Effects of Smoking on Central Corneal Thickness and the Corneal Endothelial Cell Layer in Otherwise Healthy Subjects.

OBJECTIVES: The effects of smoking on central corneal thickness (CCT), corneal endothelial cell density (ECD), and morphology were evaluated in otherwise healthy subjects. METHODS: The study included 103 current smokers and 106 healthy nonsmoking subjects without any eye disease apart from refractive errors. Endothelial cell density, percentage of hexagonality, and coefficient of variation (CV) in cell size were measured using noncontact specular microscopy. Central corneal thickness was measured by ultrasound pachymetry. RESULTS: The mean age of participants in the nonsmoker group was 31.4 ± 5.1 years (18-60) and 33.0±9.1 years (18-58) in the current smoker group. The mean CCT value was 523.7±34 µm in the nonsmoker group and 518.5±37 µm in the smoker group. The mean ECD, CV, and percentage of hexagonality values were 2,881±293.7 cells per square millimeter, 32.5±6%, and 56.6±11% in the nonsmoker group, and 2,681±323.9 cells per square millimeter, 33.4±5%, and 55.5±10% in the smoker group, respectively. Although there was no difference between the groups in terms of CCT, CV, and percentage of hexagonality values, a significant difference was determined in the case of ECD values[ZERO WIDTH SPACE][ZERO WIDTH SPACE] (P<0.001). The smoker group comprised 67 light smokers (65.0%) and 36 (35.0%) heavy smokers. Between these groups, there was no statistically significant difference in the mean values of CCT, ECD, CV, and the percentage of hexagonality. CONCLUSIONS: Although cigarette smoking has no effect on cell polymorphism and polymegethism, the results suggest that smoking reduces endothelial cell count.

Investigation of the association between glaucoma and Helicobacter pylori infection using the 14C-urea breath test.

PURPOSE: To investigate the association between glaucoma and Helicobacter pylori infection by evaluating for the presence of H. pylori infection in patients with glaucoma using the 14C-urea breath test (14C-UBT). METHODS: Using 14C-UBT, H. pylori infection positivity was compared between a group of patients with primary open-angle glaucoma and a control group with normal intraocular pressure and a normal optic disc or normal perimetry. RESULTS: The 14C-UBT was positive in 18 (51.42%) out of 35 patients in the glaucoma group and in 15 (42.85%) out of 35 patients in the control group. H. pylori infection positivity rates were similar between the glaucoma and control groups (p>0.05). CONCLUSION: According to the 14C-UBT, there is no association between primary open-angle glaucoma and H. pylori infection.

Changes in the cornea related to sickle cell disease: a pilot investigation.

PURPOSE: To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). METHODS: This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. RESULTS: The mean CCT value was 509.6 ± 20.7 µm in the study group and 520.8 ± 23.6 µm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm², 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm², 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. CONCLUSIONS: The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

Effect of intravitreal injection of dexamethasone implant on corneal endothelium in macular edema due to retinal vein occlusion.

OBJECTIVE: To evaluate the effects of dexamethasone (DEX) implant (Ozurdex(®)) on corneal endothelium in patients with retinal vein occlusion complicated with macular edema. MATERIALS AND METHODS: Patients (n = 31) received 1-3 intravitreal DEX implants in one eye. Measurements were intraocular pressure (IOP) at baseline and 1, 3, and 6 months after the first intravitreal injection and corneal specular microscopy and central corneal thickness (CCT) at baseline and 1 and 6 months. We analyzed endothelial cell density (ECD), coefficient of variation of cell size (CV), and percentage of hexagonality. RESULTS: Mean follow-up period was 9.7 ± 3.3 months. Mean number of injections was 1.5 ± 0.8. Mean IOP values were 15.6 ± 2.6 mm Hg at baseline, 17.7 ± 3.6 mm Hg at one month, 16.4 ± 4.1 mm Hg at three months, and 16.0 ± 2.7 mm Hg at six months. There was a significant difference in mean IOPs at one month and six months (p = 0.008). There were no significant differences in mean ECD (p = 0.375), CV (p = 0.661), percentage of hexagonality (p = 0.287), and CCT (p = 0.331). CONCLUSION: Although intravitreal injection of 0.7 mg DEX causes moderate elevation of IOP, it does not seem to have detrimental effects on corneal endothelium at six months.

