Fourier analysis of corneal Scheimpflug imaging: clinical use in keratoconus.

AIM: To evaluate the clinical use of Fourier analysis of videokeratography data in the diagnosis and follow-up of keratoconus (KC). METHODS: We conducted a chart review of consecutive patients presented to our cornea clinic. A team of two experienced cornea specialists divided the patients into three groups: normal cornea, forme fruste KC (FFKC), and clinical KC. The exclusion criteria were a history of previous ocular surgery, any accompanying corneal pathology other than KC, high myopia (>6.00 diopters), amblyopia, pregnancy, breastfeeding, or any current autoimmune disease. The data of Fourier series harmonic analysis were evaluated for their diagnostic capacity using the receiver operating characteristic (ROC) curve. A binary logistic regression analysis was also conducted to construct a diagnostic model. A total of 259 eyes showed progression in the clinical KC group and underwent a combination of accelerated corneal collagen cross-linking and topography-guided customized treatment with an excimer laser. RESULTS: The study included 1262 eyes (618 normal, 530 KC, and 114 FFKC) of 1262 patients. We observed that maximum decentration (MaxDec) was almost as good as maximum keratometry (Kmax) in detecting progressive KC. The area under the curve (AUC) was 0.95 for KC [95% confidence interval (CI): 0.93-0.96] and 0.84 for FFKC (95%CI: 0.79-0.88). Higher predictive accuracy was obtained using a model combining the spherical component, MaxDec, irregularity, and regular astigmatism in the center of the cornea (AUC: 0.97; sensitivity: 89%, and specificity: 96%). CONCLUSION: Decentration, Kmax, and posterior radii of curvatures from a 3.0-mm optical zone centered on the thinnest point of the cornea provide the highest accuracy with low reproducibility of Kmax.

Scheimpflug imaging of the anterior segment following simultaneous cross-linking with topography-guided custom ablation treatment for keratoconus.

PURPOSE: To report alterations in the anterior segment following accelerated corneal collagen cross-linking and topo-guided customized ablation treatment with the Nidek vision excimer laser system (Nidek Co., Ltd., Gamagori, Japan) in a single procedure. METHODS: We reviewed the medical records of patients who underwent cross-linking for progressive keratoconus. We divided patients into four groups based on the treatment protocol. Eyes were evaluated regarding uncorrected distance visual acuity, corrected distance visual acuity, keratometry (maximum [Kmax], equivalent keratometry readings, Ksteep and Kflat parameters), corneal elevations (anterior and posterior), the anterior radius of curvature, the posterior radius of curvature, anterior chamber volume, anterior chamber depth, anterior chamber angle and the pachymeter of the thinnest locale of the cornea before the surgery and at 1, 3, 6, and 12 months after the procedure. RESULTS: We included 259 eyes of 227 patients with progressive keratoconus who underwent treatment. The mean respective baseline uncorrected distance visual acuity and corrected distance visual acuity were: 0.68 ± 0.45 and 0.34 ± 0.40 in Group 1; 0.82 ± 0.44 and 0.33 ± 0.23 in Group 2; 0.61 ± 0.36 and 0.21 ± 0.17 in Group 3; and 0.65 ± 0.38 and 0.23 ± 0.18 in Group 4; logMAR did not show significant difference among the groups (p=0.14 and p=0.06, respectively). Visual improvements were better in the combined surgery groups. Mean Kmax in Groups 1, 2, 3, and 4 were 57.24 ± 7.51, 59.26 ± 6.94, 53.73 ± 4.60, and 54.31 ± 4.25 diopter (D), respectively. Group 1 demonstrated increased Kmax for 6 months. Maximum flattening by 3.38 ± 2.35 D 1 year after surgery was observed in Group 4 (p<0.05). Decreased anterior chamber angle, anterior chamber depth, and anterior chamber volume were similar, indicating the stability of the anterior chamber. CONCLUSION: Visual and anatomical improvement is better, with improved stability of the anterior segment, in combined surgery groups compared with cross-linking alone.

Curcumin enhances cisplatin-induced human laryngeal squamous cancer cell death through activation of TRPM2 channel and mitochondrial oxidative stress.

