Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series.

PURPOSE: To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. METHODS: In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. RESULTS: Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. CONCLUSION: Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.

New approach to AGV implantation with scleral tunnel method by prolene suture: Simsek Technique.

PURPOSE: To present the short-term outcomes of our novel technique, the suture-assisted method, in long scleral tunnel Ahmed Glaucoma Valve (AGV) implantation. METHODS: This retrospective study included glaucoma patients who underwent AGV implantation using the suture-assisted long scleral tunnel method and were fellowed for at least 6 months between January 2022 and November 2022. Preoperative and postoperative assessments included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment examinations, anti-glaucomatous medications, and intraoperative and postoperative complications were also evaluated. RESULTS: Eight eyes of seven patients were included in the study. The mean age was 52.25 ± 29.38 years (r:8-76 years), and there were 5 female and 2 male patients. The mean follow-up duration period was 8.62 ± 2.50 months (r:6-12 months). The mean IOP was 27.12 ± 3.48 mmHg preoperatively and 11.62 ± 3.48 mmHg on postoperative on 1st day, 11.62 ± 3.20 mmHg at 1st week, 18.75 ± 8.94 mmHg at 1st month, 16.62 ± 2.72 mmHg at 3rd month, 16.12 ± 3.75 mmHg at 6th month. Postoperative hyphema was observed in one eye, and tenon cyst excision was performed in two eyes. No tube exposure was observed in any eye during the follow-up period. No hypotony-related complications were observed during follow-up. CONCLUSION: We believe that suture-asissted application of the long scleral tunnel method not only prevents tube exposure but also facilitates the passage of the AGV silicone tube through the scleral tunnel, reducing the surgical time contributing to a decreased the risk of infection.

The effect of systemic sclerosis and its subtypes on ocular anterior and posterior segment parameters.

PURPOSE: To evaluate anterior and posterior segment parameters in the eyes of patients with systemic sclerosis (SSc) and examine the effect of disease and disease subtypes on these parameters. METHODS: This cross-sectional study included 54 eyes of 27 SSc patients and 54 eyes of 27 age- and sex-matched healthy controls. In addition to a complete ophthalmologic examination, all patients were examined using a Scheimpflug camera, specular microscopy, and spectral domain optical coherence tomography. RESULTS: The mean age of the patients was 52.5 ± 11.4 years and 19 patients were female. Anterior chamber volume, central corneal thickness, and central macular thickness (CMT) were significantly lower in the eyes of SSc patients compared to healthy controls (p = 0.01, p = 0.03, and p = 0.006, respectively). When evaluated according to SSc subtype, CMT was lower in diffuse SSc patients (p = 0.001), while mean retinal nerve fiber layer (RNFL) and inferior quadrant RNFL values were lower in limited SSc (p = 0.003 and p = 0.005, respectively). CONCLUSION: In the eyes of patients with SSc, some ocular parameters may show decreases compared to healthy individuals, presumably secondary to disease-related vasculopathy and fibrosis. CMT and RNFL parameters may be affected differently according to disease subtype.

Treatment Adherence Effect on the Visual Acuity of Behçet's Uveitis Patients.

PURPOSE: This study aimed to explore the relationship between treatment adherence, visual acuity, quality of life (QoL), depression, and anxiety levels in individuals with Behçet's uveitis (BU). METHODS: A total of 55 BU patients and 55 healthy controls completed sociodemographic questionnaires, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF), Self-reported Questionnaire About Treatment Compliance, and the Morisky Medication Adherence Scale (MMAS). The scores obtained from these scales were analyzed to assess the relationship between treatment adherence, visual acuity, QoL, depression, and anxiety levels. RESULTS: The results revealed that 36 (65.4%) of the 55 BU patients exhibited depressive symptoms, while 45 (81.8%) of them experienced symptoms of anxiety. Patients with BU demonstrated significantly higher BAI and BDI scores compared to the healthy control group (p < 0.001). Furthermore, the patient group reported lower mean scores across multiple domains of the WHOQOL-BREF questionnaire, including general health, psychological health, social relationships, and environment (p < 0.05). Moreover, a significant association was observed between low treatment adherence and lower values of best-corrected visual acuity (BCVA) (p < 0.05), as well as a higher frequency of uveitis attacks (p = 0.005). CONCLUSION: Poor treatment adherence in BU patients has a negative effect on final visual acuity outcomes. Moreover, BU patients experience lower QoL and higher rates of depression and anxiety compared to the healthy control group. These findings highlight the importance of addressing treatment adherence and psychological well-being in the management of BU.

