Frequency of antiseptic resistance genes in clinical staphycocci and enterococci isolates in Turkey.

BACKGROUND: Disinfectants and antiseptics are biocides widely used in hospitals to prevent spread of pathogens. It has been reported that antiseptic resistance genes, qac's, caused tolerance to a variety of biocidal agents, such as benzalkonium chloride (BAC) and chlorhexidine digluconate (CHDG) in Staphylococcus spp. isolates. We aimed to search the frequency of antiseptic resistance genes in clinical Staphylococcus spp. and Enterococcus spp. isolates to investigate the possible association with antiseptic tolerance and antibiotic resistance. METHODS: Antiseptic resistance genes (qacA/B, smr, qacG, qacH, and qacJ) isolated from Gram-positive cocci (69 Staphylococcus spp. and 69 Enterococcus spp.) were analyzed by PCR method. The minimum inhibitory concentrations (MICs) of BAC and CHDG were determined by agar dilution method, whereas antibiotic susceptibility was analyzed by disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) criteria. RESULTS: The frequency of antiseptic resistance genes was found to be high (49/69; 71.0%) in our clinical staphylococci isolates but absent (0/69; 0%) in enterococci isolates. The frequency of qacA/B and smr genes was higher (25/40; 62.5% and 7/40; 17.5%, respectively) in coagulase negative staphylococci (CNS) when compared to Staphylococcus aureus strains (3/29; 10.3%, and 4/29; 13.8%, respectively). In contrast, the frequency of qacG and qacJ genes was higher (11/29; 37.9% and 8/29; 27.5%, respectively) in S. aureus than those of CNS (5/40; 12.5%, 10/40; 25.0%) strains. qacH was not identified in none of the strains. We found an association between presence of antiseptic resistance genes and increased MIC values of BAC (>4 µg/mL) in staphylococci and it was found to be statistically statistically significant (p < 0.01). We also showed that MICs of BAC and CHDG of vancomycin-resistant enterococci (VRE) isolates were significantly higher than those of vancomycin-susceptible enterococci (VSE) isolates (p < 0.01). CONCLUSIONS: For our knowledge, our study is the first to investigate antiseptic resistance genes in enterococci and also qacG, qacH, and qacJ genes in staphylococci isolates in Turkey. Further studies are needed to revise the biocide policy and to support infection control programs to avoid the development of new resistance mechanisms.

Syrian Civil-War-Related Intraocular Foreign Body Injuries: A Four-Year Retrospective Analysis.

PURPOSE: To analyze the data of patients who underwent vitreoretinal surgery due to intraocular foreign body (IOFB) injuries that occurred in the Syrian civil war. METHODS: Seventy-eight eyes of 78 patients who underwent vitreoretinal surgery due to IOFB injuries that occurred during the Syrian civil war were analyzed. RESULTS: Forty-four eyes (56.4%) had traumatic cataract, 44 (56.4%) had retinal tears, 42 (53.8%) had vitreous hemorrhage, 18 (23%) had retinal detachment, 12 (15.3%) had endophthalmitis, and eight eyes had hyphema (10.2%). IOFBs consisted of metal in 62 eyes (79.4%), stone in eight eyes (10.2%), organic material in four eyes (5.1%), and glass in four eyes (5.1%). Approximately 86% of the eyes had initial VAs of 4/200 or worse. However, VAs improved in 64 eyes (82%) after the surgeries. CONCLUSIONS: Despite delays in treatment and the severity of injuries, 82% (64/78) of the eyes had an improvement in VA after the surgeries.

