Evaluation of Eyelid, Angle, and Anterior Segment Parameters Using Scheimpflug Camera and Topography System in Obstructive Sleep Apnea Syndrome.

Objectives: The purpose of the study was to investigate the eyelid hyperlaxity, anterior segment, and corneal topographic parameters in patients with obstructive sleep apnea syndrome (OSAS) using Scheimpflug camera and topography system. Methods: In this prospective and cross-sectional clinical study, 32 eyes of 32 patients with OSAS and thirty-two eyes of 32 healthy subjects were evaluated. The participants with OSAS were selected from those with an apnea-hypopnea index ≥ 15. The minimum corneal thickness (ThkMin), apical corneal thickness (ACT), central corneal thickness (CCT), pupillary diameter (PD), aqueous depth (AD), aqueous volume (AV), anterior chamber angle (ACA), horizontal anterior chamber diameter (HACD), corneal volume (CV), simulated K readings (sim-K), front and back corneal keratometric values at 3 mm, RMS/A values, highest point of ectasia on the anterior and posterior corneal surface (KVf, KVb), symmetry indices and keratoconus measurements were taken by combined Scheimpflug-Placido corneal topography and compared with healthy subjects. Upper eyelid hyperlaxity (UEH) and floppy eyelid syndrome were also evaluated. Results: There were no statistically significant difference between groups in terms of age, gender, PD, ACT, CV, HACD, simK readings, front and back keratometric values, RMS/A-KVf and KVb values, symmetry indices, and keratoconus measurements (p>0.05). ThkMin, CCT, AD, AV, and ACA values were significantly higher in OSAS group compared to the control (p<0.05). UEH was detected in two cases in the control group (6.3%) and in 13 cases in the OSAS group (40.6%) and the difference was significant (p<0.001). Conclusion: The anterior chamber depth, ACA, AV, CCT, and UEH increase in OSAS. These ocular morphological changes occurring in OSAS may explain why these patients prones to normotensive glaucoma.

Novel Bacterial Cellulose Membrane to Reduce Fibrosis Following Trabeculectomy.

PURPOSE: The aim was to evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in trabeculectomy and the biocompatibility of BCM with conjunctiva and sclera. MATERIALS AND METHODS: Twenty-one eyes of 21 adult rabbits underwent fornix-based trabeculectomy. Standard surgery was done to control group (CG, n=7). Mitomycin-C (MMC) (0.3 mg/mL, 3 min) was applied to MMC group only (MMCG, n=7). BCM (~100 µm thick, 10×10 mm, single layer) was covered on the sclerotomy area before conjunctiva was closed in BCM group (BCMG, n=7). Intraocular pressures (IOP) were measured before, and 7, 14, 28, and 45 days after surgery (IOP-POD7, POD14, POD28, POD45). The IOP decrease were expressed as DIOP%-POD7, DIOP%-POD14, DIOP%-POD28, and DIOP%-POD45. The rabbits were sacrificed on the 45th day. Conjunctival vessel number, degrees of fibrosis, total inflammation, foreign body reaction, inflammatory cell types (B cells, T cells, plasma cells), macrophages, bleb spaces and the expression of α-smooth muscle actin were studied using histopathology and immunohistochemistry techniques. The groups were compared using nonparametric tests. RESULTS: There was no statistically significant difference between the groups regarding baseline IOP and DIOP%-POD7 (P>0.05). While DIOP%-POD14, 28 and 45 were similar between BCMG and MMCG, they were significantly lower in CG (P<0.05). The lowest conjunctival vessel number was detected in the MMCG but the difference was not significant. There was no difference between BCMG and CG with regard to the numbers of B cells, T cells, and macrophages, however, these cells were significantly lower in MMCG (P<0.05). Five cases had mild and 2 cases had moderate foreign body reaction in the BCMG. There was mild to moderate inflammation in all BCM cases. While fibrosis and α-smooth muscle actin staining were higher in the CG (P<0.001), they were minimal in the BCM and MMCGs. CONCLUSIONS: BCM showed good biocompatibility and provided better control of IOP with minimal fibrosis at the trabeculectomy site compared with the control group.