Identification of novel variants in Turkish families with non-syndromic congenital cataracts using whole-exome sequencing.

PURPOSE: The present study aimed to identify the molecular etiology of non-syndromic congenital cataract (CC) using whole-exome sequencing (WES) analysis. METHODS: In the present study, ophthalmologic results and pedigree analysis of the families of 12 patients with non-syndromic CC were evaluated. WES analysis was conducted after DNA was isolated from peripheral blood samples obtained from the patients. RESULTS: Twelve non-syndromic probands (10 males and 2 females) with bilateral CC were included in the study. Patient age ranged between 1 and 11 months. WES analysis showed pathogenic/likely pathogenic variant in 7 (58%) of the 12 families and variant of unknown significance (VUS) in 5 (42%) of them. All the 13 different variants detected in 9 different CC-related genes were co-segregated with the disease. Autosomal dominant inheritance was found in 7 (58%) of the families and autosomal recessive inheritance was found in 5 (42%) of them. CONCLUSION: To the best of our knowledge, the present research is one of the limited numbers of studies in the Turkish population in which genetically heterogeneous non-syndromic CC was investigated using WES analysis. Novel variants that we identified in DNMBP, LSS, and WFS1 genes, which are rarely associated with the CC phenotype, have contributed to the mutation spectrum of this disease. Identifying the relevant molecular genetic etiology allows accurate genetic counseling to be provided to the families.

The effects of facial mask use on ocular surface parameters and tear film cytokine profile in prolonged use.

OBJECTIVE: To compare tear fluid levels of matrix metalloproteinase 9 (MMP-9) and IL-1ß cytokines between healthcare workers wearing facial masks and controls with correlations in clinical findings. METHODS: In a prospective, controlled clinical trial tear fluid was analyzed for MMP-9 and IL-1ß levels using a commercially available test (Invitrogen; Thermo Fisher Scientific Inc. Waltham, Massachusetts, USA). Symptoms and signs of dry eye disease (DED) were evaluated using the ocular surface disease index (OSDI), noninvasive tear break-up time (NIBUT), tear meniscus height (TMH), Oxford corneal staining, meibomiography, and clinical findings of meibomian gland dysfunction (MGD). RESULTS: In the 38 eyes of healthcare workers and 30 eyes of controls, there was no statistically significant difference between the groups in terms of age and sex (p > 0.05). The mean OSDI score, daily mask wear time, meibomiography degree, and rate of positive clinical findings of MGD were higher in group 1 than in group 2, and the mean NIBUT was higher in group 2. (p > 0.05). The mean values of IL-1ß and MMP-9 were higher in group 1 (p = 0.036 and p = 0.001, respectively). The TMH and Oxford score percentages were similar between the two groups (p > 0.05). CONCLUSIONS: Elevated levels of IL-1ß and MMP-9 in the basal tear fluid reveal increased ocular inflammation in healthcare professionals. Lower NIBUT values with higher OSDI and meibomian gland loss scores support ocular surface disturbance depending on regular mask use.

Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness in Adult Children of Patients With Pseudoexfoliation Glaucoma.