In this study, laryngeal tumor cells were killed through the production of excessive reactive oxygen species (ROS) and Ca2+ influx by cisplatin (CISP). Nevertheless, a resistance was determined against CISP treatment in the tumor cells. We have investigated the stimulating role of curcumin (CURC) on CISP-induced human laryngeal squamous cancer (Hep2) cell death through TRPM2 channel activation, and its protective role against the adverse effects of CISP in normal kidney (MPK) cells. Hep2 and MPK cells were divided into four groups as control group, CURC group (10µM for 24 hrs), CISP group (25 µM for 24 hrs), and CURC + CISP combination group. CISP-induced decrease of cell viability, cell count, glutathione peroxidase and glutathione level in Hep2 cells were further increased by CURC treatment, but the CISP-induced normal MPK cell death was reduced by the treatment. CISP-induced increase of apoptosis, Ca2+ fluorescence intensity, TRPM2 expression and current densities through the increase of lipid peroxidation, intracellular and mitochondrial oxidative stress were stimulated by CURC treatment. In conclusion, CISP-induced increases in mitochondrial ROS and cell death levels in Hep2 cells were further enhanced through the increase of TRPM2 activation with the effect of CURC treatment. CISP-induced drug resistance in Hep2 cells might be reduced by CURC treatment.

Clinical and Radiological Comparison of Effects of Platelet-Rich Plasma, Hyaluronic Acid, and Corticosteroid Injections on Temporomandibular Joint Osteoarthritis.

There are few studies in the literature that comparatively evaluate the use of intra-articular orticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). In this study, the authors aimed to compare the clinical results of intra-articular CS, HA, and PRP injections in patients who presented to the authors' clinic with temporomandibular joint (TMJ) pain and clinically diagnosed with TMJ-osteoarthritis. Patients were evaluated in 2 groups as those patients who felt pain on lateral (n = 31), and posterior (n = 43) palpation. Patients who were evaluated in the study were randomly assigned to 3 different treatment groups as Group 1 (PRP), Group 2 (HA), and Group 3 (CS). Pain felt on the TMJ on lateral and posterior palpation was assessed before treatment and every month for 3 months using a 5-point pain scale. Presence of crepitation, loss of function, and loss of strength were assessed before treatment and every month for 3 months. Significant changes were observed in the PRP and HA groups when the patients were evaluated according to the VAS scores evaluated at different follow-up times for TMJ pain on lateral palpation. Significant changes were observed in the PRP, HA, and CS groups when VAS scores were evaluated according to the patients' follow-up times for TMJ pain on lateral palpation. In conclusion, the findings of this study have shown that intra-articular PRP injections decreased TMJ palpation pain more effectively compared with the HA and CS groups.

Clinical Features and Surgical Results in Harada-Ito Surgery Patients.

Symptomatic excyclotorsion is an important clinical problem, especially in acquired superior oblique muscle palsy. Excyclotorsion can disrupt the fusion and cause torsional diplopia. Harada-Ito surgery (HI) is a widely used method for treating excyclotorsions. This method relieves the torsional diplopia by increasing the effect of the incyclotorsion. In this study, we aimed to report the clinical features of patients with torsional diplopia due to acquired trochlear nerve palsy and the results of HI surgery in these patients.

Novel biomarkers for patients with idiopathic acute anterior uveitis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio.

AIM: To assess the levels of the neutrophil to lymphocyte ratio (N/L) and the platelet to lymphocyte ratio (P/L) in patients with idiopathic acute anterior uveitis (AAU) and to compare with healthy controls. METHODS: Thirty-six male patients with idiopathic AAU and 36 male healthy subjects were enrolled in this retrospective study. Complete ophthalmological examination and complete blood count measurements results of all subjects were evaluated. RESULTS: There was a significant difference in N/L and P/L between idiopathic AAU and control groups (P=0.006, P=0.022). Also, correlation analysis revealed a significant correlation between C-reactive protein (CRP) and N/L (P=0.002; r=0.461). CONCLUSION: Our study for the first time provides evidence of N/L and P/L may be useful biomarkers in patients with idiopathic AAU. N/L is correlated with CRP, so it can be a useful biomarker to predict the prognosis in idiopathic AAU.

Retinal Nerve Fiber Layer and Peripapillary Choroidal Thicknesses in Non-Glaucomatous Unilateral Optic Atrophy Compared with Unilateral Advanced Pseudoexfoliative Glaucoma.

