. Significantly higher contrast sensitivity levels were recorded with scleral contact lenses compared with those recorded with uncorrected contrast sensitivity and spectacle-corrected contrast sensitivity (p<0.05). We found the National Eye Institute Visual Functioning Questionnaire overall score for patients with scleral contact lens treatment to be significantly higher compared with that for patients with uncorrected sight (p<0.05). Conclusion: Scleral contact lenses are an effective alternative visual correction method for keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism. A significant increase in visual acuity and contrast sensitivity can be obtained with scleral contact lenses in patients with irregular corneas.

RESUMO Objetivo: Avaliar o desempenho da qualidade visual das lentes de contato esclerais em pacientes com ceratocone, degeneração marginal transparente e astigmatismo pós-ceratoplastia e seu impacto na qualidade de vida. Métodos: Foram incluídos 40 pacientes (58 olhos) com ceratocone, degeneração marginal transparente ou astigmatismo pós-ce­ratoplastia que foram examinados entre outubro de 2014 e junho de 2017 e adaptados com lentes de contato esclerais neste estudo. Antes de ajustar as lentes de contato esclerais, registrou-se refração, acuidade visual à distância não corrigida, acuidade visual à distância corrigida por óculos, sensibilidade ao contraste não corrigida e sensibilidade ao contraste corrigida por óculos. Rea­lizamos topografia da córnea e aplicamos um questionário que incluía o Questionário de Funcionamento Visual do National Eye Institute para todos os participantes. Registramos a sensibilidade ao contraste corrigida e corrigimos a acuidade visual à distância no terceiro mês após a adaptação das lentes de contato esclerais e solicitamos aos participantes que repetissem o Questionário de Funcionamento Visual do National Eye Institute. Resultados: A idade média dos pacientes foi de 28,12 ± 13,19 anos. A acuidade visual à distância não corrigida logMAR média, a acuidade visual à distância corrigida por óculos e a distância visual corrigida com as lentes de contato esclerais foram 0,91 ± 0,21 (0,40-1,80), 0,57 ± 0,12 (0,10-1,80), 0,16 ± 0,02 (0,00-1,30), respectivamente. Observamos uma acuidade visual à distância corrigida significativamente maior com lentes de contato esclerais em comparação à acuidade visual à distância não corrigida e à acuidade visual à distância corrigida por óculos (p<0,05). Sensibilidade ao contraste médio não corrigido, sensibilidade ao contraste corrigida por óculos e CCS com lentes de contato esclerais foram 0,97 ± 0,12 (0,30-1,65), 1,16 ± 0,51 (0,30-1,80), 1,51 ± 0,25 (0,90-1,80), respectivamente. Significativamente maiores níveis de sensibilidade ao contraste foram registrados com lentes de contato esclerais em comparação com aqueles registrados com sensibilidade ao contraste não corrigida e sensibilidade ao contraste corrigida por óculos (p<0,05). Descobrimos que a pontuação geral do Questionário de Funcionamento Visual do National Eye Institute para pacientes em tratamento com lentes de contato esclerais é significativamente maior em comparação com pacientes com visão não corrigia (p<0,05). Conclusão: As lentes de contato esclerais constituem um método alternativo eficaz de correção visual alternativa para o ceratocone, degeneração marginal transparente e o astigmatismo pós-ceratoplastia. Um aumento significativo na acuidade visual e sensibilidade ao contraste pode ser obtido com lentes de contato esclerais em pacientes com córneas irregulares.

Effect of the bioprotectant agent trehalose on corneal epithelial healing after corneal cross-linking for keratoconus / Efeito do agente bioprotetor trealose na cicatrização epitelial da córnea após reticulação corneana para ceratocone

ABSTRACT Purpose: This study aimed to compare the effectiveness of eye drops containing a combination of sodium hyaluronate and trehalose and sodium hyaluronate for the treatment of corneal cross-linking and epithelial healing. Methods: This study included 46 eyes of 23 keratoconus patients who underwent corneal cross-linking on both eyes. Unpreserved trehalose 30 mg/mL and sodium hyaluronate 1.5 mg/mL (Thealoz Duo®; Thea, France) were applied six times a day on one eye of each patient and unpreserved sodium hyaluronate 0.15% (Eye Still®; Teka, Inc., Istanbul) was applied on the other eye. Patients were examined daily until complete re-epithelialization. Postoperative examinations to assess the measured size of epithelial defect were performed using slit-lamp biomicroscopy. Results: The study included 23 patients (13 females and 10 males) with a mean age of 20.9 ± 10.3 years. Corneal epithelial healing time after cross-linking was 2.3 ± 1.2 days for the trehalose and sodium hyaluronate group and 3.8 ± 2.9 days for the sodium hyaluronate group (p=0.03). Conclusion: The application of eye drops containing the combination of trehalose and sodium hyaluronate resulted in faster corneal re-epithelialization following corneal cross-linking than that of eye drops containing sodium hyaluronate alone.