PRCIS: The adult children of patients with pseudoexfoliation glaucoma (PXG) had universally lower retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness values compared with individuals with a negative family history of PXG. PURPOSE: This study aimed to evaluate RNFL and GCC thicknesses in the adult children of individuals with PXG compared with people without a parental history of PXG. MATERIALS AND METHODS: This cross-sectional observational study included 40 eyes of 40 adults with confirmed parental history of PXG and 40 eyes of 40 healthy adults with no parental history of PXG. RNFL and macular GCC thicknesses were measured by spectral-domain optical coherence tomography (Nidek RS-3000 Advance) and compared between the groups. All subjects also underwent visual field testing (program 30-2 of the Humphrey Field Analyzer), and their mean deviation and pattern SD values were compared. RESULTS: Compared with adults without parental PXG, those with a parental history of PXG had significantly lower RNFL thickness overall (mean 98.2 vs 109.5 µm) and in all quadrants (inferior, superior, nasal, and temporal) ( P <0.001 for all). They also had significantly lower GCC thickness overall (mean 97.9 vs 109.4 µm) and in both hemispheres (superior and inferior) ( P <0.001 for all). There was no significant difference between the groups in terms of mean deviation or pattern SD values ( P >0.05). CONCLUSION: PXG in a parent was associated with significantly thinner RNFL and GCC compared with those with no history of PXG in a parent. Longer follow-up and prospective controlled clinical studies are needed to evaluate whether these findings may serve as an early indicator of glaucoma in the adult children of known PXG patients.

Infectious interface keratitis after Descemet membrane endothelial keratoplasty / Ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet

ABSTRACT Purpose: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). Conclusion: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.

RESUMO Objetivo: Avaliar o curso clínico e o manejo da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet. Métodos: Um total de 352 casos submetidos a ceratoplastia endotelial da membrana de Descemet foram revisados retrospectivamente. Pacientes com ceratite infecciosa de interface foram analisados durante o acompanhamento. As análises microbiológicas, o tempo até o início da infecção, os achados clínicos, a duração do acompanhamento, o tratamento e a acuidade visual para longe corrigida pós-tratamento foram registrados. Resultados: Ceratite infecciosa de interface foi detectada em 8 olhos de 8 casos. Três patógenos fúngicos e três bacterianos foram identificados em todos os casos e receberam tratamento médico de acordo com a sensibilidade da cultura. O tratamento antifúngico foi iniciado em dois casos sem crescimento em cultura, com diagnóstico preliminar de ceratite infecciosa fúngica. Injeções antifúngicas intraestromais foram usadas em todos os casos com infecções fúngicas. O tempo médio para o início da infecção foi de 164 dias (variação: 2-282 dias). A ceratite infecciosa de interface pós-operatória desenvolveu-se no período inicial em dois casos. A duração média do acompanhamento foi de 13,4 ± 6,2 meses (variação: 6-26 meses). A ceratoplastia endotelial de membrana de Descemet foi realizada em dois casos (25%) e ceratoplastia penetrante terapêutica em quatro casos (50%) que não se recuperaram com tratamento médico. A acuidade visual para longe corrigida final foi de 20/40 ou melhor em 5/8 (62,5%) dos pacientes. Conclusões: O diagnóstico e o tratamento da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet são difíceis. A intervenção cirúrgica precoce deve ser o procedimento preferido se não houver resposta ao tratamento médico. Melhor sobrevida do enxerto e melhor acuidade visual podem ser alcançadas com ceratoplastia penetrante terapêutica e ceratoplastia endotelial da membrana de Descemet em pacientes com ceratite infecciosa de interface

The electromyographic analysis of orbicularis oculi muscle in epiphora.

Purpose: Functional epiphora is a clinical condition that presents with the complaint of watery eyes, but without anatomical stenosis in the lacrimal drainage system. Although the mechanism is not clear, there are various possibilities involving the movement of the orbicularis oculi muscle, especially its deeper segment (Horner's muscle). We aimed to evaluate the function of the orbicularis oculi muscle in patients with patent, but dysfunctional lacrimal drainage system using a quantitative motor unit potential (MUP) analysis. Methods: Twenty-eight patients with functional epiphora (mean age = 59 years) and a control group of 28 volunteers were included in the study. Inclusion criteria were persistent and symptomatic epiphora or wiping >10 times per day and diagnosis confirmation by lacrimal irrigation test. Electromyography (EMG) was performed on the deeper segment of the orbicularis oculi muscle (medial and lateral parts). MUP parameters (duration time, amplitude, number of phases, number of turns, area, rise time, and thickness) were evaluated in both groups. Any increase in amplitude, prolongation time (>14 ms), number of turns, and satellite potential was taken as characteristic of the neurogenic type of epiphora, whereas shortened motor unit duration time, increased phase number, and low amplitude are the features of myopathic type. Results: Upon MUP analysis of the medial and lateral orbicularis oculi muscle, the increase in duration and thickness values in the medial part and the increase in duration, amplitude, area, and thickness values of the lateral part were found to be statistically significant in the patient group compared to the control group (P < 0.001). In the evaluation of the patients' medial and lateral orbicularis oculi muscle, the increase in phase values and decrease in amplitude, area, and rise time values were found to be statistically significant (P = 0.024, P < 0.001, P < 0.001, and P = 0.010, respectively). Conclusion: These data show that functional epiphora is due to neurogenic damage of the orbicularis oculi muscle and should be investigated in more detail.