Efficacy of Hyperbaric Oxygen Therapy on Central Corneal Thickness, Intraocular Pressure, and Nerve Fiber Layer in Patients with Type 2 Diabetes: A Prospective Cohort Study.

PURPOSE: To evaluate the effect of hyperbaric oxygen therapy (HBOT) on central corneal thickness (CCT), intraocular pressure (IOP), and the retinal nerve fiber layer (RNFL) thickness in patients with type 2 diabetes mellitus. METHODS: This prospective non-randomized cohort study consisted of type 2 diabetes mellitus patients who received 30 sessions of HBOT for diabetic foot ulcer. The CCT, IOP, and RNFL measured at baseline, after the 10th session of HBOT, after the 20th session of HBOT, after the 30th session of HBOT, and after the 3 months of the last session of HBOT. We gained the superior-nasal, superior-temporal, inferior-nasal, inferior-temporal, nasal and temporal quadrant RNFL values with a spectral-domain optical coharence tomography. RESULTS: Forty-six eyes of 46 patients included in the study. During the study period, a statistically significant increase in mean IOP values compared to baseline was observed (p < 0.001). We found no significant changes at CCT and all quadrants of RNFL values during HBOT and after 3 months of the treatment (p > 0.05). During the study period, the IOP levels increased over 21 mmHg (between 22 and 28 mmHg) in seven eyes (15.2%). The mean hemoglobin A1c values of these patients with IOP >21 mmHg were 8.2 ± 0.9 mg/dL, and there was significant differences compared with those of patients with IOP values ≤21 mmHg (7.4 ± 2.8 mg/dL) (p = 0.001). CONCLUSIONS: HBOT increase IOP in type 2 diabetic patients especially in ones with impaired blood glucose regulation. However, it does not cause any changes in CCT and RNFL. As diabetic retinopathy and diabetic foot ulcer are in common pathologies, thus this brief report concludes a need for further studies with longer follow-up periods to explore the potential interaction of HBOT on CCT, IOP, and RNFL.

Effect of Topical Antibiotic Prophylaxis on Conjunctival Flora and Antibiotic Resistance Following Intravitreal Injections in Patients with Type 2 Diabetes.

PURPOSE: We sought to determine changes in the conjunctival bacterial flora and antibiotic resistance after topical antibiotic drops for infection prophylaxis were administered following intravitreal injections in patients with type 2 diabetes. METHODS: This prospective and nonrandomized cohort study included 116 eyes of 116 treatment-naive patients with type 2 diabetes who received six serial intravitreal anti-vascular endothelial growth factor injections for macular edema. Three conjunctival cultures were obtained from each eye over the course of the study (Culture 1, baseline; Culture 2, 1 month after the third injection; and Culture 3, 1 month after the sixth injection). The study subjects were given topical moxifloxacin hydrochloride for 4 days after each monthly intravitreal injection. The growth patterns of conjunctival bacterial flora and the antibiotic resistance to several commonly used antibiotics were examined. RESULTS: The rate of culture positivity increased significantly during the observation period (Culture 1, n = 47, 40.5%; Culture 2, n = 58, 50%; Culture 3, n = 76, 65.5%, p < 0.001). The bacterium with the highest baseline culture positivity was Staphylococcus epidermidis (n = 45, 38.8%), which increased significantly during the observation period (p < 0.001). No significant increase was noted in the culture positivity of the other bacteria with baseline culture positivity (p > 0.05). Regarding antibiotic susceptibility, significant increases in resistance to the fluoroquinolone group of drugs were noted (p < 0.001). No significant changes in sensitivity were detected in the other 11 investigated antibiotics that are commonly used in clinical practice (p > 0.05). CONCLUSIONS: The use of topical moxifloxacin after each intravitreal injection significantly increases the fluoroquinolone resistance of the ocular surface flora and the culture-positivity rate of S. epidermidis in patients with type 2 diabetes.

