Visual Outcomes, Endothelial Loss, and Complications Following Iris-Claw Intraocular Lens Implantation and Trocar-Assisted Sutureless Scleral Fixation of Intraocular Lenses.

Objectives: Iris-claw intraocular lens (IC-IOL) implantation and sutureless scleral fixation of intraocular lenses (SSF-IOL) are two commonly preferred surgical approaches for the management of aphakic patients without sufficient capsular support. The aim of this study was to compare the outcomes of IC-IOL implantation and trocar-assisted SSF-IOL implantation. Methods: The medical records of secondary IOL implantation patients were retrospectively reviewed. All patients had a detailed ophthalmological examination, including LogMAR best-corrected distance visual acuity (CDVA), intraocular pressure (IOP), and endothelial cell density (ECD) preoperatively and postoperatively. SPSS 21.0 software was used for the statistical analysis. Results: There were 15 patients in the IC-IOL group and 12 patients in the SSF-IOL group. Age and gender distributions were similar between the groups (p=0.456 and p=0.398, respectively). Similarly, patients in both groups had similar CDVA preoperatively and postoperatively (p=0.51, p=0.48, respectively). Both IC-IOL and SSF-IOL implantation significantly increased CDVA (p=0.001 and p=0.005, respectively). IOP remained unchanged in both groups. However, ECD reduced significantly following both IC-IOL and SSF-IOL implantation (p=0.001 and p=0.005, respectively) and trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation (439.5±89 vs. 164.4±53, p=0.013). Conclusion: Both surgical approaches increased CDVA significantly and at similar levels. However, trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation. None of the patients developed bullous keratopathy, but this difference should be kept in mind, especially in patients with critically low ECD.

Endothelial loss following postoperative intracameral triamcinolone acetonide and subconjunctival dexamethasone injections.

OBJECTIVES: To compare endothelial toxicity and efficacy of two local steroid injections (intracameral triamcinolone acetonide and subconjunctival dexamethasone) in controlling postoperative inflammation following pars plana vitrectomy (PPV) combined with phacoemulsification cataract surgery. METHODS: This cohort included 54 patients that underwent combined surgery and received either intracameral triamcinolone acetonide injections (n = 27, IC-TA group) or subconjunctival dexamethasone (n = 27, Sc-Dex group) injections at the end of the surgery. All participants had at least 4 months or longer follow-up. A detailed ophthalmologic examination including intraocular pressure (IOP) measurement and specular microscopy was performed at every visit. RESULTS: Endothelial cell density (ECD) reduced significantly in IC-TA group postoperatively (2418 vs. 2249, p = 0.019), while it did not change significantly in Sc-Dex group (2541 vs. 2492, p = 0.247). Postoperative ECD was also significantly lower in IC-TA group compared to Sc-Dex group (p = 0.011). Preoperative and postoperative IOP values remained unchanged both in IC-TA and Sc-Dex groups (p = 0.424 and p = 0.523, respectively). However, 4 patients in IC-TA group and 5 patients in the Sc-Dex group needed glaucoma medications. The postoperative need for glaucoma medications was similar between the groups (p = 0.347). Postoperative inflammation was well controlled in both groups and none of the patients developed fibrin membrane or synechiae postoperatively. CONCLUSION: Both treatments were effective in controlling postoperative inflammation, but patients in IC-TA group experienced significantly higher endothelial loss. Sc-Dex injections are safer in terms of endothelial loss and preferable to control postoperative inflammation following complex intraocular surgeries.

Optical coherence tomography and Scheimpflug imaging of the iridocorneal angle following intravitreal injection of different medications: A longitudinal analysis.