Effect of manual upper eyelid elevation on intraocular pressure measurement by noncontact tonometer.

PURPOSE: To evaluate whether manual upper eyelid elevation (MUEE) affects intraocular pressure (IOP) values obtained with a noncontact tonometer (NT). METHODS: This cross-sectional study included 122 eyes of 122 non-glaucomatous adults. All patients underwent IOP measurement using both NT and Goldmann applanation tonometer (GAT). The order of measurements was NT without MUEE, NT with MUEE, and GAT. Both eyes of each patient were measured and one of the eyes was randomly selected for inclusion in the study. Central corneal thickness (CCT) and palpebral fissure height (PFH; distance between upper and lower eyelids) was recorded. RESULTS: The patients' mean age was 43.91 ± 12.36 (20-61) years and 62.3% were women. Mean IOP values measured by NT without MUEE, NT with MUEE, and GAT were 15.98 ± 2.39, 15.84 ± 2.53, and 14.33 ± 2.3 mmHg, respectively. There was no statistically significant difference in mean IOP between NT without and with MUEE (p = 0.506). Mean IOP values obtained by NT with and without MUEE were significantly higher than those obtained by GAT (p < 0.001). The difference in IOP values measured by NT without and with MUEE was positively correlated with PFH (r = 0.214; p = 0.018). CCT and IOP values obtained by NT without MUEE and GAT were positively correlated (r = 0.300; p = 0.001 and r = 0.311; p = 0.001, respectively). CONCLUSION: MUEE does not have a significant effect on IOP measurements by NT. The difference between IOP measured by NT without and with MUEE increases with greater PFH.

Two-year results of a novel sutureless scleral fixation surgery with the haptic hook technique.

PURPOSE: In this study, we evaluated the visual results and complication rates of the novel technique of sutureless scleral fixated intraocular lens (SFIOL) surgery in patients without capsular support. METHODS: In this retrospective study, patients who did not have adequate capsular support and who underwent sutureless SFIOL between 2013 and 2017 at the University of Health Science Dr. Lütfi Kirdar Kartal Training and Research Hospital's Eye Clinic were included. Preoperative and postoperative best corrected visual acuity (BCVA), perioperative and postoperative complications, surgical indications, previous surgeries, and surgical procedures were evaluated. RESULTS: The study included 131 eyes of 162 patients who underwent sutureless SFIOL surgery. Thirty-one patients were excluded from the study because of missing data. The mean age of the patients was 61.5 ± 23.2 years, 72 of whom were female, and the mean follow-up period was 24.3 ± 11.4 months. When all the patients were evaluated together, the preoperative mean BCVA was 1.11 ± 1.01, 0.86 ± 0.76 in the first month, 0.71 ± 0.69 in the third month, and 0.60 ± 0.50 in the second year after surgery according to logMAR. CONCLUSION: The 2-year results of our study demonstrate that the haptic hook technique for sutureless SFIOL surgery is effective and safe in aphakia rehabilitation. However, haptic hooks and their associated future complications must be monitored for a longer period of time to reach a definite conclusion.

Infectious interface keratitis after Descemet membrane endothelial keratoplasty.

PURPOSE: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. METHODS: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. RESULTS: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). CONCLUSION: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.

Sutureless Scleral-Fixated Intraocular Lens Implantation in the Treatment of Congenital Lens Subluxation Related to Marfan Syndrome.