The effect of hyperbaric oxygen therapy on retinal thickness and progression of retinopathy in patients with Type 2 diabetes: a prospective cohort study.

Purpose: Evaluation of the effect of hyperbaric oxygen therapy (HBOT) on the progression of retinopathy, choroidal and retinal thickness in patients with type 2 diabetes mellitus (DM). Materials and methods: This prospective non-randomized cohort study consisted of 60 eyes of 30 patients who received 30 sessions of HBOT for a diabetic foot ulcer (DFU). The participants were divided into three groups; group 1: mild-moderate non-proliferative diabetic retinopathy (DRP) (n = 14), group 2: severe non-proliferative DRP (n = 20) and group 3: DRP without active proliferative findings with the applied laser for at least 2 years (n = 26). The cases were examined on base-line (measurement-1), after the 10th session of HBOT (Measurement-2), after the 20th session of HBOT (Measurement-3), after the 30th session of HBOT (Measurement-4), and after 10 days of the last session of HBOT (Measurement-5). The changes in central macular thickness (CMT; subfoveal point [CMT-SF], nasal point [CMT-N] and temporal point [CMT-T]), central choroidal thickness (CCT; subfoveal point [CCT-SF], nasal point [CCT-N] and temporal point [CCT-T]), and the stage of DRP were compared. Results: There was no significant difference between groups in terms of change ratio (CR%) in CMT-SF and CMT-N values. However, in Measurement-3, CR% in CMT-T was significantly higher in group 1 (p = 0.019). A significant increase in CMT-N and CMT-T parameters over time was observed in Group 1 (p < 0.05). There was a significant decrease in CCT-SF, CCT-N, and CCT-T values with time in each of the three groups (p < 0.05). At the end of HBOT, there was no progression or regression in the stage of DRP in any group. Conclusions: HBOT has both a thinning effect on the choroid layer in all three groups and a thickening effect on the macula in the mild-moderate non-proliferative diabetic eyes.

A Comparison Study of Ranibizumab and Aflibercept in Patients with Naive Diabetic Macular Edema in Presence of Serous Retinal Detachment.

Aim of the study: The aim of this study is to compare the efficacy of intravitreal injection of Aflibercept and Ranibizumab in the treatment of naive diabetic macular edema (DME) with serous retinal detachment (SRD). Materials and methods: In this prospective, non-randomized-cohort study, 60 eyes with DME with SRD were divided into 2 groups: group 1 consisted of 30 eyes treated with intravitreal injection of 0.5 mg/0.1 mL Ranibizumab (IVR) and group 2 consisted of 30 eyes treated with intravitreal injection of 2 mg/0.05 mL Aflibercept (IVA). After three sequential injections with 30-40-day interval as a loading dose, all patients were followed up for 12 months. The best-corrected visual acuity (BCVA), central macular thickness (CMT), SRD's height (SRDH) and the number of reinjections of the drugs were compared. Results: The groups were similar in terms of age and sex (p > 0.05). There was no difference between groups in terms of the baseline BCVA, CMT and SRDH (p > 0.05). There was no significant difference between groups with regard to BCVA and CMT values for 12 months (p > 0.05). SRDH decreased significantly in both groups; however, the reduction of SRDH was considerably higher in group 2 for 12 months (p < 0.05). The mean number of reinjection was 4.40 ± 0.85 in group 1 and 3.16 ± 0.75 in group 2 and it was noticeably lower in group 2 (p < 0.001). The number of cases with persistent SRD at the end of the study was 14 (46.6%) in group 1 and 5 (16.6%) in group 2 (p < 0.001). Conclusions: Aflibercept may treat SRD more efficiently in patients with DME compared to Ranibizumab with fewer injections.

Evaluation of retinal nerve fibre layer, ganglion cell layer and choroidal thickness with optical coherence tomography in migraine patients: a case-control study.

