Correlation of Ocular Pulse Amplitude, Choroidal Thickness, and Internal Carotid Artery Doppler Ultrasound Findings in Normal Eyes.

INTRODUCTION: The choroid receives about 65-85% of ocular blood flow, which comes from the ophthalmic artery (OA), the first branch of the internal carotid artery (ICA). In the foveal avascular zone, there is no retinal vascular supply; therefore, choroidal blood supply plays a significant role in this subfoveal region. The ocular pulse amplitude (OPA) provides useful information about intraocular blood flow and is an indirect indicator of choroidal perfusion. In this study, we aimed to assess the correlation between the OPA, subfoveal choroidal thickness (CT), and ICA Doppler ultrasound findings in healthy eyes. METHODS: In total, 48 eyes of 48 healthy volunteers were included in this study. All eyes underwent detailed ophthalmic evaluation, including slit-lamp biomicroscopy, fundus examination, axial length, OPA measurements, and optical coherence tomography (OCT) with enhanced depth imaging mode. Carotid Doppler ultrasound examination was performed by the radiologist. The correlation between the OPA, subfoveal CT, and ICA Doppler findings [peak systolic velocity (PSV) and end-diastolic velocity (EDV)] were evaluated, considering gender and age. RESULTS: The mean OPA was 3.06 ± 1.34 mmHg. The mean subfoveal CT was 305.85 ± 33.98 µm. The mean PSV and EDV of ICA were 73.25 ± 23.63 cm/s and 26.93 ± 13.42 cm/s, respectively. A moderate positive correlation was found between OPA and subfoveal CT (p = 0.001; rho = 0.481). This relationship was present in both men and women. While a positive correlation was found between the OPA and subfoveal CT in subjects under the age of 50 years, there was no correlation in those over the age of 50 years. CONCLUSIONS: A fair correlation was found between the OPA and subfoveal CT in healthy subjects under the age of 50.

Pregnancy-induced progression of keratoconus.

PURPOSE: To report eyes with keratoconus that progressed during pregnancy. METHODS: Seven eyes of 4 patients with progression of keratoconus during pregnancy were included in this study. The mean age of patients and the mean follow-up duration were 29.3 years and 39 months, respectively. Progressive keratoconus was documented with changes in refraction, corneal topography, and rigid gas-permeable lens fitting pattern. Patients with accompanying systemic and ocular diseases associated with keratoconus, uncontrolled atopic disease, and eye rubbing were excluded. RESULTS: Mean increase in spherical equivalent refraction and simulated keratometry values were 1.4 ± 1.1 and 1.1 ± 0.8 diopters, respectively. In eyes wearing rigid gas-permeable lenses, increase in corneal apical touch and decrease in the base curve radius of the best-fitting contact lens were observed. CONCLUSIONS: Hormonal changes during pregnancy may affect corneal biomechanics negatively, and pregnancy may be a previously unrecognized risk factor for progression of keratoconus. To our knowledge, this is the first study showing pregnancy-induced keratoconus progression in patients with no accompanying disease.

Recurrent endogenous Candida.

We report a 61-year-old who developed candidemia following pancreatic tumor surgery, and presented with bilateral multifocal chorioretinitis and vitritis. Chorioretinal lesions regressed with fluconazole therapy. Pars plana vitrectomy was performed with resultant improved visual acuity, but vitritis recurred with the next chemotherapy session. With the cessation of chemotherapy, vitritis regressed without any systemic treatment.

Higher-order aberrations and visual acuity after LASEK.

BACKGROUND: To determine ocular higher-order aberrations (HOAs) in eyes with supernormal vision after myopic astigmatic laser subepithelial keratomileusis (LASEK) and to compare the findings with those in eyes with natural supernormal vision. METHODS: Ocular HOAs were measured after LASEK in 20 eyes of 12 myopic astigmatic patients with postoperative uncorrected visual acuity (UCVA) of >20/16 (group 1). Patients who were included in the study had no visual symptoms like glare, halo or double vision. The measurements were taken 8.3 +/- 3 months after LASEK surgery. In group 2 ocular HOAs were examined in 20 eyes of 10 subjects with natural UCVA of >20/16 as a control. Measurements were taken across a pupil with a diameter of 4.0 mm and 6.0 mm. Root-mean-square (RMS) values of HOAs, Z(3)-1, Z(3)1, Z(4)0, Z(5)-1, Z(5)1 and Z(6)0 were analyzed. RESULTS: The mean RMS values for each order were higher in group 1 when compared with group 2 at 4.0 mm and 6.0 mm pupil diameters. There was no statistically significant difference between groups in spherical and coma aberrations (P > 0.05). Mean RMS values for total HOAs were 0.187 +/- 0.09 microm at 4.0 mm and 0.438 +/- 0.178 microm at 6.0 mm pupil in group 1 and 0.120 +/- 0.049 microm at 4.0 mm and 0.344 +/- 0.083 microm at 6.0 mm pupil in group 2. The difference between groups in total HOAs was statistically significant at 4.0 mm and 6.0 mm pupil diameters (P < 0.05). CONCLUSION: Ocular HOAs exist in eyes with supernormal vision. After LASEK, the amount of HOAs of the eye increases under both mesopic and photopic conditions. However the amount of HOA increase does not seem to be consistent with visual symptoms.

Effectiveness of laser-assisted subepithelial keratectomy to treat residual refractive errors after laser in situ keratomileusis.

PURPOSE: To evaluate the effectiveness of laser-assisted subepithelial keratectomy (LASEK) to treat residual refractive errors after laser in situ keratomileusis (LASIK). SETTINGS: Isik Eye Clinic, Ankara, Turkey. METHODS: This retrospective study included 24 eyes of 15 patients who had retreatment by LASEK for residual refractive errors after myopic LASIK. All patients had examinations that included slitlamp biomicroscopy, subjective and cycloplegic refractions, uncorrected visual acuity (UCVA), best corrected visual acuity, corneal topography, and pachymetry preoperatively and postoperatively. Postoperative examinations were performed at 1 week and 1, 3, and 6 months. RESULTS: The patient cohort comprised 9 men and 6 women. The median spherical equivalent (SE) of attempted correction for retreatment with LASEK was -1.25 diopters (D). The median follow-up after LASEK was 11.5 months (range 6 to 16 months). At the end of the follow-up, the median SE of the refractive error was -0.38 D. The median UCVA increased from 20/45 before LASEK to 20/25 at the last follow-up visit, which was statistically significant (P<.001). After LASEK, significant postoperative haze developed in 5 eyes. In all 5 eyes, the estimated ablation depth was more than 40 mum and the SE of attempted correction was -2.00 D or greater. CONCLUSIONS: Laser-assisted subepithelial keratectomy retreatment in eyes with myopic regression after LASIK resulted in a significant improvement in UCVA that was comparable to the improvement after flap lifting. An SE of attempted correction greater than -2.00 D was associated with a significant rate of haze.

Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?

PURPOSE: To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR). METHODS: This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure. RESULTS: The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye. CONCLUSIONS: The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.