PURPOSE: To investigate retinal nerve fiber layer thickness (RNFL-T) and peripapillary choroidal thickness (PC-T) in non-glaucomatous optic atrophy (OA) patients in comparison with unaffected and control eyes, furthermore, to compare thickness profiles with unilateral pseudoexfoliative advanced glaucoma. MATERIALS AND METHODS: Thirty-three eyes with OA (Group A), 33 unaffected fellow eyes (Group B), 25 right eyes of 25 control subjects (Group C), and 15 eyes with advanced glaucoma (Group D) were enrolled. RNFL-T was measured in six regions by spectral-domain optical coherence tomography. Enhanced depth imaging optical coherence tomography was obtained to evaluate PC-T in corresponding regions. RESULTS: RNFL-T was significantly lower in Group A than in Groups B and C globally and at all peripapillary regions (all p < 0.001). P-CT in Group A was significantly lower globally (p = 0.03) and in three regions (temporal, p = 0.001; temporal-superior, p = 0.01; and nasal-inferior, p = 0.037) versus Group C. However, it was significantly thinner than in Group B in all regions (temporal, p = 0.02; temporal-superior, p = 0.013; nasal-superior, p = 0.044; nasal, p = 0.02; nasal-inferior, p < 0.001; and temporal-inferior, p < 0.001) and globally (p < 0.001). In Group A RNFL-T (thicker superiorly and inferiorly; thinner temporally and nasally) and PC-T (superior > temporal > nasal > inferior) profiles were almost identical to that in unaffected fellow eyes and control eyes. However, Group D showed different patterns with less regional differences in RNFL-T, and the greatest value of PC-T in nasal quadrant. CONCLUSIONS: Besides retinal nerve fiber layer thinning, non-glaucomatous OA is associated with choroidal thinning. The RNFL-T and PC-T profiles in advanced glaucoma eyes differed from the common patterns seen among OA eyes, unaffected fellow eyes, and control eyes.

The effect of single dose of brimonidine-purite 0.15％ on choroidal thickness in healthy volunteers / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the potential posterior segment effects of topical application of brimonidine-purite 0.15％ through measurement of choroidal thickness (CT) in healthy eyes using enhanced depth imaging spectraldomain optical coherence tomography (EDI-SD-OCT).METHODS:Thirty-two eyes of 32 healthy subjects were included in this prospective,placebo controlled interventional clinical trial.They received one drop of topical preservative-free artificial tears as placebo for the first day and one drop of brimonidine-purite 0.15％ for the second day.Intraocular pressure,ocular perfusion pressure (OPP),and EDI-SD-OCT were performed at baseline,at 1,3 and 5h after the treatments.RESULTS:Compared to the measurements obtained at baseline,the CT measurements obtained after the topical application of brimonidine-purite 0.15％ significantly increased at the sub-fovea (P=0.001),at temporal 1500 μm to the fovea (P=0.003) and at nasal 1500 μm to the fovea (P=0.003).Choroidal thickness was unchanged in placebo group during the study (P ＞0.05).There was no significant reduction in the OPP in both groups (P ＞0.05).There were no adverse events during the study.CONCLUSIONS:Contrary to expectations,topical administration of brimonidine-purite 0.15％ resulted with thickening of sub-foveal,temporal and nasal CT.This might be related to altered auto-regulation mechanisms in choroidal vessels.

Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis / Eficácia do aflibercept em pacientes portadores de degeneração macular relacionada à idade exsudativa com resistência completa e taquifilaxia ao ranibizumab

ABSTRACT Purpose: The present study compared the efficacy of aflibercept for neovascular age-related macular degeneration (NV-AMD) in patients with complete ranibizumab resistance and tachyphylaxis. Methods: Forty-four eyes of 38 neovascular age-related macular degeneration patients were evaluated. Eyes were divided into a complete resistance group (n=23 eyes) and tachyphylaxis group (n=21 eyes). Results: After three injections, eight (38.1%) patients in the tachyphylaxis group and nine (39.1%) in the complete resistance group presented with macular dryness. After the first injection of aflibercept, the mean visual acuity improved significantly in the tachyphylaxis group (p=0.018) but remained unchanged in the complete resistance group (p=0.37). There was a non-significant trend towards improved mean visual acuity in both groups after the second and third injections relative to the acuity at the final visit for ranibizumab treatment. In the tachyphylaxis group, the presence of subfoveal pigmented epithelium detachment (PED) decreased significantly after intravitreal aflibercept treatment. Conclusions: Although treatment with aflibercept yielded generally positive anatomical results in both groups, no significant increase in visual acuity was achieved.