Diurnal variation in choroidal thickness and body temperature / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate how body temperature (BT) affects choroidal thickness (CT) according to measurements taken with enhanced depth imaging optical coherence tomography (EDI-OCT).METHODS: In this prospective study, the CT of 41 healthy patients was measured hourly from 9∶00 to 17∶00 at the fovea (SF-CT), 500 μm nasal to the fovea(N-CT), and 500 μm temporal to the fovea (T-CT) using EDI-OCT.BT was also measured hourly from 9∶00 to 17∶00 using a non-contact infrared thermometer.Possible correlations between diurnal variations of CT and BT were evaluated.RESULTS: SF-CT values significantly differed between measurements at 9∶00 and 13∶00 (P=0.021), 9∶00 and 14∶00 (P=0.012), 9∶00 and 16∶00 (P=0.048), and 9∶00 and 17∶00 (P=0.002).N-CT values also significantly differed between measurements at 9∶00 and 13∶00 (P=0.004), though T-CT did not significantly vary during the 8h period (P >0.05 for all).CONCLUSION: CT is not significantly associated with hourly changes in BT from 9∶00 to 17∶00.

Effect of Hydroxychloroquine on the Retinal Layers: A Quantitative Evaluation with Spectral-Domain Optical Coherence Tomography.

Purpose. To evaluate the effect of hydroxychloroquine on retinal pigment epithelium- (RPE-) Bruch's membrane complex, photoreceptor outer segment, and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses using spectral-domain optical coherence tomography (SD-OCT). Methods. In this prospective case-control study, 51 eyes of 51 hydroxychloroquine patients and 30 eyes of 30 healthy subjects were included. High-quality images were obtained using a Cirrus HD-OCT with 5-line raster mode; the photoreceptor inner segment (IS) and outer segment (OS), sum of the segments (IS + OS), and RPE-Bruch's membrane complex were analyzed. Results. The thicknesses of the IS + OS and OS layers were significantly lower in the hydroxychloroquine subjects compared to the control subjects (P < 0.05). RPE-Bruch's membrane complex thicknesses were significantly higher in the hydroxychloroquine subjects than for those of the control subjects (P < 0.05). The minimum and temporal-inferior macular GCIPL thicknesses were significantly different between the patients with hydroxychloroquine use and the control subjects (P = 0.04 and P = 0.03, resp.). Conclusions. The foveal photoreceptor OS thinning, loss of GCIPL, and RPE-Bruch's membrane thickening were detected in patients with hydroxychloroquine therapy. This quantitative approach using SD-OCT images may have important implications to use as an early indicator of retinal toxicity without any visible signs of hydroxychloroquine retinopathy.

Retinopathy of prematurity: incidence, risk factors, and evaluation of screening criteria.

BACKGROUND/AIM: The goal of this study was to investigate the incidence of retinopathy of prematurity (ROP) and the relationship between risk factors and disease in premature newborns in our neonatal intensive care unit. MATERIALS AND METHODS: A total of 219 premature subjects were retrospectively evaluated for retinopathy. Demographic information, clinical data, and risk factors were reviewed. RESULTS: The gestational ages of the infants included in the study ranged between 25 and 36 weeks, and the birth weights ranged between 670 and 4460 g. In this study, the incidence of ROP was 20.1% (44) in preterm infants: 16 had stage 1 (36.4%), 15 had stage 2 (34.1%), 11 had stage 3 (25%), 1 had stage 4 (2.3%), 1 had stage 5 (2.3%), and 6 had plus (+) disease (7.2%). The risk factors associated with the development of ROP included low birth weight, ventilation treatment, bronchopulmonary dysplasia, and maternal preeclampsia. The risk factors were analyzed with logistic regression analysis. The odds ratios were 5.952 (95% confidence interval [CI]: 2.030-17.447), 20.070 (95% CI: 4.213-95.600), 5.879 (1.916-18.037), and 3.200 (95% CI: 1.002-11.535), respectively. CONCLUSION: In this study, birth weight, ventilation treatment, bronchopulmonary dysplasia, and maternal preeclampsia were the most important risk factors for the development of ROP.

Comparison of corneal topographic measurements and high order aberrations in keratoconus and normal eyes.