PURPOSE: Intravitreal injection of medications induces a sudden increase in posterior segment volume and pushes iris plane anteriorly to narrow iridocorneal angle. The aim of this study to follow and define longitudinal course of these changes following intravitreal injection of 3 different anti-vascular endothelial growth factor (VEGF) medications or dexamethasone implant. MATERIALS AND METHODS: This prospective, longitudinal study included 89 eyes of 89 patients that had an intravitreal injection of bevacizumab (n = 20) or ranibizumab (n = 26) or aflibercept (n = 22) or dexamethasone implant (n = 21). All the participants had a detailed ophthalmological examination including anterior segment optical coherence tomography (AS-OCT) and Scheimpflug imaging of the iridocorneal angle, evaluation of anterior chamber depth (ACD), axial length with optical biometry and endothelial cell counts with specular microscopy just before the injection, at post-injection day 1, and post-injection 1st month. RESULTS: Iridocorneal angle became significantly wider following intravitreal injection of dexamethasone implant at nasal and temporal quadrants at the post-injection 1st month both in AS-OCT (p = 0.006, p = 0.002, respectively) and Scheimpflug imaging (p = 0.003, p = 0.004, respectively). Small changes were observed in iridocorneal angle following anti-VEGF injections but these small could not be confirmed in both imaging techniques. There were also no changes in ACD, axial length and endothelial counts in all groups. CONCLUSION: Dexamethasone implants induced widening of iridocorneal angle that persisted at the post-injection 1st month both at nasal and temporal quadrants. However, intravitreal injection of anti-VEGF agents did not have a comparable effect on iridocorneal angle.

Long-term follow-up of choroidal changes following COVID-19 infection: analysis of choroidal thickness and choroidal vascularity index.

OBJECTIVE: To investigate subclinical choroidal involvement in patients with systemic coronavirus disease 2019 (COVID-19) infection and evaluate its long-term course. MATERIALS AND METHODS: This prospective, longitudinal study included 32 eyes of 16 COVID-19 patients and 34 eyes of 17 age-matched healthy control subjects. All the participants had a detailed ophthalmologic assessment, including visual acuity assessment, slit-lamp examination, and indirect ophthalmoscopy. Enhanced depth optical coherence tomography imaging of the posterior pole and peripapillary region was performed in the early (days 15-40) and late (ninth month) postinfectious periods. Choroidal vascularity index (CVI) was calculated using ImageJ software (National Institutes of Health, Bethesda, Md.). RESULTS: None of the patients had any examination finding associated with the ocular involvement of COVID-19. Subfoveal choroidal thickness (SFCT) decreased significantly in the early postinfectious period compared with the healthy control individuals (p = 0.045). SFCT increased significantly in the late postinfectious period compared with the early period (p = 0.002), and the difference between patients and control individuals became statistically insignificant (p = 0.362). There was a similar trend for the peripapillary choroidal thickness measurements. CVI remained unchanged (p = 0.721) despite the significant decrease in SFCT and total choroidal area (p = 0.042), indicating that this decrease occurred both in choroidal stroma and in blood vessels. CVI remained unchanged in the late postinfectious period (p = 0.575) compared with the early period, indicating that recovery occurred in the entire choroidal tissue. CONCLUSION: This study demonstrates that choroidal thickness was reduced in all measured areas and that this decrease affected all choroidal layers. This choroidopathy was reversible and recovered in the ninth postinfectious month.

The influence of corneal incision size on endothelial cell loss and surgically induced astigmatism following phacoemulsification cataract surgery.

OBJECTIVE: Corneal incision size has influence both on corneal biomechanics and intracameral fluid dynamics during phacoemulsification cataract surgery. The aim of this study was to evaluate the impact of corneal incision size on endothelial cell loss and surgically induced astigmatism (SIA) following phacoemulsification cataract surgery. METHODS: This prospective, randomized, and comparative study included 61 eyes with senile cataracts. The patients were randomly assigned to 2.2 mm and 2.8 mm corneal incision sizes and were operated with the same phacoemulsification system. Phacoemulsifcation energy parameters, pre-operative and post-operative endothelial cell counts and corneal astigmatism values were specifically recorded. SIA was calculated according to Alpins method and the results of both groups were compared. RESULTS: There were 31 eyes in the microincisional (2.2 mm) group and 30 eyes in the standard incision (2.8 mm) group. There was no significant difference between the groups for age and gender distribution (p=0.09 and p=0.18, respectively). Similar levels of cumulative dissipated energy was used during phacoemulsification in both groups (p=0.70). SIA was slightly higher in the standard incision group compared to microincisional group (0.47D at 64° vs. 0.37D at 61°, p=0.30). Pre-operative and post-operative uncorrected visual acuity (UCVA) was similar between the groups (p=0.45 and p=0.27).Endothelial cell loss tended to be slightly higher in the microincisional group compared to standard incision group (174.87±132.27 vs. 160.84±121.58, p=0.75), but this difference was not statistically significant. CONCLUSION: Smaller corneal incisions slightly reduced SIA, but tended to induce more endothelial cell loss. This small difference in SIA did not cause a significant change in the postoperative UCVA. Therefore, the trend in reducing corneal incision sizes below 2.8 mm might not be contributing the surgical outcomes of the patients, especially when we consider potential corneal endothelial changes.

