The Management of Refractory Dry Eye With Semi-Scleral Contact Lens.

We presented a case of refractory dry eye management with semi-scleral contact lens. Dry eye was associated with facial nerve (cranial nerve VII) palsy as a result of cerebellopontine angle tumor surgery. She was treated with several topical treatments and punctal plug. Despite the treatments, her symptoms still persisted. Her ophthalmic examination revealed scleral exposure because of lagophthalmos, conjunctival hyperemia, corneal debris, scar, and diffuse punctate epitheliopathy on her right eye. Lissamine green staining showed diffuse conjunctival and corneal staining. Therapeutic semi-scleral lenses were fitted. The corneal findings were resolved and the quality of patient life was improved with the aid of semi-scleral lens after 3 months.

Comparison of Aqueous Humor Nitric Oxide Levels After Different Corneal Collagen Cross-Linking Methods.

PURPOSE: Nitric oxide production can cause either apoptotic or necrotic cell death through oxidative stress. We aimed to investigate the nitrite oxide metabolites (NOx) and nitrite levels in the aqueous humor of rabbit eyes after different methods of corneal collagen cross-linking (CXL). MATERIALS AND METHODS: Twenty-four eyes of 12 adult New Zealand rabbits were used. They were assigned into four groups, each including six eyes. Group 1 (control) consisted of eyes with no treatment. Group 2 received UV-A power setting at 3 mW/cm2 for 30 minutes of continuous exposure and named as standard CXL group. Group 3 received UV-A power setting at 30 mW/cm2 for 3 minutes of continuous exposure and named as accelerated CXL (A-CXL) group. Group 4 received UV-A power setting at 30 mW/cm2 for 6 minutes of pulsed exposure (1 sec on, 1 sec off) and named as pulse-light accelerated CXL (PLA-CXL). Aqueous humors were aspirated from anterior chamber with a 27G needle after 1 hour UV-A exposure. NOx and nitrite levels were measured Results: The nitrite levels in aqueous humor were significantly increased in Group 2 and Group 3 when compared with Group 1 (p = 0.000, p = 0.036, respectively). When treatment modalities were compared with each other, high nitrite level in Group 2 was statistically significant when compared with Group 4 (p = 0.019). NOx levels were higher in Group 2 when compared with Group 1 (p = 0.006). CONCLUSIONS: Numerous studies investigated the physiological and pathophysiological roles of NO. NO is considered one of the most important molecule for ocular health. According to NOx level in aqueous humor, it seems that PLA-CXL is the safest method due to the similar results with control group.

Protein Oxidation Levels After Different Corneal Collagen Cross-Linking Methods.

PURPOSE: To evaluate advanced oxidation protein products (AOPP) levels, superoxide dismutase (SOD) enzyme activity, and total sulfhydryl (TSH) levels in rabbit corneas after different corneal collagen cross-linking (CXL) methods. METHODS: Eighteen eyes of 9 adult New Zealand rabbits were divided into 3 groups of 6 eyes. The standard CXL group was continuously exposed to UV-A at a power setting of 3 mW/cm for 30 minutes. The accelerated CXL (A-CXL) group was continuously exposed to UV-A at a power setting of 30 mW/cm for 3 minutes. The pulse light-accelerated CXL (PLA-CXL) group received UV-A at a power setting of 30 mW/cm for 6 minutes of pulsed exposure (1 second on, 1 second off). Corneas were obtained after 1 hour of UV-A exposure, and 360-degree keratotomy was performed. SOD enzyme activity, AOPP, and TSH levels were measured in the corneal tissues. RESULTS: Compared with the standard CXL and A-CXL groups (133.2 ± 8.5 and 140.2 ± 6.2 µmol/mg, respectively), AOPP levels were found to be significantly increased in the PLA-CXL group (230.7 ± 30.2 µmol/mg) (P = 0.005 and 0.009, respectively). SOD enzyme activities and TSH levels did not differ between the groups (P = 0.167 and 0.187, respectively). CONCLUSIONS: CXL creates covalent bonds between collagen fibers because of reactive oxygen species. This means that more oxygen concentration during the CXL method will produce more reactive oxygen species and, thereby, AOPP. This means that in which CXL method occurs in more oxygen concentration that will produce more reactive oxygen species and thereby AOPP. This study demonstrated that PLA-CXL results in more AOPP formation than did standard CXL and A-CXL.