RESUMO Objetivo: Este estudo teve como objetivo comparar a eficácia de colírios contendo uma combinação de hialurônico de sódio e hialuronato de sódio e trealose para o tratamento da cicatrização epitelial em pacientes com cross-linking corneano. Métodos: Este estudo inclui 46 olhos de 23 pacientes com ceratocone, que foram operados com cross-linking corneano em ambos os olhos. Trealose não preservada 30 mg/mL e hialuronato de sódio 1,5 mg/mL (Thealoz Duo®; Thea, França) foram aplicados seis vezes por dia em um olho de cada paciente e hialuronato de sódio não conservado, 0,15% (Eye Still®; Teka, Inc., Istambul) foi aplicada no outro olho. Os pacientes foram examinados diariamente até a completa reepitelização. Exames pós-operatórios para avaliar o tamanho medido do defeito epitelial foram realizados usando biomicroscopia com lâmpada de fenda. Resultados: O estudo incluiu 23 pacientes (13 mulheres e 10 homens) com idade média de 20,9 ± 10,3. O tempo de cicatrização epitelial da córnea após o cross-linking foi de 2,3 ± 1,2 dias para o grupo trealose e hialuronato de sódio e 3,8 ± 2,9 dias para o grupo hialurônico de sódio (p=0,03). Conclusão: A aplicação de gotas para os olhos contendo combinação de trealose e hialuronato de sódio resultou em uma re-epitelização da córnea mais rápida após o cross-linking corneano do que a de gotas contendo hialurônico de sódio apenas.

Effect of the bioprotectant agent trehalose on corneal epithelial healing after corneal cross-linking for keratoconus.

PURPOSE: This study aimed to compare the effectiveness of eye drops containing a combination of sodium hyaluronate and trehalose and sodium hyaluronate for the treatment of corneal cross-linking and epithelial healing. METHODS: This study included 46 eyes of 23 keratoconus patients who underwent corneal cross-linking on both eyes. Unpreserved trehalose 30 mg/mL and sodium hyaluronate 1.5 mg/mL (Thealoz Duo®; Thea, France) were applied six times a day on one eye of each patient and unpreserved sodium hyaluronate 0.15% (Eye Still®; Teka, Inc., Istanbul) was applied on the other eye. Patients were examined daily until complete re-epithelialization. Postoperative examinations to assess the measured size of epithelial defect were performed using slit-lamp biomicroscopy. RESULTS: The study included 23 patients (13 females and 10 males) with a mean age of 20.9 ± 10.3 years. Corneal epithelial healing time after cross-linking was 2.3 ± 1.2 days for the trehalose and sodium hyaluronate group and 3.8 ± 2.9 days for the sodium hyaluronate group (p=0.03). CONCLUSION: The application of eye drops containing the combination of trehalose and sodium hyaluronate resulted in faster corneal re-epithelialization following corneal cross-linking than that of eye drops containing sodium hyaluronate alone.

Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas.

PURPOSE: We aimed to evaluate the visual quality performance of scleral contact lenses in patients with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism, and their impact on quality of life. METHODS: We included 40 patients (58 eyes) with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism who were examined between October 2014 and June 2017 and fitted with scleral contact lenses in this study. Before fitting scleral contact lenses, we noted refraction, uncorrected distance visual acuity, spectacle-corrected distance visual acuity, uncorrected contrast sensitivity, and spectacle-corrected contrast sensitivity. We performed corneal topography on and applied a questionnaire that included the National Eye Institute Visual Functioning Questionnaire to all participants. We recorded corrected contrast sensitivity and corrected distance visual acuity on the third month after fitting scleral contact lenses and requested that subjects repeat the National Eye Institute Visual Functioning Questionnaire. RESULTS: The mean age of patients was 28.12 ± 13.19 years. Mean logMAR uncorrected distance visual acuity, spectacle-corrected distance visual acuity, and corrected distance visual acuity with scleral contact lenses were 0.91 ± 0.21 (0.40-1.80), 0.57 ± 0.12 (0.10-1.80), and 0.16 ± 0.02 (0.00-1.30), respectively. We observed significantly higher corrected distance visual acuity with scleral contact lenses compared with uncorrected distance visual acuity and spectacle-corrected distance visual acuity (p<0.05). Mean uncorrected contrast sensitivity, spectacle-corrected contrast sensitivity and CCS with scleral contact lenses were 0.97 ± 0.12 (0.30-1.65), 1.16 ± 0.51 (0.30-1.80), and 1.51 ± 0.25 (0.90-1.80), respectively. Significantly higher contrast sensitivity levels were recorded with scleral contact lenses compared with those recorded with uncorrected contrast sensitivity and spectacle-corrected contrast sensitivity (p<0.05). We found the National Eye Institute Visual Functioning Questionnaire overall score for patients with scleral contact lens treatment to be significantly higher compared with that for patients with uncorrected sight (p<0.05). CONCLUSION: Scleral contact lenses are an effective alternative visual correction method for keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism. A significant increase in visual acuity and contrast sensitivity can be obtained with scleral contact lenses in patients with irregular corneas.

Hydro cone lens visual performance and impact on quality of life in irregular corneas.

The aim of this study is to evaluate the visual performance (efficiency) of HydroCone (Toris K) soft silicon hydrogel lenses in patients with irregular corneas.

Lid-parallel conjunctival folds (LIPCOF) and dry eye: a multicentre study.

AIMS: The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye. METHODS: At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7±16.2 years. The LIPCOF were graded according to the method of Höh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions. RESULTS: The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r>0.2, p<0.001), and negative correlations with BUT and results of the Schirmer 1 test (r<-0.2, p<0.001). The LIPCOF score exhibited a significant correlation with the overall subjective symptoms (r=0.250, p<0.001). The sensitivity and specificity of LIPCOF grading for discriminating between normal and dry eyes were best with the cut-off between LIPCOF degrees 1 and 2. CONCLUSIONS: The displayed medium sensitivity and specificity, and good positive predictive value of the LIPCOF test support the use of LIPCOF grading as a simple, quick and non-invasive dry eye screening tool.