Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus.

Objectives: The aim of the study was to evaluate the fitting process, clinical performance, and patient satisfaction of hybrid contact lenses (HCL) in patients with keratoconus (KC). Materials and Methods: Sixty-eight KC patients (35 female, 33 male) who were prescribed HCL were included in the study. Corneal topographic parameters, best corrected visual acuity (BCVA) with eyeglasses, the number of HCL trials, prescribed HCL base curve (BC), and visual acuity with HCL were recorded from hospital records. A contact lens satisfaction survey was sent to the patients via email or WhatsApp and the data was statistically analyzed using IBM SPSS Statistics version 22.0. Results: The study included 110 eyes of 68 patients with a mean age of 27.34±8 years (range: 12-48 years). According to the Amsler-Krumeich classification, 35.5% of the eyes were stage 1, 50.9% were stage 2, and 13.5% were stage 3 or 4. Mean K1, K2, and Kmean values were 7.14±0.50 mm (range 5.72-8.30 mm), 6.63±0.49 mm (range 5.07-7.84 mm), and 6.89±0.48 mm (range 5.39-8.06 mm), respectively. The average number of lens trials was 1.59±0.82 (range 1-4). The mean BC of the prescribed HCL was 6.84±0.50 mm (range 5.60-8.00 mm). BCVA with glasses was 0.36±0.2 (range 0.05-0.8), and 0.80±0.14 (range 0.3-1.0) with HCL (p<0.0001). The overall survey score was 3.54 out of 5, the overall satisfaction score was 3.27, the average vision satisfaction score was 3.62, the average satisfaction score for lens insertion and removal was 3.01, and the average satisfaction score for lens comfort was 2.97. Conclusion: Prescribed HCL BC is usually close to the topographic Kmean value and in most of the patients, fitting was successful with the first or second CL trial. The overall satisfaction score was moderate to good and the disadvantages were low comfort compared to soft CL, difficulty with insertion and removal, short lens life, and high cost.

Short-Term Clinical Results of Preferred Retinal Locus Training

Objectives: This study evaluated acoustic biofeedback training using microperimetry in patients with foveal scars and an eligible retinal locus for better fixation. Materials and Methods: A total of 29 eligible patients were enrolled in the study. The acoustic biofeedback training module in the MAIA (Macular Integrity Assessment, CenterVue®, Italy) microperimeter was used for training. To determine the treatment efficacy, the following variables were compared before and after testing: best corrected visual acuity (BCVA); MAIA microperimeter full threshold 4-2 test parameters of average threshold value, fixation parameters P1 and P2, and bivariate contour ellipse area (BCEA) for 63% and 95% of fixation points; contrast sensitivity (CSV 1000E Contrast Sensitivity Test); reading speed using the Minnesota Low-Vision Reading Test (MNREAD reading chart); and quality of life (NEI-VFQ-25). In addition, fixation stability parameters were recorded during each session. Results: The study group consisted of 29 patients with a mean age of 68.72±8.34 years. Median BCVA was initially 0.8 (0.2-1.6) logMAR and was 0.8 (0.1-1.6) logMAR after 8 weeks of preferred retinal locus training (p=0.003). The fixation stability parameter P1 improved from a mean of 21.28±3.08% to 32.69±3.69% (p=0.001) while mean P2 improved from 52.79±4.53% to 68.31±3.89% (p=0.001). Mean BCEA 63% decreased from 16.11±2.27°2 to 13.34±2.26°2 (p=0.127) and mean BCEA 95% decreased from 45.87±6.72°2 to 40.01±6.78°2 (p=0.247) after training. Binocular reading speed was 38.28±6.25 words per minute (wpm) before training and 45.34±7.35 wpm after training (p<0.001). Statistically significant improvement was observed in contrast sensitivity and quality of life questionnaire scores after training. Conclusion: Beginning with the fifth session, biofeedback training for a new trained retinal locus improved average sensitivity, fixation stability, reading speed, contrast sensitivity, and quality of life in patients with macular scarring.