The effects of remifentanil and esmolol on increase in intraocular pressure due to laryngoscopy and tracheal intubation: a double-blind, randomized clinical trial.

PURPOSE: This study aimed to compare the effects of remifentanil and esmolol on the elevation of intraocular pressure (IOP) and hemodynamic response. METHODS: After approval of the institutional Ethics Committee and obtaining informed consent, 60 adult patients with American Society of Anesthesiologists I-II status undergoing elective, nonophthalmic surgery were included in the study. Exclusion criteria were preexisting eye disease, neuromuscular disease, esophageal reflux, hiatus hernia, allergy to any of the study drugs, and the use of ß-blockers, diuretics, or other antihypertensive agents. The patients were randomized into 2 groups by using the sealed-envelope method, as follows: group E (esmolol) and group R (remifentanil). A single intravenous dose of esmolol (0.5 mg/kg) or remifentanil (1 µg/kg) just before induction agents were given to patients in groups E and R, respectively. IOP, heart rate (HR), and mean arterial pressure (MAP) values were recorded before intubation and at 1, 3, 5, and 10 minutes after intubation. RESULTS: The IOP decrease in group R was statistically significant compared with group E (P<0.01). HR values at 10 minutes after intubation were significantly decreased in group E compared with group R (P<0.05). There was no significant difference in MAP values between the groups. CONCLUSIONS: It was concluded that remifentanil is more effective than esmolol in preventing IOP elevation related to laryngoscopy and tracheal intubation, while there is no significant difference between the 2 agents in terms of HR and MAP.

Assessment of Neutrophil/Lymphocyte Ratio in Patients with Age-related Macular Degeneration.

PURPOSE: To investigate the neutrophil/lymphocyte ratio (NLR) as an indicator of inflammation in patients with age-related macular degeneration (AMD). METHODS: Patients were evaluated by a review of records. The study included 81 patients with dry AMD (group 1), 84 patients with wet AMD (group 2), and 80 healthy age- and sex-matched controls (group 3). The NLR of the patients was obtained from the hospital laboratory archive and was measured by dividing the neutrophil count by the lymphocyte count. RESULTS: A significant difference was found in NLR values between groups 1 and 2 (p = 0.017), groups 2 and 3 (p < 0.001), and groups 1 and 3 (p < 0.001). In correlation analyses, NLR was correlated positively with age (r = 0.22, p <0.001) and disease severity (r = 0.40, p < 0.001). CONCLUSIONS: Patients with AMD have higher NLR compared with controls, and NLR correlates with disease severity. NLR may be used as a biomarker of inflammation in AMD.

A novel capsulorhexis technique in white cataract surgery.

PURPOSE: To investigate the efficacy and safety of novel capsulorhexis technique in white cataract surgery using the irrigation-aspiration system of a phaco device. MATERIALS AND METHODS: 53 eyes of 50 patients were included in the study. Patients were randomly divided into two groups. To 27 eyes of 27 patients in Group 1, continuous curvilinear capsulorhexis (CCC) was made using an irrigation-aspiration system by a phaco machine. To 26 eyes of 23 patients in Group 2, CCC was made using an ocular visco-elastic device (OVD) and utrata forceps. Surgical results were compared between two groups. RESULTS: No difference in outcome endothelial cell count or central corneal thickness was noted between the two groups. CCC-2 has been completed totally in Group 1 but only 22 eyes in the other group. CONCLUSIONS: Capsulorhexis with described technique is safe in white cataracts. This technique may be an alternative in capsulorhexis to the other method, which is made using OVD and forceps.

Peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layers thickness in ankylosing spondylitis.

