Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report / Implantação intracorneana de uma lente intraocular dobrável direcionada incorretamente durante cirurgia de facoemulsificação: relato de caso

ABSTRACT A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

RESUMO Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

Could Corneal Densitometry be a Progression Criterion for Subclinical Keratoconus?

Objectives: The objective of this study is to investigate the changes in topometry, tomography, and corneal densitometry in subclinical keratoconus (SK) at the 6-month interval. Methods: The clinical keratoconus and SK groups included 25 eyes; the control group included 22 eyes from 22 patients. Corneal topographic, tomographic, topometric, and densitometric values obtained using the Pentacam HR imaging system were analyzed. Results: Posterior elevation (PE), Keratoconus index (KI), index of height asymmetry (IHA), index of height decentration (IHD), Dp, Da, Final D, maximum pachymetric progression index (PPImax), and maximum Ambrósio relational thickness parameters showed significant changes between the baseline and the 6th-month follow-up in SK group (p<0.05 for all values). There were significant changes in all zones except a central layer of 6-10 zone, anterior, and central layer of 10-12 zone between the baseline and the 6th-month follow-up in the SK group (p<0.05, for all values). The changes in mean±standard deviation of KI, IHA, IHD, PPImax parameters, and corneal densitometry values of the posterior layer of 0-2 mm and 2-6 mm zones were significant in the SK group compared to the controls (p<0.05, for all values). Conclusion: PE, KI, IHA, IHD, and PPImax parameters as well as increasing corneal light backscatter of the posterior central layer might be useful for follow-up of progression of SK. New multimeric parameters created by combinations of topometric, tomographic, and corneal densitometry parameters could be the future of SK follow-up.

Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report.

A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

Long-term evaluation of posterior corneal surface parameters after accelerated corneal cross-linking with a comparison with uncross-linked keratoconic eyes.

PURPOSE: To evaluate the 36 months changes in posterior corneal surface parameters in keratoconic eyes after accelerated corneal cross-linking and to compare the data with uncross-linked progressive and non-progressive keratoconic eyes. METHODS: Thirty five cross-linked, 30 uncross-linked progressive, and 30 uncross-linked non-progressive keratoconic eyes were included. Maximum keratometry (Kmax), thinnest pachymetry, minimum radius of curvature back (Rminback), asphericity back, posterior elevation and corneal densitometry, back corneal higher order aberrations (HOAs), back surface deviation (Db), final D, posterior radius of curvature (PRC) and 'B' unit values were recorded at baseline and at the 12, 24, 36 months follow-up. Data were analyzed with repeated measures ANOVA and paired t-tests. RESULTS: Kmax and thinnest pachymetry were significantly changed in the cross-linked and progressive uncross-linked groups. Rminback, asphericity back, and HOAs did not change in either group. Total posterior corneal densitometry improved; posterior elevation, Db and B unit worsened in the cross-linked group and did not change in the uncross-linked groups. PRC and final D worsened in the cross-linked and progressive uncross-linked groups, and did not change in the non-progressive group. CONCLUSION: Despite a decreased Kmax, the posterior corneal surface parameters, posterior elevation values were determined to have significantly worsened in the cross-linked group and this increase was higher than in progressive uncross-linked eyes.

Comparison of Outcomes of External Dacryocystorhinostomy and Transcanalicular Laser-Assisted Dacryocystorhinostomy in Patients with Primary Acquired Nasolacrimal Duct Obstruction.

PURPOSE: This study aimed to compare anatomical and functional outcomes of external dacryocystorhinostomy (EX-DCR) and transcanalicular multidiode laser dacryocystorhinostomy (TDL-DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: This study was conducted on 60 eyes of 60 patients with PANDO. The study subjects were randomly divided into two groups. Group 1 included 30 patients who underwent EX-DCR, and group 2 included 30 patients who underwent TDL-DCR. Surgery success rates were determined by patency of the neo-ostium, with free saline flow on irrigation and the absence of epiphora. RESULTS: There were 23 women (76.7%) and 7 men (23.3%) with a mean age of 47.33 ± 12.44 years in group 1, and 18 women (60%) and 12 men (40%) with a mean age of 46.2 ± 19.4 years in group 2. There was no significant difference between groups 1 and 2 with respect to age or gender (p = 0.801, p = 0.267, respectively). The mean duration of symptoms was 3.2 years, ranging from 1.5 to 5 years. The mean postoperative follow-up was 12.3 ± 2.44 months. At the end of the follow-up period, the surgery success rates were 96.7% (29/30 eyes) in group 1, and 90% (27/30 eyes) in group 2. There was no statistical difference in the surgery success rates between groups (p = 0.612). CONCLUSION: TDL-DCR is a minimally invasive and safe procedure. The lack of bleeding and incision scar and shorter operation time suggest that TDL-DCR can be a good alternative in PANDO patients.