In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography Findings in Two Cases with Mucopolysaccharidoses

The mucopolysaccharidoses are a group of disorders caused by inherited defects in lysosomal enzymes resulting in widespread intracellular and extracellular accumulation of glycosaminoglycans. Due to the mucopolysaccharidoses subtype, glycosaminoglycans can be deposited in many organs and tissues including cornea. In this report, we presented in vivo confocal microscopy and anterior segment optical coherence tomography findings in a 39-year old man with Scheie syndrome and a 41-year old woman with Morquio syndrome (Heidelberg Retina Tomograph 3 Rostock module, Germany) and reviewed the literature. On in vivo confocal microscopy, there were multiple small and larger hyperreflective deposits in the epithelium, Bowman layer and anterior stroma and abnormally shaped, elongated keratocytes with hyporeflective round structures, which might be vacuoles in the anterior-mid stroma. In anterior segment optical coherence tomography images, accumulation of glycosaminoglycans deposits lead to an increased hypereflective appearance throughout the thickened cornea.

Correlation of Demarcation Line Depth With Medium-Term Efficacy of Different Corneal Collagen Cross-Linking Protocols in Keratoconus.

PURPOSE: To compare demarcation line depth (DD) and topographic changes among different corneal collagen cross-linking (CXL) protocols and to evaluate the relation of DD with medium-term efficacy of CXL in halting progression of keratoconus. METHODS: The study included 124 patients (mean age 19 ± 4.8 years) with progressive keratoconus who underwent conventional (3 mW/cm/30 min), accelerated (18 mW/cm/5 min), or transepithelial (TE) CXL (3 mW/cm/30 min) and followed up for at least 2 years. Baseline and final corneal topographic parameters and DD determined with anterior segment optical coherence tomography 1 month after CXL were compared among the protocols and the correlation between DD and topographic changes at the end of 24 months was analyzed. P < 0.05 was considered as statistically significant. RESULTS: Mean DD was significantly higher in the conventional and accelerated groups (335.19 ± 71.13 µm and 304.97 ± 94.45 µm, respectively) compared with the TE group (239.92 ± 71.37 µm) (P < 0.001). After conventional and TE CXL, keratometric parameters improved remarkably, whereas accelerated CXL only lowered K1 and Kmax (P < 0.05). No correlation was found between DD and topographic changes (P > 0.05). Progression was detected in 3 eyes in the conventional group (4.1%), 3 in the accelerated group (7.7%), and none in the TE group. The use of either riboflavin D or M made no differences in terms of DD and topographic parameters (P > 0.05). CONCLUSIONS: In conventional and accelerated protocols, corneal stromal demarcation line is deeper compared with TE CXL; however, the DD has no correlation with topographic changes, which means that DD is not a direct measure for the efficacy of CXL.

Does Cataract Surgery Simulation Correlate with Real-life Experience?

OBJECTIVES: To evaluate the correlation of cataract surgical simulator and real-life surgical experience and its contribution to surgical training. MATERIALS AND METHODS: Sixteen doctors in our department were divided into three groups based on their surgical experience. After being familiarized with the device, the participants were evaluated while performing the navigation, forceps, bimanual practice, anti-tremor and capsulorhexis stages. The capsulorhexis stage was repeated five times. Participants were also assessed while performing capsulorhexis again with their non-dominant hand. The influence of repetition and surgical experience on the recorded points was evaluated. P values below 0.05 were considered statistically significant. RESULTS: There was correlation between the participants' surgical experience and their scores in the capsulorhexis module. Their dominant hand was more successful than the non-dominant hand in capsulorhexis (p=0.004). Capsulorhexis scores increased with repetition (p=0.001). CONCLUSION: Results achieved with the cataract surgery simulation device correlate with surgical experience. The increase in performance upon repeated practice indicates that the simulator supports surgical training.

Correlation of Corneal Endothelial Cell Density with Corneal Tomographic Parameters in Eyes with Keratoconus.