The use of Online Videos for Vitreoretinal Surgery Training: A Comprehensive Analysis.

Objectives: The current study aimed to test the quality and educational utility of the videos of retinal detachment surgery available on YouTube. Methods: YouTube was searched using the keywords "retinal detachment, retinal detachment surgery" in October 2019. The steps of pars plana vitrectomy surgery were standardized according to the literature. The videos were evaluated in a blinded fashion by two retina specialists with the use of the Modified DISCERN, Health on the Net Foundation (HON)code, the Journal of American Medical Association (JAMA) checklist, and the Global Quality Score (GQS). Results: A total of 125 videos were reviewed. The total surgery score was 3.11 (2.16-3.67 IQR), and the most commonly shown surgical stages were photocoagulation and core vitrectomy (n = 99 [79.2%] and n = 97 [77.6%], respectively). In the multivariate linear regression model, the duration of video (minutes) (ß- Coefficient 0.033, p<0.001), the HONcode score (ß-Coefficient 0.310, p=0.005), and GQS (ß-Coefficient 0.768, p<0.001) were associated with better educational content, whereas JAMA and Modified DISCERN scores were not. Conclusion: So far, the educational value of YouTube videos has been unsatisfactory. Assessing the videos using tools such as HONcode, video duration and GQS may provide better educational perspective to ophthalmology trainees.

Low levels of soluble low-density lipoprotein receptor-related protein 1 in patients with type 2 diabetes mellitus and diabetic retinopathy.

Low-density lipoprotein receptor-related protein-1 (LRP-1) is a large transmembrane receptor. LRP-1 plays a role in diverse cellular processes, including lipid metabolism, cell growth, migration, and regeneration. Soluble form of LRP-1 (sLRP-1) can be detected in serum. sLRP-1 can serve as a biomarker of atherosclerosis and cardiometabolic diseases. This study investigated the concentrations of the circulating serum sLRP-1 in patients with retinopathy and type 2 diabetes mellitus. Fifty-two patients with diabetic retinopathy and 71 controls were enrolled based on well-defined eligibility criteria. Venous blood samples were collected after 12 h of fasting. sLRP-1 concentrations were measured using the commercially available ELISA in an accredited laboratory. The mean age of patients and control groups were 63.6 and 48.5 years, respectively. The median disease duration was 8.1 years. The median serum sLRP-1 levels were lower in patients with diabetic retinopathy compared to the controls (2.11 µg/mL versus 2.44 µg/mL, p = 0.034). No significant correlation was observed between the sLRP-1 and serum lipid levels. The sLRP-1 levels are low in patients with diabetic retinopathy compared to healthy controls, and future studies are needed to assess sLRP-1 as a potential biomarker in diabetic retinopathy.

Corneal Sensation and Nerve Fiber Changes in Patients With Interstitial Cystitis.