Comparative Evaluation of Central Corneal Thickness in Cross-Linked Keratoconic Eyes.

PURPOSE: To compare the central corneal thickness (CCT) measurements measured by using the Pentacam Scheimpflug system with the CCT measured using ultrasound pachymetry (UP) and to compare the compatibility between the methods in normal, keratoconic, and cross-linked keratoconic corneas. METHODS: The study included 50 eyes of 50 patients with keratoconus (keratoconus group), 50 eyes of 50 patients with progressive keratoconus who underwent corneal cross-linking treatment (CCL group), and 50 eyes of 50 healthy subjects (control group). Patients in the keratoconus and CCL groups were further classified into mild (mean keratometry [Km] ≤ 47 D) and moderate keratoconus subgroups (47.0 < Km < 52.0 D). CCT values were noted from the Pentacam Scheimpflug and UP. RESULTS: The difference between the Pentacam and UP values was largest in the CCL group (-20.9 0.21.5 µm), followed by the keratoconus and control groups (-10.6 0.20.3 and 0.4 0.6.8 µm). The Pentacam and UP measurements were not comparable in the keratoconus and CCL groups (P = 0.001 and P < 0.001), whereas they were comparable in the control group (P = 0.62). In subgroup analysis, the 2 methods were comparable in the mild keratoconus subgroup (P = 0.12) and not comparable in the moderate keratoconus subgroup and in both mild and moderate subgroups of the CCL group (P = 0.001, P < 0.001 and P < 0.001). CONCLUSIONS: Pentacam Scheimpflug tomography and UP can be used interchangeably in normal and mild keratoconic eyes, but not in moderate keratoconic and cross-linked keratoconic eyes. Pachymetry measurements from Scheimpflug must be interpreted with extreme caution with different methods before planning an invasive procedure in these eyes.

The comparison of antimicrobial effectiveness of contact lens solutions.

PURPOSE: The aim of this study was to compare the effects of widely used multipurpose contact lens solutions against Staphylococcus aureus and Pseudomonas aeruginosa, in addition to cystic and trophozoite forms of Acanthamoeba castellanii and A. polyphaga, that cause microbial keratitis. METHODS: Three multipurpose solutions were tested: SOLO-care, ReNu, and Opti-Free Express. The test solutions were challenged with P. aeruginosa (ATCC 27853) and S. aureus (ATCC 2913) based on the ISO stand-alone and regiment test procedure for disinfecting products, A. polyphaga (ATCC 30871) and A. castellanii (1501/1A) cystic and trophozoite forms. Multipurpose solutions were sampled for surviving microorganisms at manufacturer's minimum recommended disinfection time. The number of viable organisms was determined, and log reductions were calculated. RESULTS: ReNu and SOLO-care resulted in a reduction greater than the required mean 3.0 logarithmic reduction against S. aureus, and SOLO-care and Opti-Free Express resulted in a reduction more than the required mean 3.0 logarithmic reduction against P. aeruginosa. Against the cystic and trophozoite forms of A. castellanii, the log reduction provided by SOLO-care was 1.01 and 1.31 log, respectively. ReNu provided a 0.83 log reduction of the cystic form and a 1.21 log reduction of the trophozoite form. Using Opti-Free Express, the log reduction for both forms was 1.31. SOLO-care led to a 0.61 log reduction of the cystic form of A. polyphaga and a 1.01 log reduction of the trophozoite form. ReNu provided a 0.41 log reduction of the cystic form and a 4.99 log reduction of the trophozoite form. Opti-free Express resulted in a 0.89 log reduction of the cystic form and a 3.11 log reduction of the trophozoite form. CONCLUSIONS: Multipurpose contact lens solutions using similar regimens can show different disinfection abilities.

Relationship between mean platelet volume and central serous chorioretinopathy.