PURPOSE: The aim of this report was to compare corneal topographic measurements and anterior high order corneal aberrations in eyes with keratoconus and normal eyes by using Scheimpflug-Placido topography. METHODS: Eighty cases diagnosed with mild (group 1), moderate (group 2), and advanced (group 3) stage keratoconus (KC) according to Amsler-Krumeich Classification and 81 healthy (control group) cases were retrospectively examined. The mean keratometric measurements (as both diopters (Kavg) and mm values (mmavg)), central corneal thickness values (CCT), high order aberration (HOA), total wavefront aberration (TWA), coma, trefoil, and spherical aberration measurements were performed using Sirius topography equipment. The topographic values were compared between the groups. RESULTS: There were 25 cases in group 1 KC (15.5%), 34 cases in group 2 KC (21.1%), 21 cases in group 3 KC (13.1%), and 81 cases (50.3%) in the control group. In terms of mean age and gender distributions, there was no statistically significant difference between the groups (p>0.05). However, there was significant difference between the groups in terms of Kavg, CCT, HOA, TWA, coma, trefoil, and spherical aberration values (p<0.01). Mean HOA, TWA, coma, trefoil, and spherical aberration values were observed to increase with the severity of KC disease. CONCLUSIONS: Anterior high order corneal aberrations were significantly increased in eyes with moderate and advanced keratoconus. Anterior high order corneal aberration measurements are a useful tool to guide the physician in diagnosis and classification of keratoconus.

Retinal nerve fiber layer, ganglion cell complex, and choroidal thicknesses in migraine.

PURPOSE: To evaluate the thicknesses of the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCL), and choroid layer using spectral domain optical coherence tomography (SD-OCT) for investigating the effects of vascular changes on the eye and optic nerve in patients who have migraine with aura. METHODS: Forty-five patients who had migraine with aura (migraine group) and 45 healthy individuals (control group) were enrolled in the study. Age, gender, duration after migraine diagnosis, intraocular pressure, and axial length measurements were recorded in each case. RNFL, GCL, and choroid layer thicknesses were measured using SD-OCT in all participants. RESULTS: The mean age was 36.1 ± 6.7 (20-45) years in the migraine group and 35.7 ± 8.6 (19-45) years in the control group. There was no significant difference in the RNFL thicknesses of the temporal and nasal quadrants (p >0.05). The RNFL thicknesses of the superior and inferior quadrants were significantly lower in the migraine group compared with those in the control group (p =0.001, p <0.01, respectively). Measurements for the superior and inferior GCL were not significantly different between the groups (p >0.05). Subfoveal, temporal, and nasal choroidal thickness measurements at 500 µm, 1000 µm, and 1500 µm were significantly lower in the migraine group than in the control group (p =0.001; p <0.01, respectively). CONCLUSIONS: Compared with the controls, the RNFL and choroid layer were determined to be thinner in patients who had chronic migraine with aura.

Toward Novel Diagnostics for Primary Open-Angle Glaucoma? An Association Study of Polymorphic Variation in Ras Homolog Family Member (A, B, C, D) Genes RHOA, RHOB, RHOC, and RHOD.

The annual economic burden of visual disorders in the United States was estimated as $139 billion. The World Health Organization has listed glaucoma in the top 10 priority eye diseases. Primary open-angle glaucoma (POAG) is a common subtype, with a lack of clinical tools for early diagnosis. The Rho GTPases belong to the Ras superfamily of proteins; the RhoA immunostaining in the optic nerve head in human glaucoma is reportedly increased. We investigated the association of polymorphisms in the Ras Homolog Family Member A, B, C, and D genes (RHOA, RHOB, RHOC, and RHOD, respectively). In a total sample of 361 unrelated subjects (179 patients with POAG and 182 age- and sex-matched healthy controls), RHOA (rs6784820, rs974495), RHOB (rs62121967), RHOC (rs11102522), and RHOD (rs61891303, rs2282502) polymorphisms were characterized by the BioMark HD dynamic array system with real-time polymerarse chain reaction. Among these candidate genetic markers and considering the Bonferroni correction, RHOA rs974495 polymorphism was significantly associated with POAG (p = 0.0011), with the TT genotype increasing the disease risk 4.9 times (95% CI 1.630-15.023). The allele and haplotype distributions of the above RHO candidate polymorphisms did not diplay a significant association. This is the first study, to the best of our knowledge, to identify a significant genotypic association between POAG and RHOA gene rs974495 polymorphism. These observations warrant replication in independent samples in the pursuit of precision medicine for rapid and early glaucoma diagnosis, and molecular targets for innovation in therapeutics of this common eye disease.