PURPOSE: Central sensitization syndromes are associated with ocular surface discomfort and certain changes in corneal sensation. The aim of this study was to evaluate corneal changes in patients with interstitial cystitis (IC). METHODS: Thirty patients with IC and 32 healthy control subjects were included in this study. All patients had a detailed ophthalmological examination including measurement of corneal sensation with Cochet-Bonnet esthesiometer, tear breakup time, Schirmer I test, and Ocular Surface Disease Index questionnaire. After these examinations, corneal subbasal nerve plexus of the patients was evaluated with in vivo corneal confocal microscopy (IVCM) and the images were analyzed using fully automated software (ACC Metrics Corneal Nerve Fiber Analyzer V.2). RESULTS: There was no significant difference between the groups regarding age and gender distribution. Corneal sensation was significantly higher in patients with IC (P = 0.03), whereas tear breakup time, Schirmer I test, and Ocular Surface Disease Index scores were similar between the patients and controls. IVCM demonstrated nerve fiber loss in patients with IC. Corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length were significantly reduced in patients with IC compared with healthy controls (P < 0.001, P = 0.04, and P < 0.001, respectively). CONCLUSIONS: Patients with IC had increased corneal sensation and decreased nerve fiber density in IVCM analysis. Corneal nerve fiber loss might decrease the induction threshold of the remaining fibers to induce peripheral sensitization, which may also trigger central sensitization in long term.

A Novel Use of Retinoscopy for the Evaluation of Binocular Balance of Spherical Refractive Errors.

PURPOSE: Binocular balancing is an important component of refractive correction to avoid asthenopic complaints. Polaroid filters are commonly used for binocular balancing; they rely on subjective examination and cannot represent daily visual activities. We describe a new examination approach to evaluate binocular balance with retinoscopy, which is an objective examination method and does not require strict patient cooperation. METHODS: Healthy young individuals with refractive errors (under the age of 40) were included in this study. Each patient was examined by three different ophthalmologists in the same room at 20-min intervals. The first ophthalmologist performed refractive examination separately for each eye, the second physician used binocular balance tests with polaroid glasses, and the third physician practiced binocular balance test with retinoscopy. After completion of clinical examinations, autorefractometry was repeated with cycloplegia. The difference between the spherical equivalents (SE) of the eyes was calculated for each method and compared with the SE difference obtained by cycloplegic autorefractometry. The SPSS 21.0 software was used for the statistical tests. RESULTS: The study included 30 patients (16 males, 14 females) and the mean age of the patients was 21 ± 8.5 years (range 10-37 years). There was no significant difference between the four groups for the interocular difference of SE (Greenhouse-Geisser F = 1.390, p = 0.257). The highest correlation was found between the retinoscopic binocular balance technique and cycloplegic autorefractometry (r = 0.878, p < 0.001). In addition, the intraclass correlation coefficient and the 95% limits of agreement supported strong agreement. CONCLUSION: Currently used binocular examination tests are subjective and some patients give inconsistent answers impairing the reliability of the outcome. These tests cannot be performed on patients with limited ability to cooperate. This study demonstrates that the use of retinoscopy in the evaluation of binocular balance delivers reliable results and is a low-cost, practical approach to address the above-mentioned problems.

Corneal neuropathic pain in irritable bowel syndrome: clinical findings and in vivo corneal confocal microscopy.

PURPOSE: Ocular discomfort is a common symptom in central sensitization syndromes. The aim of this study was to evaluate ocular surface discomfort and related corneal changes in patients with irritable bowel syndrome. METHODS: Twenty-nine patients with IBS (20 female, 9 male, mean age: 45.3 ± 10.1 years) and 37 healthy control subjects (25 female, 12 male, mean age: 44.95 ± 9.76 years) were included. A detailed ophthalmological examination was performed to all participants including tear break-up time (TBUT) and Schirmer test I with anesthetic (SIT). Ocular discomfort was evaluated using the ocular surface disease index (OSDI) questionnaire and corneal sensation was evaluated with Cochet-Bonnet esthesiometer. Corneal subbasal nerve plexus was evaluated with in vivo corneal confocal microscopy (IVCM). RESULTS: There was no significant difference between the groups for age, gender distribution, and visual acuity. OSDI scores were significantly higher (p = 0.008) and TBUT was significantly reduced in patients with IBS compared to controls (p = 0.001 for right eye, p = 0.014 for left eye). However, there was no significant difference in corneal touch sensation and SIT results between the groups. IVCM revealed that corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length were significantly reduced in patients with IBS (p < 0.001, p < 0.001, and p = 0.023, respectively). CONCLUSION: Patients with IBS have increased dry eye-associated ocular surface complaints and nerve fiber loss in corneal subbasal nerve plexus. IBS should be remembered in the differential diagnosis, when there is discordance between the level of ocular surface discomfort and dry eye disease associated corneal findings.