OBJECTIVES: To examine changes in corneal endothelial cell density (ECD) in different stages of keratoconus and evaluate its correlation with corneal tomographic parameters. MATERIALS AND METHODS: Two hundred six patients with keratoconus were enrolled in the study. Corneal topography was performed by Sirius (CSO, Italy), which has a rotating Scheimpflug camera and a Placido disc topographer. Automatic endothelial analysis was done with the non-contact endothelial microscope (20x probe) of Confoscan-4 (NIDEK, Japan). The eyes were classified into stages based on steepest keratometric value as follows: mild <45 D; moderate 45-52 D; severe >52 D and according to thinnest cornea thickness (TCT) as <400 µm, 400-450 µm, and >450 µm. Tomographic and endothelial cell parameters were compared among the groups using Kruskal-Wallis test and the correlations between them were analyzed using Spearman correlation. RESULTS: The study included 391 eyes of 100 male (24.29±7.7 years, range 11-47 years) and 106 female (26.26±7.5 years, range 13-45 years) patients (p=0.07). Mean ECD values were 2628±262 cells/mm2, 2541.9±260.4 cells/mm2, and 2414.6±384.3 cells/mm2 in mild, moderate, and severe keratoconus, respectively (p<0.001) and 2592.3±277 cells/mm2, 2502±307 cells/mm2 and 2348±296 cells/mm2 in corneas with TCT values >450 µm, 400-450 µm, and <400 µm, respectively (p<0.001). ECD showed significant negative correlation with keratometric and elevation parameters and positive correlation with pachymetric parameters (p<0.05). CONCLUSION: As endothelial cell numbers seem to decrease with the progression of keratoconus, specular/confocal microscopy screening should be carried out, especially in eyes with advanced stages and corneas with TCT <400 µm.

Evaluation of Choroidal Thickness in Non-arteritic Anterior Ischaemic Optic Neuropathy at the Acute and Chronic Stages.

The objective of this study was to evaluate the measurements of choroidal thickness (CT) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION) at the acute and chronic stages. This case-control study compares three groups: Group 1 included 23 eyes of 23 patients with chronic NAION, Group 2 consisted of 24 eyes of 24 patients with acute NAION, and Group 3 included 24 eyes of 24 age-matched control subjects. The average CTs for Group 1, Group 2, and Group 3 were 261.24 ± 50.04, 280.05 ± 74.94, and 254.74 ± 50.11 µm, respectively. For all measurements, no statistical significance was found between the groups (p = 0.319, 0.357, 0.680, and 0.178 for the CTs as average, foveal, superior, and inferior, respectively). Similarly, there was no difference between the CT measurements of the affected and unaffected eyes in Group 1 and Group 2 (p = 0.571, 0.741 for average, respectively). The amount of time after the onset of the disease ranged from 6.0 to 48 months (23.86 ± 16.70 months) in Group 1 and from 1 to 30 days (7.45 ± 8.86 days) in Group 2. There was no correlation between the CTs and follow-up times in Group 1 (p = 0.768 for average) and no association between the CTs and the thicknesses of the retinal nerve fibre layers in Group 2 (p = 0.453 for average). CT is not directly influenced by NAION at either the acute or the chronic stage of the disease. These results may also demonstrate that the changes of CT do not increase the risk of experiencing a NAION attack.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole.

Postoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

Posterior Corneal Steepening in Posterior Polymorphous Corneal Dystrophy.

PURPOSE: The aim was to evaluate the anterior and posterior corneal topographic characteristics of three patients with posterior polymorphous corneal dystrophy (PPCD) using a rotating Scheimpflug camera combined with a Placido disc system (Sirius, CSO, Italy). CASE REPORTS: Two children with unilateral PPCD and a 53-year-old woman with bilateral PPCD were diagnosed by the presence of vesicles and railroad track lesions at the level of the Descemet membrane with slitlamp biomicroscopy and in vivo confocal microscopy. Anisometropic and/or meridional amblyopia was detected in both children. In the 16-year-old child, there was unilateral anterior corneal steepening with high astigmatism (plano -7.00 x 170) in the eye with PPCD. The 5-year-old boy had unilateral axial myopia and against-the-rule corneal astigmatism (-12.00 -2.00 x 90). Corneal topography of the woman revealed with-the-rule astigmatism and thin corneas (464 µm OD and 445 µm OS) in both eyes. Posterior corneal steepening greater than 25 µm either in a vertical or in a horizontal pattern changing with the orientation of the railroad track band lesions was detected in all subjects. CONCLUSIONS: Besides anterior corneal changes, PPCD seems to cause posterior corneal elevation, which necessitates corneal tomographic evaluation. In unilateral or highly asymmetric cases, children with PPCD should be screened for amblyopia.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole / Endoftalmite fúngica pós-operatória causada por Trichosporon asahii tratada com voriconazol

ABSTRACTPostoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

RESUMOEndoftalmite fúngica pós-operatória é uma complicação rara mas devastadora da cirurgia de catarata. A vitrectomia e injeção intravítrea de anfotericina B, bem como agentes fungicidas sistêmicos, têm sido sugeridos como tratamentos ideais para endoftalmite fúngica. No entanto, esta terapia pode falhar em erradicar as espécies de fungos resistentes aos agentes antifúngicos atuais. Uma dessas espécies de fungos é o fungo saprófita,Trichosporon asahii, que é frequentemente observada, como causa de endoftalmite endógena, em pacientes imunodeprimidos. Relatamos um caso de endoftalmite pós-operatória causada porT. asahii que é resistente a anfotericina B. Ao nosso conhecimento, este é o primeiro relato de endoftalmite porT. asahii tratado com sucesso com voriconazol intravítreo e sistêmico, vitrectomia viapars plana, e remoção da lente intraocular e saco capsular.