The aim of this study was to investigate the mean platelet volume (MPV) of patients with central serous chorioretinopathy (CSCR). Thirty patients were included in the study. Thirty healthy volunteers were recruited as the control group. All patients and control subjects underwent complete ocular examination. Hemoglobin, hematocrit, white blood cell, neutrophil, lymphocyte, platelet count, and MPV of the participants were recorded. Data of patients with CSCR were compared with the control subjects. Patients with CSCR had significantly higher MPV values (9.76 ± 1.36 fL) compared with the control subjects (8.37 ± 0.72 fL) (p = 0.004). No significant difference was found in platelet counts between the CSCR group and the control group (259 ± 53.75 and 243 ± 52.11 K/Ul, p = 0.253). According to the receiver operator characteristics curve analysis, the optimal cut-off value of MPV to predict the CSCR was >9.4, with 60.0 % sensitivity and 93.3 % specificity. Our results demonstrated that the MPV values were significantly higher in patients with CSCR. MPV may be used as a predictive tool for identifying risk for CSCR.

Evaluation of Choroidal Thickness in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma.

Purpose. To compare the macular and peripapillary choroidal thickness in eyes with pseudoexfoliation (PEX) syndrome and PEX glaucoma with the normal eyes of healthy controls. Materials and Methods. In this prospective study, 30 eyes of 30 patients with PEX syndrome, 28 eyes of 28 patients with PEX glaucoma, and 30 eyes of 30 age-matched healthy subjects were enrolled. Choroidal thicknesses in the macular and peripapillary areas were measured by using spectral domain optical coherence tomography. Results. Gender, age, and axial length did not significantly differ between the groups (all, p > 0.05). The mean values of choroidal thickness in the macular and peripapillary areas (except the superior quadrant) in the patients with PEX syndrome and PEX glaucoma were lower compared with controls (all p < 0.05). The mean values of the macular and peripapillary choroidal thickness in the PEX glaucoma group were lower compared with PEX syndrome group; however this difference was not significant. Conclusions. The findings of this study revealed that macular and peripapillary choroidal thicknesses were decreased in PEX syndrome and PEX glaucoma cases. The role of choroid in the development of glaucomatous damage in patients with PEX syndrome remains unclear.

Evaluation of inner and outer retinal thickness in patients receiving intravitreal ranibizumab injections for diabetic macular edema.

PURPOSE: To measure inner and outer retinal thickness with optical coherence tomography (OCT) in patients in whom intravitreal ranibizumab was administered due to diabetic macular edema (DME) and to investigate its relation to the visual prognosis. METHODS: In this retrospective case series, there were 60 consecutive eyes with DME in which intravitreal ranibizumab injection was performed for 3 times in 1-month intervals. All patients underwent full ophthalmic examination and spectral-domain OCT (SD-OCT). The total retinal thickness, the inner thickness, and the outer thickness in 4 parafoveal subfields were measured. The correlation between the retinal thickness and logMAR best-corrected visual acuity (BCVA) was investigated. RESULTS: No significant correlation was found between the total retinal thickness in the central and other subfields and either the baseline or final visit logMAR BCVA values (p>0.05). There was a significant positive correlation between the final visit logMAR BCVA values and pretreatment inner retinal thickness in the nasal and inferior subfields (r = 0.270, p = 0.037, and r = 0.410, p = 0.001, respectively). There was significant negative correlation between the final visit logMAR BCVA values and pretreatment outer retinal thickness in nasal and temporal parafoveal subfields (r = -0.297, p = 0.021, and r = -0.268, p = 0.038, respectively). CONCLUSIONS: It could be beneficial to use inner and outer retinal thickness instead of total retinal thickness in determination of short-term prognosis in patients who had intravitreal ranibizumab injection for DME.

