The effect of epilepsy and anti-epileptic drugs on the anterior and posterior segment of the eye.

CLINICAL RELEVANCE: Understanding the causes of visual symptoms in epilepsy patients is important for early diagnosis and taking precautions. BACKGROUND: The aim of this study is to evaluate the anterior and posterior segment parameters in patients with generalized tonic-clonic epilepsy (GTCE). METHODS: This retrospective study included 50 eyes of 50 patients with GTCE and 55 eyes of 55 healthy controls. For all participants, detailed ophthalmic examinations were obtained from the files of patients. Anterior segment parameters were measured using corneal topography and non-contact specular microscopy, and posterior segment parameters were measured using swept-source optical coherence tomography. RESULTS: The mean age of the patients with GTCE was 43.3 ± 13.2 years, and in the healthy controls it was 47.6 ± 10.7 years (p = 0.405). In GTCE patients, 34 patients were treated with monotherapy (MT) and 16 patients with polytherapy (PT). Central macular thickness (CMT) was statistically significantly thin in GTCE patients (p = 0.001). The average and four quadrants (superior, inferior, nasal, temporal) retinal nerve fibre layer (RNFL) were thinner in GTCE patients than in the healthy controls, but there was no statistically significant difference (p > 0.05, all). The central corneal thickness was statistically significantly thin in GTCE patients (p = 0.04). Endothelial cell density (ECD), endothelial cell number (ECN), and average cell area (ACA) were statistically significantly lower in GTCE patients than in the healthy controls (p < 0.05, all). Although the CMT, average, and four-quadrants RNFL were thinner in the PT group compared to the MT group, no statistically significant difference was observed (p > 0.05, all). Total high-order aberrations (HOAs) were 0.6 ± 0.4 in the MT group and 0.4 ± 0.1 in the PT group (p = 0.01). ECD, ECN, and ACA measurements were observed to be lower in the PT group compared to the MT group, but no statistically significant difference was detected (p > 0.05, all). CONCLUSION: There could be statistically significant differences between GTCE patients and healthy controls in anterior and posterior segment parameters. This situation may be due to the epilepsy itself or to the antiepileptic drugs.

The effect of systemic sclerosis and its subtypes on ocular anterior and posterior segment parameters.

PURPOSE: To evaluate anterior and posterior segment parameters in the eyes of patients with systemic sclerosis (SSc) and examine the effect of disease and disease subtypes on these parameters. METHODS: This cross-sectional study included 54 eyes of 27 SSc patients and 54 eyes of 27 age- and sex-matched healthy controls. In addition to a complete ophthalmologic examination, all patients were examined using a Scheimpflug camera, specular microscopy, and spectral domain optical coherence tomography. RESULTS: The mean age of the patients was 52.5 ± 11.4 years and 19 patients were female. Anterior chamber volume, central corneal thickness, and central macular thickness (CMT) were significantly lower in the eyes of SSc patients compared to healthy controls (p = 0.01, p = 0.03, and p = 0.006, respectively). When evaluated according to SSc subtype, CMT was lower in diffuse SSc patients (p = 0.001), while mean retinal nerve fiber layer (RNFL) and inferior quadrant RNFL values were lower in limited SSc (p = 0.003 and p = 0.005, respectively). CONCLUSION: In the eyes of patients with SSc, some ocular parameters may show decreases compared to healthy individuals, presumably secondary to disease-related vasculopathy and fibrosis. CMT and RNFL parameters may be affected differently according to disease subtype.

Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness in Adult Children of Patients With Pseudoexfoliation Glaucoma.

PRCIS: The adult children of patients with pseudoexfoliation glaucoma (PXG) had universally lower retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness values compared with individuals with a negative family history of PXG. PURPOSE: This study aimed to evaluate RNFL and GCC thicknesses in the adult children of individuals with PXG compared with people without a parental history of PXG. MATERIALS AND METHODS: This cross-sectional observational study included 40 eyes of 40 adults with confirmed parental history of PXG and 40 eyes of 40 healthy adults with no parental history of PXG. RNFL and macular GCC thicknesses were measured by spectral-domain optical coherence tomography (Nidek RS-3000 Advance) and compared between the groups. All subjects also underwent visual field testing (program 30-2 of the Humphrey Field Analyzer), and their mean deviation and pattern SD values were compared. RESULTS: Compared with adults without parental PXG, those with a parental history of PXG had significantly lower RNFL thickness overall (mean 98.2 vs 109.5 µm) and in all quadrants (inferior, superior, nasal, and temporal) ( P <0.001 for all). They also had significantly lower GCC thickness overall (mean 97.9 vs 109.4 µm) and in both hemispheres (superior and inferior) ( P <0.001 for all). There was no significant difference between the groups in terms of mean deviation or pattern SD values ( P >0.05). CONCLUSION: PXG in a parent was associated with significantly thinner RNFL and GCC compared with those with no history of PXG in a parent. Longer follow-up and prospective controlled clinical studies are needed to evaluate whether these findings may serve as an early indicator of glaucoma in the adult children of known PXG patients.