A PILOT STUDY OF CHOROIDAL THICKNESS IN LONG-TERM SMOKERS.

PURPOSE: To compare the choroidal thicknesses in long-term smokers with those of nonsmoking healthy individuals using spectral domain optical coherence tomography. PARTICIPANTS: Forty-six individuals who had been smoking at least for 20 years, but otherwise without systemic problems, participated in this prospective pilot study. The control group comprised 42 nonsmoking individuals. METHODS: The ages, refractions, and axial length measurements of the cases were recorded. Central macular thickness and choroidal thickness at the fovea and at 500 µm intervals from the foveal center in both temporal and nasal directions were measured using spectral domain optical coherence tomography. RESULTS: Although the smoking period of the smokers was mean 32.4 ± 9 years (range: 20-60), the mean pack-years of cigarettes was 35.1 ± 23.8 (range: 10-120). No significant difference was observed regarding refraction value and axial length between smokers and nonsmokers group. In addition, no significant difference was observed for central macular thickness and choroidal thickness values at 500, 1,000, 1,500, and 2,000 µm nasal and temporal part of the fovea, between 2 groups. CONCLUSION: Macular and choroidal thicknesses in long-term smokers were observed to be similar to those of healthy individuals.

Retinal nerve fiber layer, ganglion cell complex, and choroidal thicknesses in migraine / Espessuras da camada de fibras nervosas retinianas, complexo de células ganglionares e coroide na enxaqueca

ABSTRACT Purpose: To evaluate the thicknesses of the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCL), and choroid layer using spectral domain optical coherence tomography (SD-OCT) for investigating the effects of vascular changes on the eye and optic nerve in patients who have migraine with aura. Methods: Forty-five patients who had migraine with aura (migraine group) and 45 healthy individuals (control group) were enrolled in the study. Age, gender, duration after migraine diagnosis, intraocular pressure, and axial length measurements were recorded in each case. RNFL, GCL, and choroid layer thicknesses were measured using SD-OCT in all participants. Results: The mean age was 36.1 ± 6.7 (20-45) years in the migraine group and 35.7 ± 8.6 (19-45) years in the control group. There was no significant difference in the RNFL thicknesses of the temporal and nasal quadrants (p >0.05). The RNFL thicknesses of the superior and inferior quadrants were significantly lower in the migraine group compared with those in the control group (p =0.001, p <0.01, respectively). Measurements for the superior and inferior GCL were not significantly different between the groups (p >0.05). Subfoveal, temporal, and nasal choroidal thickness measurements at 500 µm, 1000 µm, and 1500 µm were significantly lower in the migraine group than in the control group (p =0.001; p <0.01, respectively). Conclusions: Compared with the controls, the RNFL and choroid layer were determined to be thinner in patients who had chronic migraine with aura.