OBJECTIVE: To assess the thickness of the retinal nerve fibril layer (RNFL) in cases with ankylosing spondylitis (AS). MATERIALS AND METHODS: The study included 40 AS patients who had no history of acute and/or previous uveitis and 50 healthy controls. After detailed ocular examination, the thickness of the peripapillary RNFL, the macula, and the ganglion cell-inner plexiform layers (GCIPL) were measured by spectral domain optic coherence tomography (SD-OCT). The correlation between the duration of the disease and the thickness of the RNFL, the macula, and the GCIPL were analyzed in the patients who had AS. These patients were then placed into 2 groups according to their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) score: patients with BASDAI score <4 and those with BASDAI score ≥4. The correlations between the BASDAI score and the mean GCIPL and temporal RNFL thickness were evaluated. RESULTS: No significant difference was detected in the RNFL thickness of the AS patients and that of the controls (p = 0.407). Nor was any significant difference detected in the GCIPL thickness of the AS and the control groups (p = 0.091). In addition, no significant difference was found in the macular thickness when the AS group was compared to the control group (p = 0.139). However, a negative correlation was detected between the duration of the disease and the thickness of the temporal quadrant RNFLs (r = -0.334; p = 0.035). The temporal quadrant RNFL thickness and the mean thickness of the GCPIL were significantly thinner in the AS patients with BASDAI score ≥4 (p = 0.034 and p = 0.025, respectively). Also, the BASDAI score were negatively correlated to the temporal quadrant RNFL and GCIPL thickness (r = -0.332; p = 0.036 and r = -0.348; p = 0.028, respectively). CONCLUSION: RNFL thickness and GCIPL thickness of ankylosing spondylitis may be affected by the severity and duration of the disease.

Effects of sub-Tenon's anaesthesia on ocular hemodynamics.

OBJECTIVE: To research the effects of sub-Tenon's anaesthesia (STA) on ocular hemodynamics in patients with cataract using colour Doppler imaging (CDI). DESIGN: Prospective clinical study. PARTICIPANTS: Thirty-four eyes of 34 patients with age-related cataract. METHODS: Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) values of the ophthalmic artery (OA), central retinal artery, and central retinal vein were measured by CDI before and immediately after performing sub-Tenon block using 2 mL of 2% lidocaine with adrenaline (1:200 000). RESULTS: Both PSV and EDV values were significantly decreased after sub-Tenon injection in all the studied vessels of the patients. However, no important changes were observed in the RI values of the vessels. CONCLUSIONS: STA markedly reduced ocular blood flow. The reduction may be more acceptable compared with other retrobulbar block methods. Sub-Tenon block should be performed carefully to senile patients with cataract with vascular occlusive disorder.

Orbital compression syndrome complicated by epidural hematoma and wide cephalohematoma in a patient with sickle cell disease.

Orbital wall infarctions resulting in orbital and epidural hematomas are rare manifestations of sickle cell disease (SCD). We report orbital compression syndrome associated with an epidural hematoma and wide cephalohematoma in a 15-year-old boy with SCD. An infarcted orbital bone was observed on magnetic resonance imaging and three-phase bone scintigraphy with Technetium-99m methylene diphosphonate. The patient recovered completely without surgical intervention at the end of the fourth week. Prompt diagnosis and proper management are critical for complete recovery.

Is there a relationship between pathologic myopia and dry eye syndrome?