Can Riboflavin Penetrate Stroma Without Disrupting Integrity of Corneal Epithelium in Rabbits? Iontophoresis and Ultraperformance Liquid Chromatography With Electrospray Ionization Tandem Mass Spectrometry.

PURPOSE: To examine riboflavin concentrations in corneas and aqueous humor from rabbits with standard and transepithelial methods and iontophoresis without disrupting the integrity of the corneal epithelium before corneal collagen cross-linking. METHODS: Twenty-four eyes of 12 adult New Zealand rabbits were used. They were assigned to 4 groups, each including 6 eyes. Group 1 was exposed to the standard method and given riboflavin 0.1% after epithelial debridement. Group 2 was exposed to the transepithelial method and given benzalkonium chloride (BAC), ethylenediaminetetraacetic acid (EDTA), trometamol (TRIS), hydroxypropylmethylcellulose (HPMC), and riboflavin 0.2% 3 times at 1.5-minute intervals followed by riboflavin 0.2%. Group 3 was given riboflavin 0.1% by using 1-mA electric current for 10 minutes with the help of iontophoresis without using substances disrupting the integrity of the corneal epithelium. Group 4 received the same treatment as did group 3, except that it was given riboflavin 0.2%. Following these treatments, riboflavin concentrations in aqueous humor and corneas were measured with ultraperformance liquid chromatography coupled with electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS). RESULTS: Riboflavin concentrations in the cornea and aqueous humor were higher in group 1 (42.4 ± 5.4 µg/g) than in the other groups. They were significantly higher in group 4 (34.2 ± 6.6 µg/g) than in group 2 (24.4 ± 1.2 µg/g) (P = 0.009) and group 3 (23.6 ± 6.1 µg/g) (P = 0.026). There was not a significant difference in corneal riboflavin concentrations between group 2 and group 3 (P = 0.937). CONCLUSIONS: Intrastromal and aqueous riboflavin concentrations after administration of riboflavin 0.2% through iontophoresis without disrupting the integrity of the corneal epithelium were lower than those after the standard method, but higher than those after the transepithelial method. In this study, in which riboflavin concentrations were measured with a very sensitive method, iontophoresis was observed to increase the transmission of riboflavin molecules into the cornea without using substances disrupting epithelial integrity.

Seasonal effects on pterygium surgery outcome: implications for the role of sunlight exposure.

PURPOSE: The aim of this study was to compare the results of pterygium surgery in patients when performed in the summer with the results of surgery performed in the winter. METHODS: This retrospective study enrolled 55 eyes of 53 patients with primary pterygia who underwent a surgery between December 2011 and January 2012 (winter group, 32 eyes) or between June and July 2012 (summer group, 23 eyes). All the patients were followed up for at least 1 year. Pterygium recurrence, ocular discomfort, persistent conjunctival inflammation, and graft complications were evaluated postoperatively. RESULTS: There was no significant difference between the groups in terms of age or gender. All the patients were farmers in rural areas. The overall pterygium recurrence rate was 14.5% (8 of 55 eyes). The recurrence rate in the summer group was significantly higher than in the winter group (26.1% vs. 6.2%, P = 0.048). Persistent conjunctival inflammation was also significantly higher in the summer group than in the winter group (30.4% vs. 6.2%, P = 0.022). Pterygium recurrence was significantly higher in eyes with persistent conjunctival inflammation than in eyes without inflammation (66.6% vs. 4.3%, P < 0.001). Mild and moderate ocular discomfort was significantly more frequent in the summer group than in the winter group (69.5% vs. 34.3%, P = 0.01). CONCLUSIONS: Pterygium recurrence rates were higher, and postsurgical discomfort was more common when pterygium surgery was performed in the summer compared with that in the winter, potentially because of the increased exposure to sunlight during the summer.