BACKGROUND: Evaluation of retinal nerve fibre layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (CT) with optical coherence tomography (OCT) in chronic migraine patients, to compare with healthy controls. MATERIAL AND METHOD: Ninety-four eyes of 47 chronic migraine patients (Group 1) and 68 eyes of 34 healthy individuals (Group 2) were included in this prospective case-control study. The right and left eyes were separately evaluated. Mean peripapillary RNFL thicknesses, mean GCL measured from superior and inferior quadrants, and mean CT were measured at three different regions (central, 500 µm nasal and temporal region of the fovea). RESULTS: There was no statistically significant differences in RNFL between the two groups (p > 0.05), while CT values were significantly higher and GCL values were significantly lower in chronic migraine groups (p < 0.05). There were no statistically significant differences between migraine duration, frequency and length of attacks, presence of aura, relation to menstrual cycle, white matter lesions in cranial magnetic resonance imaging and RNFL, GCL and CT (p > 0.05). DISCUSSION: In this study, we observed chronic migraine disease does not have any effect on peripapillary RNFL thickness; however, increases in CT and decreases in GCL thickness were observed in migraine patients.

Evaluation of macular and peripapillary choroidal thickness, macular volume and retinal nerve fiber layer in acromegaly patients.

PURPOSE: To evaluate macular volume, retinal nerve fiber layer, and macular and peripapillary choroidal thickness in acromegaly patients. METHOD: In this prospective, case-control study, 31 patients with acromegaly and 32 healthy subjects were recruited. Only right eyes were evaluated. Macular choroidal thickness (CT) was measured at three points, peripapillary CT was measured at eight points, and macular volume was measured at nine areas in the central 6 mm circle zone by spectraldomain optical coherence tomography (OCT). Retinal nerve fiber layer (RNFL) was measured automatically at six segments by OCT. RESULTS: The mean macular and peripapillary CT at all measuring points were significantly higher in acromegaly group (p < 0.05). RNFL thicknesses were significantly higher in acromegaly except for temporal segment (p < 0.05). The mean total, inferior and superior retinal volume of the macula were significantly higher in acromegaly group (p < 0.001), whereas there was no statistically difference was seen in retinal volume of temporal and nasal macular area between the two groups (p > 0.05). CONCLUSION: The macular and peripapillary choroidal thickness, retinal nerve fiber layer, and total retinal volume of the macula were significantly higher in acromegaly patients. Increased choroidal thickness may cause different macular pathologies such as choroidal neovascularization. RNFL results may be important in acromegaly patients with glaucoma, especially if the progress of glaucoma is monitored by OCT.

INTRAVITREAL DEXAMETHASONE IMPLANTATION IN PATIENTS WITH DIFFERENT MORPHOLOGICAL DIABETIC MACULAR EDEMA HAVING INSUFFICIENT RESPONSE TO RANIBIZUMAB.

PURPOSE: To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types. METHODS: In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12). Primary outcome measures were best corrected visual acuity, and central macular thickness. RESULTS: The three subgroups were similar in terms of age and gender (P > 0.05). Total duration of diabetes was significantly less in the serous retinal detachment subgroup (P = 0.01). There were no differences in the best corrected visual acuity between the three subgroups until the sixth month. However, the best corrected visual acuity was significantly better in the diffuse retinal thickness subgroup at the sixth month (P = 0.008). Regarding the central macular thickness values, it was statistically better in serous retinal detachment than in diffuse retinal thickening and cystoid macular edema subgroups till the sixth month (P = 0.001). However, at the sixth month, there was not any statistical difference between subgroups regarding central macular thickness values. Antiglaucomatous agents were required in 4 (11.4%) patients throughout the study. CONCLUSION: Treatment algorithms should differ according to the morphology of diabetic macular edema; however, more data is needed to give specific recommendations.

A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion.