PURPOSE: The aim of this study was to investigate the relationship between pathologic myopia and the dry eye syndrome. METHODS: Forty-five patients with a spherical equivalence (SE) greater than -6.0 diopters (D) and an axial length (AL) >26.5 mm were assigned to the pathological myopia group (group 1). Forty-four healthy individuals were selected from subjects with emmetropia whose SE values ranged from -1.0 to +1.0 D (group 2). Ocular surface disease index (OSDI) scores of all the patients were determined. All the participants underwent the following: Schirmer 1 test without anesthesia, corneal staining, tear break-up time (TBUT), Schirmer 1 test with anesthesia, and AL measurement. RESULTS: The mean age of group 1 and group 2 patients was 40.2 ± 12.3 and 38.8 ± 9.3 years. The mean values of SE, keratometry, and AL were -9.6 ± 3.8 D, 43.9 ± 1.1 D, and 27.4 ± 0.6 mm in group 1 and -0.1 ± 0.5 D, 42.3 ± 1.4 D, and 23.0 ± 0.2 mm in group 2. The mean values of the Schirmer 1 test without and with anesthesia were 14.4 ± 6.1 and 9.5 ± 4.5 mm in group 1 and 16.7 ± 6.2 and 11.4 ± 6.0 mm in group 2. The mean TBUT in group 1 was 7.2 ± 3.4 seconds, whereas that in group 2 was 13.6 ± 3.7 seconds. There was a significant difference between the groups in SE, keratometry, AL, TBUT, and OSDI scores (P < 0.001). CONCLUSIONS: Patients with pathologic myopia have lower TBUT scores and higher OSDI scores when compared with healthy individuals.

The effects of soft contact lens use on cornea and patient's recovery after autograft pterygium surgery.

PURPOSE: To investigate usage of soft contact lens (SCL) on post-operative pain relief and daily, activity due to pterygium surgery. METHODS: Autograft pterygium surgery was performed to 63 eyes of 63 patients. After surgery in 30, eyes of 30 patients in group-1, SCL was placed on the cornea. In 33 patients of group-2, antibiotic, pomade was applied and tightly covered with bandage. Follow-up visits were performed on 24th and, 48th h after the surgery. Re-epithelization time and pain scores were compared. RESULTS: Patients' 24th h pain score was 2.96 ± 0.76 in group-1, and 4.15 ± 0.75 in group-2. The mean, pain score for 48 h was 1.66 ± 0.66 in group-1, and 2.96 ± 0.68 in group-2. Patients' pain scores for, both 24th h and 48th h were lower in group-1 (p<0.01). The mean re-epithelization times in, group 1 and 2 were 48 and 56.7h, respectively. Corneal re-epithelization is improved in patients, with SCL compared to group 2. CONCLUSION: SCL seems effective on reducing post-operative pain and eye stinging, and may accelerate, corneal re-epithelization and maintaining daily activities.

Relationship between mean platelet volume and retinopathy in patients with type 2 diabetes mellitus.

OBJECTIVES: To evaluate the effect of mean platelet volume (MPV) on diabetic retinopathy in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: In this study, ocular findings and MPV values were retrospectively reviewed in 192 patients with type 2 diabetes mellitus. The patients were classified into four groups according to ocular findings, as follows: group 1, diabetic patients without diabetic retinopathy (n = 70); group 2, diabetic patients with non-proliferative diabetic retinopathy (n = 64); group 3, diabetic patients with proliferative diabetic retinopathy (n = 58); and group 4, healthy controls (n = 100). RESULTS: A significant difference was found in MPV values between groups 2 and 4 (P = 0.001), between groups 3 and 4 (P = 0.001), and between groups 1 and 4 (P = 0.004). No significant difference was found in MPV values between groups 1 and 2 (P = 0.241) and between groups 2 and 3 (P = 0.460); whereas there was a statistically significant difference between groups 1 and 3 (P = 0.015). The three diabetic groups (groups 1, 2, and 3) were compared with each other. While there was a statistically significant difference between groups 1 and 3 (P = 0.015), there was no significance between groups 2 and 3 (P = 0.46), and between group 1 and 2 (P = 0.241). Logistic regression analysis found a 1.40-fold increase in the risk of retinopathy development (OR: 1.404; P = 0.002) and a 1.46-fold increase in the risk of proliferative diabetic retinopathy (OR: 1.466; P = 0.002) as the MPV value increased. CONCLUSIONS: In diabetic patients, the risk of retinopathy development increases with higher MPV values.

Magnetic resonance imaging findings of the abducens nerves in type 1 Duane's retraction syndrome.