PURPOSE: To evaluate the efficacy and safety of bimanual capsulorhexis combined with sutureless scleral-fixated intraocular lens (IOL) implantation in children diagnosed as having Marfan syndrome. METHODS: The study included 14 eyes with subluxated lenses of 7 children who were diagnosed as having Marfan syndrome and underwent bimanual capsulorhexis combined with sutureless scleral-fixated IOL implantation by the same surgeon between 2015 and 2019 at the University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital's Eye Department. RESULTS: The mean preoperative and postoperative uncorrected visual acuity was 1.47 ± 0.41 and 0.42 ± 0.15 logarithm of the minimum angle of resolution (logMAR), respectively (P = .001). The preoperative best corrected visual acuity (BCVA) ranged from 1.30 to 0.40 logMAR with a mean value of 0.81 ± 0.30 logMAR. Postoperatively, all patients had an increase in the BCVA with a mean value of 0.20 ± 0.11 logMAR, which was statistically significant (P = .001). The mean preoperative and postoperative spherical equivalent was -9.69 ± 4.59 and -0.27 ± 1.21 diopters, respectively. CONCLUSIONS: Despite the small number of patients in this study, good visual results and a low complication rate were obtained in patients with ectopic lens. The long-term IOL status in patients who have undergone sutureless scleral-fixated IOL implantation will make it possible to better evaluate the safety and applicability of the technique. [J Pediatr Ophthalmol Strabismus. 2021;58(6):401-406.].

The impact of delayed anti-vascular endothelial growth factor treatment for retinal diseases during the COVID-19 lockdown.

PURPOSE: To assess the clinical status of treatment-naive patients who had to delay 3-dose loading anti-VEGF (anti-vascular endothelial growth factor) injections during the COVID-19 lockdown, and to evaluate the effect of the delayed visual acuity treatment on spectral domain optical coherence tomography (SD-OCT) parameters. METHOD: A total of 55 eyes of 46 patients who were received in the study period participated in this retrospective study, including 28 patients (37 eyes) with diabetic macular edema (DME), 11 patients (11 eyes) with retinal vein occlusion (RVO), and 7 patients (7 eyes) with wet age-related macular degeneration (wet-AMD). The patients were diagnosed with DME, RVO, or wet-AMD in February 2020 and had planned 3-dose loading injections in March, April, and May 2020, but could not be injected due to the COVID-19 pandemic. RESULTS: From the patients' initial examination in February 2020, the mean best corrected visual acuity (BCVA) was 0.72 ± 59 logMAR. After the patients' lockdown visit in July 2020, the mean BCVA was 0.76 ± 64 logMAR. BCVA was stable in 11 eyes, decreased in 12 eyes, and increased in 14 eyes for patients with DME. BCVA was stable in 6, decreased in 3, and increased in 2 eyes for patients with RVO, and it was stable in 4 eyes and decreased in 3 eyes for patients with wet-AMD. CONCLUSION: We concluded that 6-month delay in treatment of DME patients with non-proliferative DRP had no adverse effect on the visual acuity. However, the loading dose in wet-AMD and RVO patients should be applied as soon as possible.

Birt Hogg Dube syndrome: Rare family lung disease.

Birt Hogg Dube syndrome is a rare disease characterized by autosomal dominant inherited multiple cysts in the lungs, renal tumors and skin fibrofolliculomas. It was first described in 1977 by Birt et al. In this case report, a patient who was diagnosed with symptoms and his first degree relative is presented. Diseases that should be considered in differential diagnosis are discussed. The diagnosis of this disease is usually made after recurrent pneumothorax. Since it is a genetic disease, the importance of follow-up and screening needs of patients and their relatives is emphasized.

The impact of celiac disease and duration of gluten free diet on anterior and posterior ocular structures: Ocular imaging based study.