PURPOSE: To compare the efficacy of intravitreal injection of ranibizumab, dexamethasone implant and aflibercept for the management of macular edema (ME) related to branch retinal vein occlusion (BRVO). METHODS: This retrospective and comparative study included 62 eyes of 62 patients with BRVO and ME. Patients received one of the following treatments: 0.5 mg ranibizumab (group 1, n = 22), 0.7 mg dexamethasone implant (group 2, n = 20) and 2 mg aflibercept (group 3, n = 20). The 6-month treatment protocol in groups 1 and 3 consisted of 3-dose loading treatment for the first 3 months and followed by repeat injections based on clinical necessity. Group 2 received only single dose of 0.7 mg dexamethasone implant for 6 months. Visual acuity (VA), central macular thickness (CMT), serous retinal detachment (SRD) height and intraocular pressure (IOP) measurements were done at baseline and first 6 months of follow-up. RESULTS: At baseline, the groups did not differ in age, gender, duration of ME, VA, CMT, IOP and SRD height (p > 0.05). Mean number of injections per eye within six months were 3.64 ± 0.49 (range 3-4) in group 1, only 1 in group 2 and 3.35 ± 0.49 (range 3-4) in group 3.VA was significantly better in group 2 in first 3 months but it became the worst among three groups in sixth month. CMT did not differ between groups in first 3 months, but it was significantly higher in group 2 at sixth month. SRD height was significantly lower in group 2 in first 3 months, but there was no difference between the groups at the end of the sixth month. IOP was significantly higher in group 2 in third and sixth months. CONCLUSION: In the treatment of ME associated with BRVO, dexamethasone implant appears to be more advantageous in terms of VA and SRD height for the first 3 months. However, at the end of the sixth month of treatment, anti-VEGF drugs were more efficient in maintaining the increased visual acuity and reduced CMT. A dexamethasone implant may be the first treatment option in BRVO cases with high SRD.

The role of patient's systemic characteristics and plateletcrit in developing toxic anterior segment syndrome after uneventful phaco surgery: A case-control study.

PURPOSE: To compare the systemic and ocular characteristics and laboratory findings of patients developing toxic anterior segment syndrome (TASS) after uneventful phaco surgery with unaffected subjects undergoing the same surgery in the same session. DESIGN: A retrospective case-control study. METHODS: The study group consisted of 26 eyes of 26 patients who underwent uneventful phaco surgery and who went on to develop TASS, while the control group included 39 subjects who had routine phaco surgery in the same session by the same surgeon. The sterilization stages of reusable instruments, disposable instruments, and compositions were recorded. The preoperative systemic diseases, complete blood count parameters, glycosylated hemoglobin (HbA1c), biochemical parameters, thyroid hormone profiles, and the surgical features were compared between the two groups. RESULTS: Type 2 diabetes mellitus (DM), systemic hypertension (HT), hyperlipidemia, chronic ischaemic heart disease, and chronic renal failure were significantly more common in the TASS group (p < 0.05). Proliferative diabetic retinopathy was also more frequent in the TASS group (p = 0.003). Mean HbA1c% values, white blood cell count, neutrophil/lymphocyte ratio, platelet counts, platelet distribution width, and plateletcrit parameters were significantly higher in the TASS group (p < 0.05). Multivariate logistic regression analysis revealed that a high plateletcrit level (p = 0.001, odds ratio [95% CI]; 22.27 [3.36-147.76]) and systemic HT (p = 0.044, odds ratio [95% CI]; 7.13 [1.05-48.12]) are independently associated with the development of TASS. CONCLUSION: Although TASS may arise as a result of insufficient sterilization of instruments or intraocular solutions, patient factors may also contribute to its development. Systemic vascular disorders such as uncontrolled type 2 DM, systemic hypertension, and hyperlipidemia may increase the risk of TASS after uneventful phaco surgery. Abnormal parameters associated with systemic inflammation, such as higher plateletcrit level, may facilitate the development of TASS. These findings may be a predicting factor of TASS development for uneventful cataract surgeries.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study.