Characteristics of the Anterior Segment Biometry and Corneal Endothelium in Eyes with Pseudoexfoliation Syndrome and Senile Cataract.

OBJECTIVES: To evaluate the anterior segment biometric features and corneal endothelial changes in eyes with pseudoexfoliation (PEX) syndrome and senile cataract. MATERIALS AND METHODS: The central corneal thickness, anterior chamber depth (ACD), pupil diameter, lens thickness, endothelial cell density (ECD), and percentages of polymegathism and pleomorphism of 52 subjects with PEX and cataract were compared with 51 age- and gender-matched control subjects with cataract using optical low-coherence reflectometry (OLCR, Lenstar LS 900; Haag Streit AG, Switzerland) and in-vivo confocal microscopy (Confo Scan 4, Nidek Co. Ltd, Osaka, Japan). Nineteen subjects with PEX syndrome had glaucoma and were using anti-glaucoma medications. Only one eye of the subjects was used in statistical analysis and a p value less than 0.05 was considered statistically significant. RESULTS: None of the OLCR parameters reached statistically significant differences among the 3 groups (ANOVA p>0.05). The percentage of eyes with ACD <2.5 mm was 13.7% in the control group, 24.2% in PEX eyes without glaucoma and 21.1% in PEX eyes with glaucoma, with no statistically significant differences (p=0.45). There was a significant difference in mean ECD among the 3 groups (ANOVA p=0.02), whereas no differences could be found in respect to polymegathism and pleomorphism (p>0.05). Mean ECD was significantly lower in the PEX glaucoma group (2,199.5±176.8 cells/mm2) than the control group (2,363±229.3 cells/mm2) (p=0.02), whereas no difference was found in mean ECD of PEX eyes without glaucoma and the control group (p=0.42). ECD was less than 2,000 cells/mm2 in 15.8% of PEX subjects with glaucoma, 9.8% of control subjects and 6.1% of PEX eyes without glaucoma, with no statistically significant difference (p=0.52). CONCLUSION: As eyes with both PEX glaucoma and cataract seem to be associated with decreased endothelial cell number, specular or confocal microscopy screening should be done for the patients scheduled for intraocular surgery.

Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis.

Bilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber and atonic pupilla. We report herein a 50-year-old female who presented with bilateral ocular pain, severe photophobia and red eyes. One month ago, a fly hit her eye, and she instantly complained of a discomfort and sensation of a foreign body in both eyes. She used a fumigation therapy, a traditional method for the treatment of ophthalmomyiasis. During follow-up examinations, intraocular pressures increased over 40 mmHg bilaterally despite maximal medical therapy, which necessitated trabeculectomy surgery with mitomycin. This is a typical BAIT case with no antecedent fluoroquinolone use or viral disease, but a fumigation therapy. There might be a possible relationship between BAIT and traditional fumigation therapy or this association might be coincidental, both of which need further evaluation.

Effect of religious fasting on tear osmolarity and ocular surface.

OBJECTIVE: To evaluate the effects of religious fasting on tear secretion, tear osmolarity, corneal topography, and ocular aberrations. METHODS: This prospective controlled study comprised 29 eyes of 29 healthy men. Before ophthalmologic examination, all subjects underwent corneal topography by a placido disc corneal topography and aberrometry device (OPD Scan II). Tear osmolarity was measured using OcuSense TearLab osmometer. Ocular surface disease index (OSDI) scores, tear break-up time (BUT), Schirmer I test, and lissamine green staining were evaluated. The measurements taken before and during Ramadan at the same hours between 4.00 and 5.00 PM were compared using paired sample t test, and a P value less than 0.05 was accepted as statistically significant. RESULTS: The mean age of the study group was 27.8 ± 5.9 years (range, 20-47 years). The mean tear osmolarity values were measured as 285.6 ± 8.2 mOsm/L and 293.3 ± 16.0 mOsm/L, whereas the mean Schirmer I values were 14.8 ± 6.0 mm and 10.6 ± 5.3 mm in nonfasting and fasting periods, respectively. Tear osmolarity, OSDI, and Oxford grading scores significantly increased (P=0.02, P=0.002, P=0.003, respectively), whereas Schirmer I values and intraocular pressure decreased (both, P<0.001) during the fasting period compared with the nonfasting period. There were no significant differences in tear BUT, keratometry values, and corneal aberration measurements between nonfasting and fasting periods (P>0.05, for all). CONCLUSION: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.

Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema.

AIM: The aim of this study was to compare the effects of bevacizumab and ranibizumab on visual function and macular thickness in patients with diabetic macular edema (DME). METHODS: The data of diabetic patients who had been treated with bevacizumab for DME were reviewed. Those patients who received 1 injection of intravitreal bevacizumab and ranibizumab with at least 6-month interval were considered for enrollment. The best-corrected visual acuity (BCVA) assesment with Early Treatment Diabetic Retinopathy Study (ETDRS) chart and central subfield macular thickness (CSMT) measurement using optical coherence tomography-3 before and after the injections were recorded as outcome measures. RESULTS: The study included 29 eyes of 29 patients with a mean age of 56.18±13.07 years. The median BCVA was 59 ETDRS letters and the median CSMT was 411 µm preceeding the bevacizumab injection. At the 4th-6th week control after the injection, median BCVA increased to 61.50 ETDRS letters and the median CSMT decreased to 373 µm. This change in BCVA and CSMT was found to be statistically significant (P=0.029 and P=0.011, respectively). The mean interval between bevacizumab and ranibizumab treatment was 9.54±2.64 months. Ranibizumab treatment increased the median BCVA from 53 to 66 ETDRS letters and decreased the median CSMT from 428 µm to a level of 279 µm, which were statistically significant (P<0.001 and P<0.001, respectively). The median change in BCVA was 4.5 ETDRS letters in the bevacizumab group and 6 ETDRS letters in the ranibizumab group (P=0.58), whereas the median changes in CSMT were 41 and 100 µm after bevacizumab and ranibizumab injections, respectively (P=0.005). CONCLUSIONS: Bevacizumab and ranibizumab are both effective antivascular endothelial growth factor drugs preferred in the treatment of DME. Our comparison of both therapies on the same patients suggested that the effect on BCVA was not statistically different, but ranibizumab provided more decrease in CSMT.

Does lens status affect the course of early intraocular pressure and anterior chamber changes after intravitreal injection?

PURPOSE: This study aimed to observe changes in anterior chamber parameters and the course of intraocular pressure (IOP) after injection of 0.1 ml intravitreal triamcinolone acetonide (TA) and to determine differences between phakic and pseudophakic eyes without vitreous reflux. METHODS: A prospective observational clinical trial was conducted with 89 patients who received an intravitreal injection of TA and did not display vitreous reflux. Intraocular pressure measurements were made before injection and at 3, 10, 20, 30 and 40 mins after injection. Pentacam measurements were made before injection and at 5, 15, 30 and 45 mins after injection. RESULTS: Anterior chamber depth (ACD) and anterior chamber volume (ACV) were significantly greater in pseudophakic eyes than in phakic eyes at all measurement time-points (p < 0.001). There was a decrease in both ACD and ACV at 5 mins after injection, and a gradual increase to normal values was observed at 15, 30 and 45 mins after injection in all study eyes. Compared with pre-injection measurements, changes in ACD and ACV were statistically significant at each time-point in both phakic and pseudophakic eyes (p < 0.001). A significant increase in IOP within 3 mins of injection was observed in both groups and a more rapid decrease 10 mins after injection was observed in pseudophakic eyes. The differences in IOP between phakic and pseudophakic eyes at all measurement time-points, except baseline and 3 mins after injection, were statistically significant (p < 0.001). Intraocular pressure < 30 mmHg and < 24 mmHg was recorded in all pseudophakic eyes at 10 and 20 mins after intravitreal injection, respectively. CONCLUSIONS: Following intravitreal injection of 0.1 ml TA, without vitreous reflux, IOP decreased to safe levels more quickly in pseudophakic eyes than in phakic eyes. Although there were more pronounced changes in anterior chamber parameters in pseudophakic eyes, these changes were reversible without any residual clinical significance.