Late-Onset Haze and Severe Corneal Flattening after Combined Corneal Collagen Cross-Linking and Photorefractive Keratectomy (CXL Plus): A Case Report.

Introduction: Significant corneal flattening and haze are important complications that can occur after combined corneal collagen cross-linking (CXL) and photorefractive keratectomy (PRK) procedures (CXL Plus). Case Presentation: We present a 24-year-old man who underwent combined standard CXL and PRK. The patient experienced satisfactory vision for approximately 4 years after the surgery. However, after this period, he began to complain of visual blurring. Subsequent examination revealed significant corneal haze, excessive flattening in both eyes, and thinning (thinnest point 227 µm in the right eye, 244 µm in the left eye) 4 years postoperatively. Upon presentation, the corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/400 in the left eye. The presenting refraction was +2.50 sph, -3.50 cyl *114 in the right eye and +11.5 sph, -9.75 cyl *81 in the left eye. With rigid gas permeable contact lenses, the corrected visual acuity was 20/50 in both eyes. Before the CXL Plus surgery, initial refraction and CDVA were 20/50 in the right eye (-5.50 sph, -3.00 cyl *175) and 20/30 in the left eye (-5.50 sph, -2.75 cyl *175). The patient was treated by penetrating keratoplasty. The CDVA reached 20/30 at the final follow-up. Conclusion: Our report highlights significant corneal haze and flattening that occurred 4 years after combined CXL and PRK treatment. These findings suggest that this procedure might not be safe in suspected patients of keratoconus. Further long-term follow-up research is necessary to evaluate the safety of combined CXL and PRK procedures.

Clinical Outcomes of Femtosecond Laser-assisted Implantation of 325-Degree Versus 340-Degree Arc Length Intracorneal Ring Segments in Naive Keratoconic Eyes.

Purpose: To evaluate and compare clinical outcomes after femtosecond laser-assisted implantation of 325-degree versus 340-degree arc length intracorneal ring segments (ICRS) in eyes with keratoconus (KCN). Methods: In this prospective non-randomized interventional case series, 23 eyes of 21 patients diagnosed with KCN, underwent femtosecond laser-assisted implantation of two types of ICRS, which included a 325-degree ICRS (Group 325) and a 340-degree ICRS (Group 340). The primary outcome measures were uncorrected distance visual acuity (UDVA), and the secondary outcome measures included corrected distance visual acuity (CDVA), sphere, cylinder, mean refractive spherical equivalent (MRSE), keratometry, vectorial change in corneal astigmatism, and the location of maximum keratometry relative to the corneal apex. The study groups were compared using the primary and secondary outcome measures obtained at postoperative months six and 12. Results: Groups 325 and 340 consisted of 10 and 13 eyes, respectively. The two groups were comparable in terms of parameters measured preoperatively. On comparison to the baseline values, both study groups exhibited a significant increase in UDVA and CDVA measured at postoperative month six (Ps < 0.05) and a significant decrease in the sphere, cylinder, spherical equivalent refraction, and keratometry readings measured at postoperative months six and 12 (Ps < 0.05). No significant differences were observed between the two groups in terms of visual, refractive, and keratometric outcomes at any time point. No intraoperative or postoperative complications were observed in any of the study groups. Conclusion: Both the 325-degree ICRS and the 340-degree ICRS effectively and equally improved visual, refractive, and keratometric outcomes in keratoconic eyes.

Unilateral Presentation of Vogt-Koyanagi-Harada Syndrome.

PURPOSE: To report a case of acute Vogt-Koyanagi-Harada (VKH) disease with unilateral clinical manifestations followed by late fellow eye involvement. CASE REPORT: This case report reviews the 12-month follow-up observation of a 44-year old woman who presented to the emergency department with unilateral progressive and painless visual blurring. Ophthalmoscopic findings, best-corrected visual acuity (BCVA), fluorescein angiography (FAG), enhanced-depth optical coherence tomography (EDI-OCT), indocyanine green angiography, and response to treatment were evaluated. Her BCVA was 20/50 (logMAR: 0.4) in the right eye and 20/20 (logMAR: 0) in the left eye. Eye examination revealed optic disc swelling and multiple serous retinal detachments in the right eye and a normal left eye. She had headache, dysacusia, and mild hearing problem. Her past ocular and drug histories were unremarkable. Retinal imaging revealed characteristic features of VKH in the right eye. All laboratory testing results were inconclusive. VA and OCT findings significantly improved following the treatment with methylprednisolone 1 g/day continued by tapering dose of oral prednisolone. Two months after the presentation and during prednisolone tapering, VA of the left eye decreased and fundus examination revealed multiple serous retinal detachments in this eye. CONCLUSION: Ophthalmologists should recognize unilateral and asymmetrical VKH disease with subtle systemic involvement.