PURPOSE: To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. RESULTS: The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). CONCLUSIONS: In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion.

PURPOSE: To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period. MATERIALS AND METHODS: This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed. RESULTS: The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 µm and 82.1 ± 17.6 µm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postoperatively compared to the baseline values in all quadrants except supero-temporal quadrant; however, none of them reached statistically significant level (p > 0.05). The mean IOP values before and 6 months after implantation were 15.7 ± 2.9 mmHg and 16.5 ± 4.2 mmHg, respectively. The difference between the 6th month IOP values and baseline IOP values was not statistically significant (p = 0.236). CONCLUSION: Intravitreal DEX implant seems to have no adverse effect on RNFL thickness in BRVO patients in a 6-month period.

An excellent anatomical and visual recovery after surgical repair of an open eye injury with poor baseline prognostic factors.

Presently described is case of a 42-year-old woman with eye injury that was result of gunshot fired by a man at a wedding celebration. Bullet penetrated inferior quadrant of nasal sclera of left eye 7-12 mm behind limbus. Choroid and vitreous were prolapsed around bullet. Hemorrhage, vitreous prolapse and lens subluxation were present in anterior chamber. Presenting visual acuity (VA) was hand motion. Bullet 14x5 mm in size was carefully extracted from the eye. Fifteen days later, argon laser photocoagulation was performed on retina in area of bullet entry point. VA was 20/25 (Snellen) at final visit. In this case, although foreign body was large, area of penetration was Zone III, and initial VA was poor, early and appropriate surgical repair achieved integrity of the globe and good vision prognosis.

Macular Choroidal Thickness May Be the Earliest Determiner to Detect the Onset of Diabetic Retinopathy in Patients with Prediabetes: A Prospective and Comparative Study.

PURPOSE: To evaluate the macular and peripapillary choroidal thickness and retinal volume in prediabetes. MATERIAL AND METHODS: This prospective comparative study included 53 patients with prediabetes and 53 age- and sex-matched healthy subjects. Only right eyes were selected. Choroidal thicknesses (CT) and retinal volume were measured by optical coherence tomography. Macular CT was measured at the seven points including macular center, 1, 2, and 3 mm distances along the temporal and nasal scans. Peripapillary CT was measured at the eight points of the optic disk area. Systemic and laboratory findings of the subjects were also recorded. RESULTS: There were no significant differences in blood pressures, ocular findings including intraocular pressure, visual acuity, and refractive powers, and macular volumes between the two groups (p > 0.005). Macular and peripapillary CT at all measuring points, body mass index (BMI), fasting blood glucose (FBG), hemoglobinA1C, and lipid profile were significantly higher in prediabetic patients (p < 0.05). There was a significant positive correlation between all points of macular choroidal thicknesses with BMI, FBG, and hemoglobin A1C (p < 0.05). CONCLUSION: Prediabetic factors including impaired FBG, increased hemoglobinA1C, and BMI are independent risk factors for increase in choroidal thickness. Increased macular choroidal thickness may be the earliest determiner to detect the onset of diabetic retinopathy in prediabetes.

Ocular findings in coal miners diagnosed with pneumoconiosis.