RESUMO Objetivo: O presente estudo comparou a eficácia do aflibercept na degeneração macular neovascular relacionada à idade (NV-AMD) com de resistência completa ao ranibizumab e taquifilaxia ao ranibizumab. Método: Quarenta e quatro olhos de 38 pacientes com degeneração macular neovascular relacionada à idade foram inscritos. Eles foram divididos em dois grupos: grupo de resistência completa (n=23 olhos) e grupo taquifilaxia (n=21 olhos). Resultados: Depois de três injeções, 8 (38,1%) olhos no grupo de taquifilaxia e 9 (39,1%) olhos no grupo de resistência completa, apresentaram mácula seca. Após a primeira injeção de aflibercept, a acuidade visual média melhorou significativamente no grupo taquifilaxia (p=0,018) e manteve-se inalterada no grupo de resistência completa (p=0,37). Houve uma tendência de melhora da acuidade visual média em ambos os grupos após a segunda e terceira injeções em comparação com a última visita do tratamento com ranibizumab, mas isso não foi estatisticamente significativo. A presença de descolamento do epitélio pimentado subfoveal (PED) em olhos com taquifilaxia ao ranibizumab diminuiu significativamente após o tratamento aflibercept intravítreo. Conclusões: Embora o tratamento com aflibercept tenha mostrado resultados anatômicos positivas em ambos os grupos, não foi obtida melhora significativa da acuidade visual.

Ophthalmic pathologies in female subjects with bilateralcongenital sensorineural hearing loss.

BACKGROUND/AIM: The high prevalence of ophthalmologic pathologies in hearing-disabled subjects necessitates early screening of other sensory deficits, especially visual function. The aim of this study is to determine the frequency and clinical characteristics of ophthalmic pathologies in patients with congenital bilateral sensorineural hearing loss (SNHL). MATERIALS AND METHODS: This descriptive study is a prospective analysis of 78 young female SNHL subjects who were examined at a tertiary care university hospital with a detailed ophthalmic examination, including electroretinography (ERG) and visual field tests as needed. RESULTS: The mean age was 19.00 ± 1.69 years (range: 15 to 24 years). A total of 39 cases (50%) had at least one ocular pathology. Refractive errors were the leading problem, found in 35 patients (44.9%). Anterior segment examination revealed heterochromia iridis or Waardenburg syndrome in 2 cases (2.56%). Dilated fundus examination revealed retinal pathologies in 15 cases (19.23%), including retinitis pigmentosa or Usher's syndrome in 8 cases (10.25%). Most of the Usher's syndrome cases (87.5%) had consanguinity. CONCLUSION: Screening for congenital SNHL in the early years of life and routine yearly follow-ups are essential for maximizing the rehabilitation of this disabled group. The high rate of visually debilitating syndromic ocular pathologies associated with high frequency of consanguinity doubles the importance.

Long-term motor and sensory outcomes after surgery for infantile esotropia.

BACKGROUND/AIM: Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. METHODS: Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. RESULTS: No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80). CONCLUSION: Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.

RACK1 Is an Interaction Partner of ATG5 and a Novel Regulator of Autophagy.

Autophagy is biological mechanism allowing recycling of long-lived proteins, abnormal protein aggregates, and damaged organelles under cellular stress conditions. Following sequestration in double- or multimembrane autophagic vesicles, the cargo is delivered to lysosomes for degradation. ATG5 is a key component of an E3-like ATG12-ATG5-ATG16 protein complex that catalyzes conjugation of the MAP1LC3 protein to lipids, thus controlling autophagic vesicle formation and expansion. Accumulating data indicate that ATG5 is a convergence point for autophagy regulation. Here, we describe the scaffold protein RACK1 (receptor activated C-kinase 1, GNB2L1) as a novel ATG5 interactor and an autophagy protein. Using several independent techniques, we showed that RACK1 interacted with ATG5. Importantly, classical autophagy inducers (starvation or mammalian target of rapamycin blockage) stimulated RACK1-ATG5 interaction. Knockdown of RACK1 or prevention of its binding to ATG5 using mutagenesis blocked autophagy activation. Therefore, the scaffold protein RACK1 is a new ATG5-interacting protein and an important and novel component of the autophagy pathways.

Comparison of peripapillary choroidal thickness measurements via spectral domain optical coherence tomography with and without enhanced depth imaging.