Total oxidative stress, paraoxonase and arylesterase levels at patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

AIM: To investigate the oxidative stress status of the aqueous humor and serum of patients with pseudoexfoliation (PEX) syndrome and pseudoexfoliative glaucoma (PEG) and to measure paraoxonase (PON) and arylesterase (ARE) levels. METHODS: A total of 78 patients were enrolled in the study, with 26 patients in each separate group. The patients were divided into three groups: the first group entailed PEX syndrome patients, while the second group consisted of patients with PEG and the third group involved patients with no additional systemic diseases, other than the diagnosis of cataract as control. Total oxidative stress (TOS), total antioxidant capacity (TAC), PON, and ARE levels in aqueous humor and serum were measured. RESULTS: TAC, PON and arylesterase levels in aqueous humor and serum of the PEX syndrome and PEG patients were significantly decreased compared with control group (P<0.05). TOS values were higher in patients with PEX syndrome and PEG than controls (P<0.05). TAC, PON and ARE levels of aqueous humor did not differ significantly between the PEX syndrome and PEG groups. CONCLUSION: These findings are potentially of significance and add to the growing body of evidence for oxidative stress in PEX syndrome and PEG. Decreased antioxidant defense and increased oxidative stress system may play an important role in the pathogenesis of PEX syndrome and PEG.

Association of neutrophil/lymphocyte ratio and retinal vein occlusion.

PURPOSE: To evaluate the association between neutrophil/lymphocyte ratio (NLR) and the development of retinal vein occlusion (RVO). METHODS: Forty patients were included in the study. Forty age- and sex-matched healthy volunteers were recruited as the control group. The RVO diagnosis was made clinically, based on the findings of fundus examination. The NLR and file records of the patients and the control group were compared. RESULTS: The mean age of patients was 64 ± 12 years. Neutrophil levels were higher in RVO patients compared to the control subjects (5.1 ± 1.9 vs 3.6 ± 1.0, p<0.001). Lymphocyte levels were lower in RVO patients compared with the control subjects (2.0 ± 0.7 vs 2.6 ± 0.9, p = 0.005). The NLR was significantly higher in RVO patients compared with the control subjects (3.0 ± 2.7 vs 1.5 ± 0.3, p<0.001). According to the receiver operator characteristics curve analysis, the optimal cutoff value of NLR to predict RVO was >1.89, with 72.5% sensitivity and 100% specificity. CONCLUSIONS: The current study demonstrated that higher NLR was associated with the development of RVO. The NLR may be used as a predictive tool for identifying risk for RVO.

Aqueous humour levels of ghrelin in exfoliation syndrome and exfoliation glaucoma patients.

PURPOSE: To investigate levels of ghrelin in the aqueous humour (AqH) of patients with exfoliation syndrome and exfoliation glaucoma and compare them to levels of ghrelin in control subjects. METHODS: This cross-sectional study involved 15 patients with exfoliation syndrome, 8 with exfoliation glaucoma and 12 control subjects for whom cataract surgery was indicated. The AqH was aspirated from the anterior chamber with a 27-G needle under sterile conditions prior to tissue manipulation. Ghrelin levels were quantified using radioimmunassay kits. RESULTS: Levels of ghrelin in the AqH were 187.87 ± 80.1 pg/mL in the eyes exhibiting exfoliation syndrome, 98.53 ± 50.9 pg/mL in the eyes exhibiting exfoliation glaucoma and 111.40 ± 77.5 pg/mL in the controls. Ghrelin level of patients with exfoliation syndrome were significantly higher than those of patients with exfoliation glaucoma and the controls (P < 0.05). Ghrelin levels of patients with exfoliation glaucoma were lower than those of the controls but were not reach statistically significant (P > 0.05). Age, gender and IOP did not have a significant effect on ghrelin levels in patients with exfoliation syndrome and exfoliation glaucoma. CONCLUSION: This study is the first to report elevated levels of ghrelin in the AqH in eyes exhibiting exfoliation syndrome. Findings suggest ghrelin might play role in the etiopathogenesis of exfoliation syndrome to exfoliation glaucoma.

Apoptotic effects of topical antiglaucoma medications on conjunctival epithelium in glaucoma patients.

PURPOSE: In this study, we aimed to investigate the apoptotic effects of topical antiglaucoma medications on the conjunctival epithelium. METHODS: A total of 65 patients were included in the study. Thirty patients were included in the first group who had received antiglaucomatous therapy before trabeculectomy. In the second group, 20 patients who had received no drugs before trabeculectomy were included, while the third group underwent only cataract surgery as control. During the surgery, 2 x 4 mm conjunctival samples were harvested from the upper bulbar conjunctiva. The mean apoptosis rate was calculated by determining apoptosis at conjunctival epithelium using the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method. RESULTS: The mean apoptosis rate was 0.537 ± 0.369 (0.026 ± 0.962) in group 1, 0.139 ± 0.162 (0.005 ± 0.676) in group 2, and 0.078 ± 0.035 (0.035 ± 0.142) in the control group (group 3). The mean apoptosis rate was significantly higher in the first group than the other 2 groups (p = 0.0001). CONCLUSION: Apoptotic effects of topical antiglaucoma drugs on the conjunctival epithelial cells were found. However, our results revealed that the number of medications, duration of medication, and type of glaucoma had no effect on the apoptotic effect.