RESUMO Objetivo: Avaliar as espessuras de camada peripapilar de fibras nervosas retinianas (RNFL), complexo de células ganglionares (GCL) e da coroide utilizando a tomografia de coerência óptica de domínio espectral (SD-OCT), a fim de investigar os efeitos das alterações vasculares no olho e nervo óptico em pacientes que apresentam enxaqueca com aura. Métodos: Quarenta e cinco pacientes que apresentavam enxaqueca com aura (grupo enxaqueca) e 45 indivíduos saudáveis (grupo controle) foram incluídos no estudo. Idade, sexo, duração da enxaqueca, pressão intraocular e medidas de comprimento axial foram registrados em cada caso. Medidas da RNFL, GCL e espessuras da coroide foram obtidas com SD-OCT em todos os participantes. Resultados: A média da idade foi de 36,1 ± 6,7 (20-45) anos no grupo enxaqueca e 35,7 ± 8,6 (19-45) anos no grupo controle. Não houve diferença significativa em espessuras RNFL nos quadrantes temporal e nasal (p>0,05). A espessura da RNFL nos quadrantes superiores e inferiores foram significativamente menores no grupo de enxaqueca em comparação ao grupo controle (p=0,001; p<0,01). Medidas da GCL superior e inferior não mostraram diferença significativa entre os grupos (p>0,05). Espessuras subfoveais, temporais e nasais da coroide (CT) a 500 µm, 1000 µm e 1500 µm foram significativamente menores no grupo de enxaqueca em relação ao grupo controle (p=0,001; p<0,01). Conclusões: Comparados aos controles, as espessuras da RNFL e coroide foram mais finas em pacientes que apresentavam enxaqueca crônica com aura.

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment.

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.

An Investigation of the Frequency of Upper Respiratory Tract Infection Pathogens and their Antibiotic Patterns in Tonsils and Adenoids of Adenotonsillectomy Patients.

BACKGROUND: We aimed to investigate the potentially pathogenic bacteria of upper respiratory tract infections (URTIs) and their susceptibilities to different antibiotics. METHODS: Two-hundred adenoid and tonsil specimens from 100 patients who had undergone adenotonsillectomy were obtained and analyzed bacteriologically. Identification of the pathogens was made by conventional or commercial identification systems and antibiotic susceptibility tests were carried out by disk diffusion method. RESULTS: A total of 274 pathogens were recovered from 81% specimens of 73% of the patients. Haemophilus influenzae (31.8%) was the most prevalent pathogen, followed by Staphylococcus aureus (17.2%), Group A beta hemolytic Streptococci, GABHS (12.0%), Moraxella catarrhalis (7.7%), Streptococcus pneumoniae (7.3%), and nine other bacterial species (24.0%). Penicillins (penicillin, ampicillin) had 100% activity against GABHS followed by 96.5% in H. influenzae, 45% in S. pneumoniae, and 0% in S. aureus strains. The efficacy of beta-lactamase inhibitor antibiotics (ampicillin/sulbactam, amoxycillin/clavulanic acid) were similar to those of penicillins but had superior activity (89.4%) against S. aureus strains. Cefotaxime had high activity (100%) against GABHS and H. influenzae followed by S. aureus (89.4%). Cotrimoxazole was also active in S. aureus (97.8%) and H. influenzae (83.9%) but revealed intermediate activity (45%) in S. penumoniae and was not efficient (0%) in GABHS. Macrolids (erythromycin, clindamycin) were very efficient (100%) in GABHS followed by S. aureus (95.7%) and had intermediate activity (50%) in S. pneumoniae. Levofloxacin, telithromycin, and vancomycin had 100% activity against S. pneumoniae strains. CONCLUSIONS: Our finding have shown that H. influenzae was the most prevalent pathogen followed by S. aureus, GABHS, M. catarrhalis, and S. pneumoniae and that there was no unique antibiotic to combat all prevalent pathogens, but penicillins could be the choice in GABHS and H. influenzae; beta-lactamase inhibitors and cefotaxime for GABHS, H. influenzae, and S. aureus; macrolids in GABHS and S. aureus; cotrimoxazole in H. influenzae and S. aureus; and levofloxacin and telithromycin in the treatment of S. penumoniae related URTIs.

Investigation of the Rho-kinase Gene Polymorphism in Primary Open-angle Glaucoma.