Refractive outcome of trocar-assisted sutureless scleral fixation with 3-piece intraocular lenses.

PURPOSE: Intraocular lens (IOL) implantation with a trocar-assisted sutureless scleral fixation technique is a relatively new IOL implantation approach for aphakic eyes. During this surgery, the intrascleral position of the haptics can change the location of the IOL optic and may alter the refractive outcome. This study aimed to evaluate the refractive outcome of this surgery. METHODS: The files of 22 patients who had undergone IOL implantation with the trocar-assisted sutureless scleral fixation technique were retrospectively reviewed, and the patients were invited for final examination. IOL power was calculated with optical biometry (Lenstar LS900). IOL power calculations were performed according to formulas designed for in-the-bag IOL implantation. The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1). RESULTS: This study included 14 patients (8 male, 6 female, mean age: 62.7 ± 18.7). There were no significant differences between the preoperative and postoperative corneal astigmatism values (p = 0.16). There were also no significant differences between the postoperative corneal and total astigmatism values (p = 0.44), confirming the absence of significant IOL tilt. The difference between the implanted IOLs and the calculated IOL power for emmetropia was 0.09 D ± 0.49 D (p = 0.52). Although emmetropia was targeted, the refractive outcome shifted to hyperopia (+ 0.85 D ± 1.15 D) and was significantly different from the refractive status calculated with optical biometry (p = 0.034). CONCLUSIONS: The intrascleral fixation of IOLs results in increased posterior positioning of the IOL optic and can induce approximately 0.85 D of hyperopia if proper adjustments are not performed during IOL power calculations.

A novel, low-cost and practical illumination approach for bimanual vitrectomy.

OBJECTIVE: The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome. METHODS: Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue. RESULTS: Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4±14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05±4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p<0.001). Postoperative complications included recurrent detachment in two eyes, hypotony in one eye and endophthalmitis in one eye. The transient rise in intraocular pressure was observed in 19 patients, but there was no significant difference between the preoperative and postoperative mean IOP in the long term follow-up. CONCLUSION: This bimanual vitrectomy system provided favorable outcomes without increasing the cost of standard PPV. The advantage of this system over the chandelier illumination include the reduction in glare, the possibility to change the direction of the light during the surgery to better illuminate the surgical site and the lower cost. This approach can be used in any vitrectomy system (20G, 23G, 25G, and 27G) by changing the size of the IV cannula.

Descemet's membrane endothelial keratoplasty in aphakic and vitrectomized eye.

Objective: To report a new technique for Descemet's membrane endothelial keratoplasty (DMEK) in aphakic and vitrectomized eyes. Case description: A 56-year-old man presented with corneal decompensation in the left eye after combined pars plana vitrectomy and lensectomy for the management of a traumatic eye injury. DMEK graft and recipient bed were prepared as regular. The posterior half of the donor stroma was dissected with a crescent knife to form a temporary stromal barrier tissue. The prepared donor stromal tissue was implanted into the anterior chamber (AC) to form a barrier over the iris and pupilla. Then, the endothelial graft was safely injected into the anterior chamber and deployed by gently tapping on the corneal surface. Air tamponade was applied into the AC for 10 minutes to allow the graft to attach. Afterwards, the stromal barrier tissue was removed through the main incision and the AC was refilled with air tamponade. There were no intraoperative or postoperative complications during 1-month follow-up. Conclusion: Insertion of a temporary posterior stromal tissue as a barrier over the iris and pupilla successfully provided AC stability and prevented posterior dislocation of the graft or air tamponade. This new technique was a safe and effective approach for DMEK in aphakic and vitrectomized eyes.

Patterns of Altered Corneal Sensation in Patients With Chronic Migraine.