PURPOSE: To investigate nervus abducens and extraocular mucles in patients with Type 1 Duane's retraction syndrome using high-definition magnetic resonance imaging. METHODS: The study included 10 patients with Type I Duane's retraction syndrome who underwent magnetic resonance imaging (MRI) of the brain and orbits. RESULTS: Overall, 10 cases were included in the study. There were seven women and three men. The mean age was 5.2 years (1-15 years). MRI of the abducens nerve was performed in all cases. Of the cases, the left eye was involved in eight cases, whereas the right eye was involved in two cases. There was no bilateral eye involvement. Among the 10 patients clinically diagnosed as Type 1 Duane's retraction syndrome, the abducens nerve could not be visualized in eight cases, whereas the nerve was hypoplastic in one case and bilateral abducens nerves were present in one case by MRI. The extraocular muscles were normal in all cases on T2 weighted coronal MRI of the orbits. CONCLUSION: Absence of abducens nerve and normal extraocular muscles was detected in patients with Type 1 Duane's retraction syndrome at the affected side.

Repair of iridodialysis using 8-0 polypropylene.

PURPOSE: Investigate the effectiveness of repair of iridodialysis with 8-0 polypropylene. METHODS: We present four cases of traumatic iridodialysis that were repaired by 8-0 polypropylene suture. RESULTS: Better iris reposition and stability were achieved with 8-0 polypropylene suture despite wide degree traumatic iridodialysis in all patients. CONCLUSION: In this study, we used 8-0 polypropylene suture, which is thicker, cheaper, and more durable than 10-0 sutures. We suggest that usage of 8-0 polypropylene sutures may provide better iris repositioning.

Vacuum-assisted continuous circular capsulorhexis using bimanual irrigation and aspiration system of phaco machine in immature cataract.

Seventy-eight eye of 65 patients were enrolled in this retrospective clinical study. Two-side ports are made with a 23-gauge stiletto knife. The irrigation handpiece is introduced into the anterior chamber through one side port and 27-gauge cystotome is introduced through the other one. Anterior capsular flap is created with cystotome. The capsular flap is vacuumed with a 25-gauge visco elastic's cannula, which connected to the phaco machine vacuum. The continuous circular capsulorhexis (CCC) is completed with the using bimanual irrigation and aspiration system of phaco machine. Vacuum-assisted CCC technique was used in 78 cases of uncomplicated immature senile cataracts. All cases were done under sub-Tenon's anesthesia. A complete CCC was achieved in all cases. Performing CCC with our technique is easy, safe, and cheap. It may be an alternative method to CCC by using OVD and forceps.

The effect of enoxaparin-containing irrigation fluid used during cataract surgery on postoperative inflammation in patients with diabetes.

PURPOSE: To investigate effects of enoxaparin on postoperative inflammation in patients with moderate nonproliferative diabetic retinopathy (NPDR) and nuclear cataract. DESIGN: Prospective masked controlled trial. METHODS: setting: Institutional practice. study population: The study included 51 eyes of 51 diabetes mellitus (DM) patients with moderate NPDR and grade 2-3 nuclear cataracts. Group 1 included randomly selected patients who received enoxaparin in balanced salt solution (BSS) during cataract surgery, while standard BSS was used in Group 2. observation procedure: Patients were followed up 1 day, 1 week, and 1 and 2 months after the surgery. main outcome measures: Anterior chamber cell and flare. RESULTS: Postoperatively, 20 patients from Group 1 and 4 patients in Group 2 had less than a mean of 10 cells at day 1 (P = .012). At the first week, 20 patients from Group 1 and 10 patients from Group 2 had less than a mean of 10 cells (P = .004). When compared for flare, 20 patients from Group 1 and 8 patients from Group 2 had a flare between 0 and +1 at postoperative day 1 (P < .001). By the end of postoperative first week, 24 patients from Group 1and 18 patients from Group 2 had a flare between 0 and +1 (P = .012). There was no difference between groups in terms of postoperative inflammation at the first and second months after the surgery. CONCLUSION: The results of the study suggest that enoxaparin added into the infusion fluid may reduce postoperative inflammation in patients with DM, and this result supports the anti-inflammatory effect of enoxaparin.