PURPOSE: Genetic factors are shown to have a role in the development of primary open-angle glaucoma (POAG). The aim of this study was to determine the effects of genetic polymorphisms of Rho-kinase (ROCK) genes on the risk of POAG in a Turkish population. METHODS: Genomic DNA was extracted from leukocytes of the peripheral blood, and 8 single nucleotide polymorphisms in the ROCK1 and ROCK2 genes were analysed in 179 patients with POAG and in 182 healthy controls of similar age by using BioMark HD dynamic array system. RESULTS: Neither genotype distributions nor the allele frequencies for the ROCK1 (rs35996865) and ROCK2 [rs2290156, rs965665, rs10178332, rs2230774 (Thr431Asn), rs2230774 (Thr431Ser), rs6755196, and rs726843] gene polymorphisms showed a significant difference between the groups. There were also no marked associations between the haplotype frequencies and POAG. CONCLUSIONS: This is the first study to examine the involvement of ROCK1 and ROCK2 gene variations in the risk of POAG development. This study demonstrated that the polymorphisms studied are not associated with the increased risk of development of POAG in the Turkish population.

Choroidal and peripapillary retinal nerve fiber layer thickness in adults with anisometropic amblyopia.

PURPOSE: To evaluate choroidal thickness, macular thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopic eyes compared to fellow and normal control eyes using high-definition spectral-domain optical coherence tomography (SD-OCT). METHODS: Fifty-four without any systemic problem and ocular disease participated in this prospective study. Inclusion criteria included individuals older than 18 years with anisometropic amblyopia. Choroidal thickness, central macular thickness (CMT), and RNFL thickness were measured by using enhanced depth imaging SD-OCT. The choroidal thickness was measured at the fovea and at 500 µm intervals from the foveal center in both temporal and nasal directions. Axial length measurements of the cases were also recorded. RESULTS: Mean peripapillary RNFL thickness of the amblyopic, fellow, and control eyes was 107.5 ± 15.5 µm, 109.3 ± 12.7 µm, and 108.8 ± 8.6 µm, respectively (p = 0.343). The average CMT was 231.7 ± 14.7 µm in amblyopic eyes, 232.5 ± 15.7 µm in fellow eyes, and 230.8 ± 14.8 µm in control eyes (p = 0.599). Mean subfoveal choroidal thickness was significantly greater in the amblyopic eyes than in the fellow and control eyes (396.3 ± 104.3 µm, 361.0 ± 103.9 µm, 390.6 ± 91.7 µm). Mean axial measurement in amblyopic eyes was 22.7 ± 1.3 mm (20.5-26.1), in fellow eyes 23.1 ± 0.9 mm (20.9-25.0), and in control eyes 23.3 ± 0.9 mm. CONCLUSIONS: In adults with anisometropic amblyopia, subfoveal, temporal, and nasal choroidal thickness of amblyopic eyes are significantly thicker than in fellow eyes. However, no significant differences in peripapillary RNFL thickness or CMT were found between amblyopic and fellow or control eyes.

Corneal collagen crosslinking for ectasia after laser in situ keratomileusis: long-term results.

PURPOSE: To report the long-term results of corneal collagen crosslinking (CXL) treatment for post-laser in situ keratomileusis (LASIK) ectasia. SETTINGS: Turkiye Hospital Eye Clinic and Fatih University Medical Faculty, Department of Ophthalmology, Istanbul, Turkey. DESIGN: Retrospective case series study. METHODS: Consecutive patients with ectasia after LASIK were treated with CXL. The main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical and cylindrical refractions, and simulated keratometry (K) values. RESULTS: The study enrolled 20 eyes (14 patients; 7 women) with a mean age of 34.8 years ± 6.0 (SD) (range 25 to 45 years) and mean follow-up of 42 months (range 36 to 60 months). The UDVA and CDVA improved significantly, from 0.78 ± 0.61 logMAR to 0.53 ± 0.36 logMAR (P=.007) and from 0.27 ± 0.23 logMAR to 0.19 ± 0.13 logMAR, respectively (P≤.028). No eye lost 1 or more Snellen lines of UDVA or CDVA. Although the mean spherical refraction was not significantly different at the last visit (P=.074), the mean cylindrical refraction decreased significantly (P=.036). The maximum K value decreased from 46.0 ± 4.4 diopters (D) at baseline to 45.6 ± 3.8 D at the last visit (P=.013). By the last visit, the maximum K value decreased (≥1.0 D) in 5 eyes and remained stable in 15 eyes. No serious complications occurred. CONCLUSIONS: Corneal collagen crosslinking yielded long-term stability in cases with post-LASIK corneal ectasia without significant side effects. Improvements in visual acuity, cylindrical refraction, and maximum K values occurred. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Risk Factors in Post-LASIK Corneal Ectasia.