Comparison of the effects of bevacizumab and ranibizumab injection on corneal angiogenesis in an alkali burn induced model.

AIM: To investigate the effects of bevacizumab and ranibizumab on corneal neovascularization in an alkali burn-induced model of corneal angiogenesis. METHODS: Fifteen Wistar albino rats were divided randomly into 3 groups after chemical cauterization of the cornea. The first group received a single dose of 0.1mL saline solution as a control group whereas second and third groups received a single dose of 2.5mg bevacizumab or 1mg ranibizumab by subconjunctival injection, respectively. After three weeks, the rat corneas were evaluated by biomicroscopy and corneal photographs were taken. The percentage of neovascularization area, length of the longest new vessel, corneal edema and corneal opacity scores were assessed. RESULTS: The analysis of digital photographs showed that the percentage of neovascularization area to the total corneal area, the length of the longest new vessel, corneal edema and opacity scores were significantly lower in both study groups compared to the control group (P<0.05). Additionally, the percentage of corneal neovascularization area, the length of the longest new vessel and corneal opacity score were less with bevacizumab than ranibizumab. CONCLUSION: Subconjunctival bevacizumab and ranibizumab treatments may be effective methods in reducing corneal neovascularization. Furthermore, bevacizumab is more effective than ranibizumab in the inhibition of corneal neovascularization.

Effect of latanoprost/timolol and dorzolamide/tiomolol on intraocular pressure after phacoemulsification surgery.

AIM: To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery. METHODS: This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours. RESULTS: The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05). CONCLUSION: When compared with placebo, the use of preoperative fixed combination of latanoprost/timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes.

Ocular findings in patients with Crimean-Congo hemorrhagic fever.

PURPOSE: To describe ocular findings of patients with Crimean-Congo hemorrhagic fever (CCHF). DESIGN: Prospective, interventional, consecutive case series. METHODS: This study was conducted in Sivas, a city located in the central Anatolia, between July 1 and August 31, 2007. Confirmed CCHF patients were enrolled in the study and underwent ocular examination during hospitalization. RESULTS: Nineteen confirmed CCHF patients were included in this study. All patients were classified into 2 groups in terms of disease severity (severe vs nonsevere), according to the Swanepoel predictive criteria. Fourteen patients (73.7%) were classified as "nonsevere," and the remaining 5 patients (26.3%) were classified as "severe" in this study. One patient having severe disease died. Ocular findings were present in 14 patients (73.7%) and none of the patients presented any visual complaints. Ocular examination revealed that 7 patients (36.8%) had only bilateral multiple subconjunctival hemorrhage, and 2 patients (10.5%) (1 bilateral, 1 unilateral) had retinal hemorrhage. Five patients (26.3%) had subconjunctival hemorrhage and retinal hemorrhage. Follow-up examination 1 month later showed complete resorption of the subconjunctival hemorrhage and retinal hemorrhage. There was a statistically significant difference between patients with ocular findings and patients without ocular findings for prothrombin time (P = .011). There was no evidence of uveitis, retinal edema, sheathing of retinal vessels, or intravitreal hemorrhage in our patients. CONCLUSION: From the small sample study, CCHF caused a mild form of ocular disease. CCHF must be considered when subconjunctival or superficial retinal hemorrhages are seen in association with fever in endemic areas.

Efficacy of first Turkish made single-piece foldable hydrophobic acrylic intraocular lens Zaraccom F260 on cataract treatment.

We evaluated the efficacy of Zaraccom F260 intraocular lenses (IOL) on cataract treatment in 97 adult cataract patients (114 eyes) who underwent phacoemulsification and IOL implantation. The mean preoperative best-corrected visual acuity (BCVA) was 0.26 +/- 0.26 at one week 0.49 +/- 0.25 and 0.9 +/- 0.28 at follow-ups. The Zaraccom F 260 is an alternative for the patients requiring lens replacement.