Does Storage Time Affect the Outcomes of Split Corneal Transplantation to Reduce Corneal Donor Shortage? A Retrospective Study.

Split cornea transplantation can reduce the shortage of donor corneas. Therefore, this study aimed to evaluate the effect of split graft storage time on the outcomes of split corneal transplantation through Descemet membrane endothelial keratoplasty (DMEK) and deep anterior lamellar keratoplasty (DALK) surgeries. Split corneal transplantation was performed in 80 eyes using 41 donor corneas. The mean before and after splitting storage times and total storage times were recorded. Donor corneal buttons and split grafts were stored in short-term solution at 4°C. In both surgeries (DMEK and DALK), donor corneas were divided into groups depending on their storage times. Mean postoperative 12th month best corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT), refractive spherical equivalent (RSE), refractive astigmatism, and complication rates were compared among the groups. Correlation between storage times and 1-year BCVA, ECL, and complication rates were assessed. Clinical outcomes of the groups 1 year after the surgeries were also compared. DALK and DMEK were performed in 41 and 39 eyes, respectively. Storage times were not correlated with 1-year DMEK outcomes and only weakly correlated with post-DALK ECD, ECL, and RSE values. Except for CCT in those that underwent DALK, the outcomes of DMEK and DALK surgeries with stored and non-stored split grafts were not significantly different (P = .02). The storage times of donor corneas and split grafts do not have any impact on outcomes.

Comparison of the Success Rate of Two Different Marking Techniques (F-Mark and Asymmetric Triangular Mark) to Orient the Donor Graft During Descemet Membrane Endothelial Keratoplasty.

OBJECTIVES: We evaluated the effects of various graft-marking techniques on surgical results in patients undergoing Descemet membrane endothelial keratoplasty. MATERIALS AND METHODS: In this single-center retrospective study, 65 eyes from 55 patients that had received various types of marking or no marking and that had been used for Descemet membrane endothelial keratoplasty endothelial graft preparation were included. Patients were divided into 3 groups according to the marking technique used: group I (F-marked graft; 17 eyes), group II (asymmetric triangle-marked graft; 12 eyes), and group III (unmarked graft; 36 eyes). The main outcome measurements were best-corrected visual acuity, endothelial cell density, central corneal thickness, postoperative complications, rebubbling, and secondary keratoplasty rates. RESULTS: In groups I, II, and III, rates of patients with 6-month best-corrected visual acuity ≥ 20/32 were 35.7%, 77.8%, and 71.9%, respectively (P = .04). The mean 6-month endothelial cell density decrease for each group was 43.3%, 48.8%, and 46.4%, respectively (P = .589), whereas the mean 6-month central corneal thickness decrease for each group was 7.7%, 15.8%, and 34.0%, respectively (P = .001). Rates of primary graft failure for groups I, II, and III were 35.3%, 8.3%, and 13.9%, respectively. Rebubbling was performed in 21.5% of eyes, and secondary keratoplasty was required in 29.2% of eyes. CONCLUSIONS: Although graft-marking techniques for Descemet membrane endothelial keratoplasty greatly facilitate graft positioning during surgery, both the potential toxic effects of alcohol on the endothelium when marking with gentian violet dye and the risk of graft detachment with asymmetric marking must be considered.

Epidemiological Characteristics of Corneal Donors at a Tertiary Referral Center in Turkey: An Eye Bank Study.

OBJECTIVES: The aim of this study was to evaluate the demographic features of corneal donors and available data of corneas in our eye bank during a 14-year period. MATERIALS AND METHODS: The demographic features of the corneal donors, the causes of death, the death-to-excision interval, serology results, the mean endothelial cell density, and the reasons for discarding the corneas were retrospectively evaluated. RESULTS: During the study period, 6524 corneas were retrieved from 3326 donors (76.1% male, 23.9% female). Mean donor age was 43.7 ± 16.0 years (range, 4-75 years; median 45.0 years). The most common cause of death was cardiovascular disease (n = 1467; 44.1%). The most common reason for discarding corneas was positive serology (n = 509; 78.6%). The mean endothelial cell density was 3030.1 ± 484.3 cells/mm². There was a weak negative statistically significant correlation between age and endothelial cell density (Pearson correlation coefficient r = -0.187, P < .001). Multiorgan donations made up 1.5% of the whole group (n = 50). CONCLUSIONS: We believe that preoperative detailed evaluations of graft quality in addition to review of donor-related medical records and data from previous surgeries, after collecting them in a single system, will have a positive effect on postoperative corneal survival.