Purpose. To evaluate the risk factors for post-laser in situ keratomileusis (LASIK) ectasia. Materials and Methods. Medical records of 42 eyes of 28 (10 women, 18 men) patients who developed corneal ectasia after LASIK were retrospectively reviewed. Topographical features and surgical parameters of those patients were evaluated. Results. The mean age of patients was 34.73 ± 6.50 (23-48) years and the mean interval from LASIK to the diagnosis of post-LASIK ectasia was 36.0 ± 16.92 (12-60) months. The following factors were determined as a risk factors: deep ablation (>75 µ m) in 10 eyes, FFK (forme fruste keratoconus) in 6 eyes, steep cornea (>47 D) in 3 eyes, pellucid marginal degeneration (PMD) in 2 eyes, thin cornea (<500 µ m) in 2 eyes, thin and steep cornea in 2 eyes, thin cornea and deep ablation in 5 eyes, FFK and steep cornea in 2 eyes, and FFK, steep cornea, and deep ablation in 1 eye. However no risk factor has been determined in 9 eyes (21.4%). Conclusion. The findings of our study showed that most of the patients who developed post-LASIK ectasia have a risk factor for post-LASIK ectasia. However, the most common risk factor was deep ablation.

Surgical outcomes of isolated lens coloboma with or without cataract among young adults.

OBJECTIVE: To evaluate the visual and refractive outcomes after phacoemulsification surgery in eyes with isolated lens coloboma. DESIGN: Prospective, consecutive case series. PARTICIPANTS: Eighteen eyes with isolated lens coloboma of 13 patients were included in the study. Mean patient age was 13.9 ± 6.5 years. METHODS: Patients underwent phacoemulsification surgery, with combined implantation of capsular tension ring (CTR) and intraocular lens. In colobomas of less than 120°, a CTR was used, whereas in colobomas of more than 120°, a Cionni-modified single eyelet CTR was used to achieve better capsular centration. The main outcome measures were uncorrected distance visual acuity, corrected distance visual acuity, refraction, and keratometry. RESULTS: Mean logMAR uncorrected distance visual acuity and corrected distance visual acuity improved significantly from 1.53 ± 0.35 and 1.02 ± 0.47 before surgery to 0.67 ± 0.51 and 0.52 ± 0.49 at the last visit of the follow-up (p < 0.001). Mean refractive cylinder and spherical equivalent decreased significantly from -6.73 ± 1.73 and -6.72 ± 4.07 D preoperatively to -1.40 ± 1.39 and -0.83 ± 1.31 D at the end of the follow-up (p = 0.001 and p = 0.01, respectively). Mean keratometric astigmatism at preoperative and postoperative visits were 1.58 ± 0.97 and 1.65 ± 0.94 D, respectively (p = 0.70). CONCLUSIONS: Phacoemulsification with CTR and intraocular lens implantation is an effective and safe option for providing a refractive correction and a significant visual improvement in eyes with isolated lens coloboma.

Effects of corrective surgery on social phobia, psychological distress, disease-related disability and quality of life in adult strabismus patients.