OBJECTIVE: Migraine is a central sensitization disease characterized by recurrent unilateral headache. The aim of this study was to evaluate corneal sensitivity and associated findings in patients with migraine. METHODS: In this study, we included 58 patients with migraine (52 female and 6 male, mean age: 32.98±8.51 years) and 30 healthy control subjects (27 females and 3 males, mean age: 35.29±8.00 years). Only patients who did not have any eye disease were included in this study. Corneal sensation was evaluated with Cochet-Bonnet esthesiometer in five different regions of the cornea. RESULTS: There was no significant difference between the groups for age, sex, and visual acuity. Increased mean sensitivity of the nasal cornea in the patients with migraine was found (55.0 vs. 53.75 mm, P=0.020). There was no significant difference in mean sensitivity for central (57.5 vs. 55 mm, P=0.163), temporal (57.5 vs. 55 mm, P=0.066), superior (52.5 vs. 52.5 mm, P=0.551), and inferior cornea (48.75 vs. 47.5 mm, P=0.818), or mean overall sensation (54.0 vs. 52.75, P=0.14), although there was a trend toward increased sensitivity in the patients with migraine. Among the subgroup of patients with unilateral migraine, mean overall sensation (54.0 vs. 53.0 mm, P=0.049) and temporal sensation (57.5 vs. 55.0 mm, P=0.043) were increased on the affected side. CONCLUSION: In this study, we have demonstrated that patients with migraine have increased corneal sensation, especially in the cornea of the affected side. This finding supports the idea that corneal sensation is altered in patients with migraine.

Scleral suture fixation technique for dislocated plate haptic toric IOL.

Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error.

Central retinal vein occlusion after coronary artery bypass surgery: A case report.

OBJECTIVE: The aim of this study is to report a case of central retinal vein occlusion (CRVO) after coronary artery bypass graft (CABG) surgery. In this report, we present the third case in the literature with CRVO after cardiopulmonary bypass (CPB), and the first case after CABG. CASE REPORT: A 59-year-old male patient complaining of chest pain was admitted to our hospital. The patient underwent an elective coronary angiography and was diagnosed with three-vessel coronary artery disease. An uneventful coronary artery bypass graft operation was performed using CPB. On the second postoperative day, the patient described blurring and decreased vision in his left eye, whereas the right eye was normal. The anterior-posterior segment was examined by an ophthalmologist who diagnosed central retinal vein occlusion, using a visual acuity test, fundoscopy. After 5 months of treatment, there has been no improvement in the patient's visual acuity. CONCLUSION: As two previous case reports indicated CRVO can be a rare complication after CPB, this study demonstrated that CRVO can also be a complication of CABG. Therefore, CRVO should always be considered as a potential complication after cardiac surgery.

A comparison of corneal biomechanical properties in patients with psoriasis and healthy subjects.

OBJECTIVE: To evaluate the differences in corneal biomechanical properties between healthy subjects and patients with psoriasis using the ocular response analyzer (ORA). METHODS: Fifty-nine eyes of 59 psoriasis patients and 66 healthy individuals were included in the study. Corneal biomechanical parameters were obtained using ORA. Ultrasound pachymetry was used to measure central corneal thickness (CCT). The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) measurement and corneal-compensated IOP (IOPcc) through ORA. The dry eye evaluation was performed with tear break-up time (TBUT) and Shirmer test. RESULTS: The mean CH values in psoriasis and healthy subject eyes were 10.75±2.9 mm Hg, 11.97±3.6 mm Hg, respectively (P=0.047). The mean CRF values were 10.14±3.1 mm Hg and 11.61±3.3 mm Hg, respectively (P=0.012). The mean CCT were 539.1±36 µm and 536.3±28 µm, respectively (P=0.643). Mean TBUT values were 8.2±2.9 sec in psoriasis group and 10.4±3.6 sec in healthy subjects (P<0.001). Shirmer test values were less (8.9±3.8 mm/5 min) in psoriasis than in healthy subjects (13.1±3.6 mm) (P<0.001). CONCLUSIONS: Psoriasis can influence the corneal biomechanical properties. Patients with psoriasis had lower CH and CRF, but higher IOPg and IOPcc values than healthy controls. These corneal biomechanical changes should be considered when determining IOP values.

The destructive effects of antibiotics on the amniotic membrane ultrastructure.