OBJECTIVES: To compare peripapillary choroidal thickness (PP-CT) measurements using a spectral domain optical coherence tomography (SD-OCT) device with and without enhanced depth imaging (EDI). METHODS: Sixty healthy subjects aged from 18 to 40 years were included in this study. PP-CTs were measured in the right eyes by manual segmentation via SD-OCT both with and without EDI. The intraclass correlation coefficient (ICC) for each technique and comparison of PP-CT measurements between two techniques were evaluated. The correlation between retinal nerve fiber layer (RNFL) thickness and PP-CT was also explored on images of SD-OCT without EDI. RESULTS: The PP-CT measurements of 55 subjects were evaluated. The ICC was 0.999 (95% CI: 0.998-1.0, p < 0.001) for SD-OCT with EDI and 0.996 (95% CI: 0.995-0.997, p < 0.001) for SD-OCT without EDI. The mean PP-CT measurements in all regions and the overall mean PP-CT measurements between the two techniques were not different (p > 0.05). Additionally, there was no correlation between RNFL thickness and PP-CT (r = -0.109; p = 0.335). CONCLUSIONS: The PP-CT measurements via SD-OCT without EDI were consistent with the measurements via SD-OCT with EDI. Ophthalmologists who do not have access to EDI technology can use images of SD-OCT without EDI to measure the peripapillary choroid for research purposes. However, thicker peripapillary choroids cannot be measured using this technique and require further modifications or newer technologies, such as SD-OCT with EDI.

Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis.

PURPOSE:: The present study compared the efficacy of aflibercept for neovascular age-related macular degeneration (NV-AMD) in patients with complete ranibizumab resistance and tachyphylaxis. METHODS:: Forty-four eyes of 38 neovascular age-related macular degeneration patients were evaluated. Eyes were divided into a complete resistance group (n=23 eyes) and tachyphylaxis group (n=21 eyes). RESULTS:: After three injections, eight (38.1%) patients in the tachyphylaxis group and nine (39.1%) in the complete resistance group presented with macular dryness. After the first injection of aflibercept, the mean visual acuity improved significantly in the tachyphylaxis group (p=0.018) but remained unchanged in the complete resistance group (p=0.37). There was a non-significant trend towards improved mean visual acuity in both groups after the second and third injections relative to the acuity at the final visit for ranibizumab treatment. In the tachyphylaxis group, the presence of subfoveal pigmented epithelium detachment (PED) decreased significantly after intravitreal aflibercept treatment. CONCLUSIONS:: Although treatment with aflibercept yielded generally positive anatomical results in both groups, no significant increase in visual acuity was achieved.

Prediction of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma by Using Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio.

PURPOSE: To assess the levels of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEX) and to compare the NLR and PLR results of patients with PEX, PEX glaucoma (PXG), and healthy controls. METHODS: In total, 34 patients with PEX, 29 patients with PXG, and 42 healthy subjects were enrolled in this retrospective study. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection. RESULTS: There was a significant difference in NLR between PEX and control groups (p = 0.012) and PXG and control groups (p = 0.003). Also, a significant difference was found in PLR values between control and PXG groups (p = 0.024). CONCLUSIONS: Our study for the first time provides evidence that PLR and NLR may be useful for predicting the prognosis of PEX patients and progression to PXG.

The Impact of Reused Phaco Tip on Outcomes of Phacoemulsification Surgery.

PURPOSE: To evaluate the impact of reused phaco tip on intraoperative performance and postoperative outcomes after 2.2 mm micro-coaxial torsional and transversal phacoemulsification. MATERIAL AND METHODS: This prospective randomized study enrolled 136 eyes of 136 cataract patients; 68 eyes in torsional group (34 eyes with single use tip, 34 eyes with reused tip) and 68 eyes in transversal group (34 eyes with single use tip, 34 eyes with reused tip). Intraoperative measurements were total ultrasound (U/S) time, torsional U/S time, cumulative dissipated energy (CDE), estimated fluid use (EFU) in the torsional group and total phacoemulsification time (TPT), and effective phacoemulsification time (EPT) in transversal phacoemulsification. The central endothelial cell density (ECD) and the central corneal thickness (CCT) were evaluated preoperatively and postoperatively at 1 and 30 days using noncontact specular microscopy. RESULTS: Intraoperative measurements in torsional phacoemulsification showed significant increase in total U/S time (p = 0.01), torsional U/S time (p = 0.01), and CDE (p = 0.01) with the reused tip. The EFU was similar in both tip groups (p = 0.36). The total U/S time, torsional U/S time, and CDE in torsional group were significantly increased with the reused tip for grade III (p = 0.03 for all parameters) and grade IV cataracts (p = 0.005 for torsional U/S time and CDE; p = 0.006 for total U/S time). Intraoperative measurements in transversal phacoemulsification showed no differences in TPT and EPT between tip groups (p > 0.05). The change in ECD and CCT in torsional and transversal phacoemulsification groups were similar in both tip groups (p > 0.05). CONCLUSIONS: This study showed that sharpness of phaco tip edge increases the efficiency of torsional phacoemulsification for hard cataracts. This result does not mean that reused phaco tip may be used in soft and medium cataracts. As the timing of tip's change is a user-dependent procedure, a new single phaco tip should be used in each case if possible.