PURPOSE: To evaluate the eyes of adult celiac disease (CD) patients and investigate the association between these ocular parameters with celiac specific antibodies and duration of gluten free diet (GFD). METHODS: This cross-sectional study included 72 eyes of 36 CD patients (18-51 years of age) and 70 eyes of 35 age- and sex-matched healthy controls. In addition to a complete ophthalmologic examination, all patients were scanned by a Scheimpflug camera, specular microscopy and spectral domain optical coherence tomography. RESULTS: Endothelial cell density (ECD), anterior chamber angle (ACA) degrees, anterior chamber depth (ACD), anterior chamber volume (ACV) and central macular thickness (CMT) values were lower in CD patients as compared with control group (p values = 0.038, 0.024, 0.002, 0.038 and 0.046 respectively). ECD and CMT were lower in celiac patients whom endomysial antibodies (EMA) IgA were positive (p = 0.001, p = 0.042 respectively). Tissue transglutaminase IgA antibody (anti tTG IgA) was weakly positively correlated (p > 0.05) with ACD, and positively (r = 0.319; p < 0.05) correlated with ACV. As the duration of compliance to the diet increased in the celiac group the mean and inferior retinal nerve fiber layer (RNFL) thickness decreased (p = 0.035, p = 0.008 respectively). Mean, inferior and temporal RNFL thicknesses were lower in celiac patients whose duration of GFD was longer than 5 years (p < 0.05). CONCLUSIONS: Decreases in ECD, ACA degree, ACD, ACV and CMT can occur in CD patients. In adult celiac patients; ECD, CMT might be effected in the presence of positive EMA, and ACD, ACV might be effected in the presence of higher anti tTG IgA titer. Adult celiac patients who had longer duration of GFD may have thinner RNFL. RNFL may be thinner in celiac patients who comply with GFD for more than 5 years.

Efficiency and Safety of Scleral Lenses in Rehabilitation of Refractive Errors and High Order Aberrations After Penetrating Keratoplasty.

OBJECTIVES: Visual rehabilitation after penetrating keratoplasty (PK) has difficulties linked to the high spherical and/or cylindric refractive errors with high order aberrations (HOAs) based on the ocular surface irregularities. We aimed to present the scleral contact lens (SCL)-induced complications and improvements in refractive errors and HOA with SCL fitting in post-PK patients. METHODS: In this prospective study, 38 eyes of 35 patients who underwent PK and using SCLs were included. Uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalence, manifest astigmatism (Cyl), keratometry, and wavefront analyses of HOAs with corneal topography of all patients were measured before SCL and after 8 hrs of SCL wearing-on. The endothelial cellular density (ECD) changes at 6 months were also recorded. Any complications related to SCL were noted. RESULTS: All patients showed an improvement in visual acuity with SCL. Uncorrected visual acuity before SCL fitting was 1.15±0.26 log of minimal angle of resolution (logMAR) and BCVA was 0.84±0.24 logMAR. The contact lens-corrected visual acuity decreased to 0.13±0.09 logMAR. Spherical equivalence, Cyl, and keratometry parameters decreased significantly with SCL. The anterior corneal HOAs, coma, and astigmatism coefficients decreased significantly. Conjunctival prolapse (in one eye) and graft rejection episode (in two eyes) were observed during follow-up time (14.25±1.3 months) and they restarted to use SCLs after treatment. The ECD decrease was similar with those who not using SCLs after PK in the literature. CONCLUSION: Our results indicate that scleral lenses may be a safe and effective option for the treatment of corneal astigmatism and HOAs associated with PK.

From an asymptomatic lesion to a vision-threatening condition: Congenital hypertrophy of the retinal pigment epithelium complicated by choroidal neovascular membrane.

We reported a case of congenital hypertrophy of the retinal pigment epithelium (CHRPE) complicated by choroidal neovascular membrane (CNVM). A 41-year-old woman presented to our clinic with visual loss in the left eye. She was diagnosed as CHRPE complicated by a CNVM. The patient was treated with 2 consecutive monthly intravitreal aflibercept (IVA) injections. The best-corrected visual acuity (BCVA) improved and stabilized at 6/6. Subretinal fluid depending on CNVM resolved completely. CHRPE complicated by CNVM in the macular area is a rare condition and these cases can be treated with IVA therapy.

A Rare Cause of Hypopyon Anterior Uveitis: Relapsing Polychondritis.

Relapsing polychondritis (RP) is a rare multisystemic disease. It affects cartilage and proteoglycan-rich structures. Ocular findings are the most frequent systemic involvement of the disease. The most common ocular manifestations are episcleritis and scleritis. During the course of the disease, uveitis may also be seen. However, as far as we know, nongranulomatous anterior uveitis with hypopyon is an uncommon ocular finding. In this article, we report a 27-year-old male patient who presented with hypopyon anterior uveitis as a revealing manifestation of RP.