OBJECTIVE: Our study aimed at evaluating ocular findings and structural changes in coal mine workers who were chronically exposed to coal mine dust and diagnosed with pneumoconiosis. METHODS: Ocular findings of 161 eyes of 81 patients diagnosed with pneumoconiosis who had previously worked or are currently working in coal mines were analyzed. Forty-six coal mine workers and sex matched healthy people (n = 20) participated in the study. Workers who had early changes of pneumoconiosis were included in Group 1 (n = 17), workers diagnosed with pneumoconiosis were included in Group 2 (n = 29), and healthy subjects were included in Group 3 (n = 20). Outcome measures were the difference in peripapillary retinal nerve fiber layer (RNFL) thickness, choroidal thickness (CT), central macular thickness (CMT) and tear function tests between the groups. RESULTS: RNFL thickness values in Group 1 and 2 were lower than in Group 3, the control group, in all quadrants except the temporal quadrant. However, there was no statistically significant difference in peripapillary RNFL thickness values in any quadrants among the three groups (p > 0.05). Central subfoveal choroidal thickness and CMT measurements were thinner in Group 1 and 2 than in the control group. However, this difference among groups was not statistically significant (p > 0.05). Mean schirmer's test result was 8.8 ± 1.6 mm in group 1, 7.1 ± 1.8 mm in Group 2 and 11.5 ± 3.6 mm in the control group. Mean tear break up time (BUT) test result was 7.1 ± 1.3 seconds (sec) in Group 1, 6.5 ± 1.8 sec in Group 2 and 10.4 ± 2.9 s in the control group. The Schirmer's test and BUT test results were both statistically significantly lower in coal mine workers (Group 1 and 2) compared to the control group. Group 1 and Group 2 did not show statistically significant difference in terms of Schirmer's test and BUT test results. DISCUSSION: The association between pneumoconiosis and coal mine dust contiguity is thought to be due to the effect of coal dust by producing chronic inflammation. In addition, there are several trace elements in coal dust which are toxic to vital tissues. In this study, ocular findings suggest that systemic levels of trace elements and chronic inflammation may not reach to a level that influences ocular structures. Nonetheless, tear functions seem to be affected in coal mine workers. CONCLUSION: This study suggests that the systemic effect of coal mine dust in ocular structures is not evident. However, direct contact with coal mine and fume leads to a decrease in tear function tests.

Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis.

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50 mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50 mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11 months (interquartile range: 8-18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4 mg systemic maintenance. Visual acuity was significantly increased (p = 0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

Plateletcrit in Ocular Pseudoexfoliation Syndrome.

PURPOSE: The aim of this study was to compare all platelet markers, especially plateletcrit (PCT, total platelet mass), in patients with and without ocular pseudoexfoliation (PEX) syndrome. METHODS: One hundred six patients with ocular PEX syndrome (study group) and 106 individuals without ocular PEX syndrome (control group) were enrolled in this retrospective case-control study. The biochemical/hematological laboratory results of both the study and control groups were analyzed by a clinician blinded to the group assignments. The main outcome measures were the PCT, platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW). RESULTS: The mean PCT in the study and control groups were 0.206%±0.520% and 0.171%±0.410%, respectively (P<0.001), and the mean PDW in the study and control groups were 16.12%±1.21% and 14.68%±1.40%, respectively (P<0.001). There were no differences in the MPV or mean PLT (P=0.138 and P=0.055, respectively). The PCT cutoff value was 0.180 (area under the receiver operating characteristics curve, 0.706; P<0.001; 65% sensitivity; 74% specificity). CONCLUSIONS: The PCT and PDW were significantly higher in patients with than without ocular PEX syndrome. These increased parameters may cause microvascular blood flow resistance and the heightened inflammatory response caused by excessive platelet activity, as with other cardiovascular diseases, and may also decrease aqueous humor outflow in ocular PEX syndrome.

Peripapillary retinal nerve fiber layer and choroidal thickness in cirrhosis patients / Espessura da camada de fibras nervosas peripapilares da retina e coroide em pacientes com cirrose