BACKGROUND: Corrective surgery is done for ocular alignment and disrupted facial expression in some cases of adult strabismus patients. The effects of corrective surgery on the presence of social phobia (SP) diagnosis, the severity of social anxiety symptoms, the disease-related disability and the quality of life (QoL) among strabismus patients have not been thoroughly studied yet. METHODS: The study sample was composed of patients who had undergone corrective surgery for strabismus. Preoperative and postoperative evaluations made by using standardised measures of social phobia diagnosis (DSM-IV-TR) and severity (Liebowitz Social Anxiety Scale (LSAS)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), disability (Sheehan Disability Scale) and quality of life (short form-36). RESULTS: Preoperatively, SP diagnosis was detected in 17 of 31 (54.8%) patients, whereas postoperatively 6 of 31 (19.4%) patients had SP (p=0.001). Participants showed a significant decrease in all subscale scores and total score of both LSAS and HADS compared with their preoperative scores. Significant improvements were observed in QoL and disability scores as well. CONCLUSIONS: Adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment but also for social anxiety levels that may be associated with improvements in their QoL and disability levels.

Same-day intrastromal corneal ring segment and collagen cross-linking for ectasia after laser in situ keratomileusis: long-term results.

PURPOSE: To report the long-term results of combined same-day intrastromal corneal ring segment placement and corneal collagen cross-linking (CXL) for postoperative laser in situ keratomileusis (LASIK) ectasia. DESIGN: Retrospective, interventional case series. METHOD: This retrospective, interventional cases series was performed in Turkiye Hospital Eye Clinic and the Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey. Sixteen eyes of 14 patients with postoperative ectasia after LASIK were enrolled. All consecutive patients were treated with femtosecond laser-assisted intrastromal corneal ring segment implantation and followed by same-day corneal collagen cross-linking for ectasia occurring after LASIK. Main outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, spherical and cylindrical refraction, and simulated keratometry values. RESULTS: The mean age ± standard deviation of the 10 women and 4 men was 33.0 ± 6.5 years (range, 23 to 44 years), and the mean follow-up was 43 months (range, 36 to 62 months). The uncorrected distance visual acuity improved significantly from 1.18 ± 0.42 logarithm of the minimal angle of resolution (logMAR) units to 0.44 ± 0.22 logMAR (P < .001), and the corrected distance visual acuity improved significantly from 0.46 ± 0.26 logMAR to 0.21 ± 0.14 logMAR (P < .001). The mean spherical and cylindrical refraction decreased significantly (P < .001 for both). The maximum keratometry value decreased from baseline by 49.3 ± 4.9 diopters (D) to 43.9 ± 2.8 D at the last visit, and the minimum keratometry value decreased from 44.3 ± 4.7 D to 41.5 ± 3.5 D (P < .001 for both). No serious complications were shown during follow-up. CONCLUSIONS: Implantation of intrastromal corneal ring segment implantation combined with same-day corneal collagen cross-linking was a safe and effective treatment for ectasia occurring after LASIK. It also significantly improved the visual acuity, refraction, and keratometry values.

Choroidal thickness in healthy Turkish subjects.

AIM: To investigate choroidal thickness in healthy Turkish subjects. MATERIALS AND METHODS: Refraction, axial length (AXL) measurement, anterior chamber, and fundus examinations were performed. Eyes that had any retinal or choroidal pathology were excluded from the study. Enhanced-depth imaging optical coherence tomography was used to evaluate choroidal thickness. RESULTS: 139 eyes from 70 subjects were investigated. The mean age, AXL, spherical equivalent refractive error (SE), and subfoveal choroidal thickness (SCT) were 34.7 +/- 12.7 years, 23.31 +/- 0.91 mm, -0.15 +/- 1.64 diopters (D), and 326 +/- 60 microm, respectively. A negative correlation was found between SCT and AXL (P = 0.043). The mean age, SE, AXL, and SCT were 31.7 +/- 9.3 and 34.6 +/- 14.3 years, -0.27 +/- 1.45 and 0.02 +/- 1.89 D, 23.52 +/- 0.94 and 23.02 +/- 0.75 mm, and 324 +/- 69 and 329 +/- 40 mirom in male and female subjects, respectively (P = 0.14, P = 0.31, P = 0.001, and P = 0.58, respectively). Regression analysis showed that SCT decreased by 0.93 microm for each year of age. CONCLUSION: In healthy Turkish subjects, SCT decreased by 0.93 pm for each year of age and was thicker in men when the results were adjusted according to AXL measurements.