Central corneal thickness and Diaton transpalpebral tonometry.

BACKGROUND: To examine the effects of central corneal thickness on the measures obtained from transpalpebral tonometry (Diaton), and to identify correlations between intraocular pressure (IOP) measurements with Diaton and the Goldmann applanation tonometer (GAT). METHODS: In this cross-sectional study, 162 eyes of 81 participants were included. Intraocular pressure measurements were obtained in all patients using Diaton and GAT. Central corneal thickness was determined by ultrasound pachymetry. The participants were stratified by corneal thickness: group I <530 microm (n = 56), group II 530-560 microm (n = 65), and group III >560 microm (n = 41). RESULTS: There were moderate correlations between IOP readings obtained using the Diaton and corrected GAT (C-GAT) (r = 0.303; P < 0.0001), and between corrected Diaton (C-Diaton), and C-GAT (r = 0.399; P < 0.0001). The mean Diaton tonometer readings were lower than C-GAT measurements (Diaton-corrected GAT mean difference, 0.9 +/- 3.8 mmHg; c-Diaton-corrected GAT mean difference, 0.7 +/- 3.5 mmHg). Differences were detected between the groups of patients for the GAT values [2.4 +/- 3.6 mmHg for those with the thinnest corneas (<530 microm), 0.7 +/- 3.6 mmHg for those with moderate corneas (between 531 microm and 560 microm), and -0.6 +/- 3.6 mmHg for those with the thickest (>560 microm) corneas], whereas a significantly lower difference (0.9 +/- 3.8 mmHg) was noted for the Diaton values of all individuals. CONCLUSIONS: The Diaton measurements show moderate correlation with those provided by applanation tonometry. The Diaton tonometer seems to be more affected by the corneal thickness, especially in the thinnest corneas.

The effect of propolis in experimental Acanthamoeba keratitis.

PURPOSE: To examine the effect of propolis in a rat model of Acanthamoeba keratitis and to determine its in vitro cytotoxicity in cultured corneal epithelial cells. METHODS: Eighteen Wistar albino rats were used. Cultured corneal epithelial cells obtained from two healthy rats for in vitro cytotoxicity of propolis. Corneal stromal inoculation was performed in 16 rats with amoebic culture containing 1 x 10(6) amoeba/mL. Rats with Acanthamoeba keratitis 5 days later after the inoculation were divided randomly into four groups, and eight eyes of each group were treated with study drugs. The propolis, chlorhexidine (CHX), propolis plus CHX and control eyes were treated with topical propolis, 0.002% CHX, propolis plus 0.002% CHX and lubricant eye drops, respectively. The study drugs were instilled every one hour for 10 days. All eyes were examined and keratitis graded by slit-lamp biomicroscopy on days 2, 5 and 10 during the administration of the study drugs. After the completion of keratitis grading, all the 16 rats were humanely killed and their corneas were excised and used for Acanthamoeba culture to evaluate presence of Acanthamoeba growth after treatment 14 days later. RESULTS: Concentrations of propolis higher than 7.81 mg/mL cause damage to corneal epithelial cells in the experiment of in vitro cytotoxicity of propolis on corneal epithelial cells. The keratitis grade on day 2 in the CHX eyes was significantly lower than that in the control eyes (P < 0.05). The keratitis grades on days 5 and 10 in the propolis, CHX and propolis plus CHX eyes were significantly lower compared with those on days 5 and 10 in the control eyes (P < 0.05). In the propolis eyes, the keratitis grade on day 5 was significantly lower than that on day 2 (P < 0.05), and it was significantly lower on day 10 compared with that on day 5 (P < 0.05). In the CHX and propolis plus CHX eyes, the keratitis grade on day 10 was significantly lower compared with that on days 2 and 5 (P < 0.05). In the control eyes, there was no significant difference in the keratitis grades on days 2, 5 and 10 (P > 0.05). The culture positivity at Acanthamoeba growth after treatment experiment in the propolis, CHX and propolis plus CHX eyes was significantly lower than that in the control eyes (P < 0.05). CONCLUSIONS: We suggest that propolis had amoebicidal properties in this rat model of Acanthamoeba keratitis. Further investigations to evaluate the antimicrobial activity of the individual fractions of the resin could yield more information about its mechanism of action in treating this disease.