The aim of the study was to examine the influence of different antibiotics on amniotic membrane epithelium and to observe the related ultrastructural changes using transmission electron microscope (TEM). Prospective comparative laboratory study. Amniotic membrane samples from a single placenta were obtained using a sterilized method. Tissue samples were placed in either saline or antibiotics-containing (penicillin, streptomycin, neomycin, or amphotericin B) solutions. The viability of the amniotic membrane epithelial cells was then assessed for saline and antibiotics using both light microscope and TEM to investigate morphological changes. The ultrastructural examination of amniotic membrane epithelium held in antibiotics-containing solutions showed damage to the cell membrane, rarefaction, and loss of microvilli. Amniotic membrane from the control group showed intact epithelium, with surface microvilli and junctional complexes between the cells and the basal membrane. The destructive effects of antibiotics on freshly obtained amniotic membrane were examined with both light microscopy and transmission electron microscopy and significant differences in the ultrastructure were observed.

Evaluation of the relationship between corneal biomechanic and HbA1C levels in type 2 diabetes patients.

PURPOSE: To evaluate the corneal biomechanical properties due to the glycosylated hemoglobin (HbA1C) levels using the ocular response analyzer (ORA) in the patients with type 2 diabetes mellitus (DM). METHODS: ORA values were obtained from 156 eyes of subjects with type 2 DM and 74 eyes of healthy control subjects with similar age and sex. Subjects were divided into three groups: Group 1, healthy control subjects; Group 2, diabetes patients with HbA1C <7%; and Group 3, diabetes patients with HbA1C ≥7%. Corneal biomechanical parameters: corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements were obtained using ORA. Ultrasound pachymetry was used for measurement of central corneal thickness (CCT). RESULTS: CH and CRF were significantly different in each of the three groups (P-values for CH respectively; Groups 1 and 2=0.008, Groups 1 and 3, and Groups 2 and 3, <0.001, and for CRF respectively; =0.002, <0.001, <0.001). CCT was significantly different between Groups 1 and 3 and Groups 2 and 3 (P<0.001) but was insignificant between Groups 1 and 2 (P=0.965). IOPcc was not different between Groups 1 and 2 (P=0.524), and Groups 2 and 3 (P=0.115), but was significantly different between Groups 1 and 3 (P=0.003). IOPg was statistically different between each of the three groups (respectively; Groups 1 and 2, P=0.015, Groups 1 and 3, and Groups 2 and 3, P<0.001). CONCLUSION: Both diabetes groups were affected in terms of corneal biomechanical properties when compared to healthy subjects, there was also a positive correlation between HbA1C level and intraocular pressure.

Effect of oral isotretinoin treatment on retinal nerve fiber layer thickness.

BACKGROUND: Oral isotretinoin treatment can cause ocular side effects. OBJECTIVE: This study was performed to detect possible toxic effects of oral isotretinoin treatment on the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL). METHODS: The study population consisted of 54 eyes of 27 patients with nodulocystic acne who used oral isotretinoin (Roaccutane) treatment. Macular GCL and peripapillary RNFL thickness measurements were performed using spectral domain optical coherence tomography (OCT) before and after therapy. RESULTS: Before and after treatment, a complete ophthalmologic examination was normal in all eyes. However, posttreatment lower temporal (TL) values were significantly lower (76.80 ± 16.31) than pretreatment TL values (84.96 ± 24.83) (p  =  .02). There was no statistically significant difference in the other OCT values, upper temporal, superotemporal, superonasal, upper nasal, lower nasal, inferonasal, and inferotemporal (p  =  .35, p  =  .40, p  =  .56, p  =  .95, p  =  .94, p  =  .93, p  =  .61, respectively). Also, there was no statistically significant difference between the right and left eyes and between genders for all parameters (p > .05). CONCLUSION: The use of oral isotretinoin treatment has increased in recent years. In addition, oral isotretinoin treatment has a broad adverse effect potential on the ocular system. The measurement of RNFL thickness, especially TL thickness, by OCT may be useful for detecting the possible toxic effect of oral isotretinoin therapy on RNFL.