ABSTRACT Purpose: To evaluate the effect of cirrhosis on peripapillary retinal nerve fiber layer and choroidal thickness with enhanced depth imaging optical coherence tomography. Methods: This cross sectional, single center study was undertaken at Bulent Ecevit University Ophthalmology department with the participation of internal medicine, Gastroenterology department. Patients who were treated with the diagnosis of cirrhosis (n=75) were examined in the ophthalmology clinic. Age and sex matched patients (n=50) who were healthy and met the inclusion, exclusion criteria were included in the study. Complete ophthalmological examination included visual acuity with Snellen chart, intraocular pressure measurement with applanation tonometry, biomicroscopy of anterior and posterior segments, gonioscopy, axial length measurement, visual field examination, peripapillary retinal nerve fiber layer, central macular and subfoveal choroidal thickness measurements. Results: The difference between intraocular pressure values was not statistically significant between cirrhosis and control group (p=0.843). However, mean peripapillary retinal nerve fiber layer thickness was significantly thinner in cirrhosis group in all regions (p<0.001) and subfoveal choroidal thickness was significantly thinner in cirrhosis group also (p<0.001). Moreover, central macular thickness of cirrhosis group was significantly thicker than the control group (p=0.001). Conclusion: Peripapillary retinal nerve fiber layer and subfoveal choroidal thickness was significantly thinner in cirrhosis patients.

RESUMO Objetivo: Avaliar o efeito da cirrose na camada de fibras nervosas da retina e na espessura da coroide através da tomografia de coerência óptica com imagem de profundidade aprimorada. Métodos: Este estudo transversal, de único centro, foi realizado no departamento de Oftalmologia da Universidade Bulent Ecevit com a participação do departamento de medicina interna em gtastroenterologia. Os pacientes que foram tratados com o diagnóstico de cirrose (n = 75) foram examinados na clínica da oftalmologia. Foram incluídos pacientes correspondentes em idade e sexo (n = 50) que fossem saudáveis e possuíssem o critério de inclusão exigido pelo estudo. Realização de exame oftalmológico completo: acuidade visual com tabela de Snellen, a medida da pressão intraocular com tonometria de aplanação, biomicroscopia do segmento anterior e posterior, gonioscopia, medida do comprimento axial, exame de campo visual, camada de fibras nervosas da retina, macular central e medidas de espessura de coroide. Resultados: A diferença entre os valores de pressão intraocular não foram estatisticamente significativos entre os grupos cirrótico e controle (p=0,843). Entretanto, a espessura da camada de fibras nervosas da retina foi significativamente mais fina no grupo cirrótico em todas as regiões (p=0,001) e a espessura subfoveal da coroide também foi significativamente mais fina no grupo cirrótico (p=0,001). Além disso, a espessura macular central do grupo cirrótico foi significativamente mais grossa do que no grupo de controle (p=0,001). Conclusão: Por fim, as espessuras das camadas de fibras nervosas da retina e subfoveal da coroide foram significativamente mais finas nos pacientes com cirrose.

A comparison of corneal biomechanical properties in patients with psoriasis and healthy subjects.

OBJECTIVE: To evaluate the differences in corneal biomechanical properties between healthy subjects and patients with psoriasis using the ocular response analyzer (ORA). METHODS: Fifty-nine eyes of 59 psoriasis patients and 66 healthy individuals were included in the study. Corneal biomechanical parameters were obtained using ORA. Ultrasound pachymetry was used to measure central corneal thickness (CCT). The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg) measurement and corneal-compensated IOP (IOPcc) through ORA. The dry eye evaluation was performed with tear break-up time (TBUT) and Shirmer test. RESULTS: The mean CH values in psoriasis and healthy subject eyes were 10.75±2.9 mm Hg, 11.97±3.6 mm Hg, respectively (P=0.047). The mean CRF values were 10.14±3.1 mm Hg and 11.61±3.3 mm Hg, respectively (P=0.012). The mean CCT were 539.1±36 µm and 536.3±28 µm, respectively (P=0.643). Mean TBUT values were 8.2±2.9 sec in psoriasis group and 10.4±3.6 sec in healthy subjects (P<0.001). Shirmer test values were less (8.9±3.8 mm/5 min) in psoriasis than in healthy subjects (13.1±3.6 mm) (P<0.001). CONCLUSIONS: Psoriasis can influence the corneal biomechanical properties. Patients with psoriasis had lower CH and CRF, but higher IOPg and IOPcc values than healthy controls. These corneal biomechanical changes should be considered when determining IOP values.