The Consumption of Synbiotic Bread Containing Lactobacillus sporogenes and Inulin Affects Nitric Oxide and Malondialdehyde in Patients with Type 2 Diabetes Mellitus: Randomized, Double-Blind, Placebo-Controlled Trial.

OBJECTIVES: To our knowledge, no reports are available indicating the effects of synbiotic bread consumption on nitric oxide (NO), biomarkers of oxidative stress, and liver enzymes among patients with type 2 diabetes mellitus (T2DM). This study was performed to determine the effects of the daily consumption of synbiotic bread on NO, biomarkers of oxidative stress, and liver enzymes in patients with T2DM. METHODS: This randomized, double-blind, placebo-controlled trial was performed among 81 patients with diabetes, aged 35-70 years old. After a 2-week run-in period, patients were randomly divided into 3 groups: group A (n = 27) received synbiotic bread containing viable and the heat-resistant probiotic Lactobacillus sporogenes (1 × 108 CFU) and 0.07 g inulin per 1 g, group B (n = 27) received probiotic bread containing Lactobacillus sporogenes (1 × 108 CFU), and group C (n = 27) received control bread for 8 weeks. Patients were asked to consume the synbiotic, probiotic, or control breads 3 times a day in 40 g packages for a total of 120 g/day. Fasting blood samples were taken at baseline and after an 8-week intervention for quantificationof related markers. RESULTS: After 8 weeks, the consumption of synbiotic bread compared to the probiotic and control breads resulted in a significant rise in plasma NO (40.6 ± 34.4 vs 18.5 ± 36.2 and -0.8 ± 24.5 µmol/L, respectively, p < 0.001) and a significant reduction in malondialdehyde (MDA) levels (-0.7 ± 0.7 vs 0.6 ± 1.7 and 0.5 ± 1.5 µmol/L, respectively, p = 0.001). We did not find any significant effect of the synbiotic bread consumption on plasma total antioxidant capacity (TAC), plasma glutathione (GSH), catalase, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure compared to the probiotic and control breads. CONCLUSION: In conclusion, consumption of the synbiotic bread for 8 weeks among patients with T2DM had beneficial effects on plasma NO and MDA levels; however, it did not affect plasma TAC, GSH, catalase levels, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure.

Opioid receptor antagonist promotes angiogenesis in bile duct ligated rats.

BACKGROUND AND AIM: Angiogenesis, formation of new capillaries from existing vasculature, plays a pivotal role in different pathological states such as many chronic inflammatory diseases including the chronic liver diseases. There is increasing evidence demonstrating accumulation of endogenous opioids and their role in the pathophysiology and manifestations of cholestasis, the main feature of a number of chronic progressive liver diseases. Hence, we investigated the significance of endogenous opioids in angiogenesis in an experimental model of cholestasis. METHODS: Cholestasis was induced in male Sprague-Dawley rats by bile duct ligation and resection. Naltrexone, an opioid antagonist (20 mg/kg/day) was administered to cholestatic animals for 22 +/- 1 days. The serial sections from liver tissue were stained with von Willebrand Factor antibody and micro-vessel density was assessed by calculating mean micro-vessel number in three hot spots high power microscopic fields. RESULTS: Naltrexone treatment in bile duct ligated rats led to a marked increase in the micro-vessel number (6.34 +/- 0.21 vs 5.61 +/- 0.22) (P < 0.05), which had already increased during cholestasis. CONCLUSION: In order to clarify the impacts of opioid system blockade in cirrhosis, our findings demonstrate the promoting role of opioid antagonist in angiogenesis in a rat model of cholestasis.