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.

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 New Surgical Treatment Option for Chronic Total Oculomotor Nerve Palsy: A Modified Technique for Medial Transposition of Split Lateral Rectus Muscle.

PURPOSE: To describe a new surgical modified procedure in patients with chronic total oculomotor nerve palsy and to evaluate the results of this procedure. METHODS: Eight eyes of 6 consecutive patients who underwent strabismus surgery due to chronic total oculomotor nerve palsy were enrolled in the study. The lateral rectus muscle was split into two halves and disinserted from the sclera. The upper half of the muscle was passed under the superior rectus muscle and the inferior half of the muscle was passed under the inferior rectus muscle. The two halves of the muscle were moved to the medial rectus muscle insertion area and were sutured to sclera near the insertion. Additional medial rectus resections were made in the undercorrected patients. RESULTS: The mean age was 21.8 ± 12.1 years (range: 11 to 42 years). Postoperatively, 4 of 6 patients had stable horizontal deviations; 1 had orthophoria, 2 had 10 prism diopters (PD) of exotropia, and 1 had 10 PD of esotropia. However, 2 cases had 25 and 30 PD of undercorrection. Additional medial rectus resections were made in these undercorrected patients and horizontal deviations reduced to 15 and 20 PD of exotropia, respectively. The mean primary position horizontal deviation, which was 74.1 ± 10.2 PD before the surgeries, reduced to 10.8 ± 6.6 PD after the surgeries (P < .001). CONCLUSIONS: The authors described a new and relatively simple modified surgical procedure for the treatment of chronic total ocular nerve palsy and reached satisfactory outcomes. Further studies with larger sample sizes are warranted. [J Pediatr Ophthalmol Strabismus. 2016;53(3):150-154.].

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.

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.

Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results.

PURPOSE: To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis. METHODS: A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12. RESULTS: The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment. CONCLUSIONS: A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.

Using liquid crystal glasses to treat ambyopia in children.

PURPOSE: To evaluate the effectiveness of liquid crystal glasses (LCG) in the treatment of children with monocular amblyopia. METHODS: A total of 14 amblyopic eyes of 14 children with monocular amblyopia were enrolled in the study. LCG with appropriate refractive correction were ordered for each patient. Each patient was examined with the new LCG before treatment and monthly thereafter. The parents were informed about the use, care, and charging of the glasses. Best-corrected visual acuity was measured as Snellen decimal notation and converted to logarithm of the minimum angle of resolution (logMAR) for statistical analyses. RESULTS: The mean age of the study population was 7.4 ± 1.4 years. Ten patients (71%) had anisometropic amblyopia; 2 (14%), strabismic amblyopia; and 2 (14%), mixed amblyopia. The mean follow-up period was 4.0 ± 1.2 months (range, 3-7 months). The mean duration of using LCG was 8.2 ± 2.5 hours daily (range, 4-12 hours). All of 14 patients used the LCG as suggested. The mean logMAR best-corrected visual acuity of the amblyopic eyes was 0.6 ± 0.3 at baseline, improving to 0.3 ± 0.2 at final follow-up (P < 0.001). No side effects were observed. CONCLUSIONS: The current study demonstrated that LCG wear improved visual acuity in children with monocular amblyopia. Additional studies are needed to determine whether this effect is due to the LCG on/off feature or to refractive correction alone.

Association between penetrating eye injuries and attention deficit hyperactivity disorder in children.

PURPOSE: To investigate whether there is an association between penetrating eye injuries and attention deficit hyperactivity disorder (ADHD) symptoms in children. METHODS: 45 children aged 3-18 years who were treated due to penetrating ocular injuries (patient group) and 75 control subjects (control group) were enrolled in the study. The symptoms of ADHD were evaluated by the Turkish adapted and validated form of the Conner Parent Rating Scale (CPRS). RESULTS: The mean age was 8.9±4.1 years in the patient group and 9.7±3.7 years in the control group. All subscale scores of CPRS were higher in the patient group compared with the control group (all p<0.05). Gender-specific analyses showed that the boys of the patient group had significantly higher mean scores of all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder, compared with the boys of the control group (all p<0.05). However, the girls of the patient group had higher mean scores of only the conduct disorder subscale (p<0.05) compared with the girls of the control group. Three of 45 patients (6.6%) and 0 of 75 control subjects (0%) had a history of previous ocular trauma (p<0.05). CONCLUSIONS: There was an association between penetrating eye injuries and inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder in boys, and conduct disorder in girls. An appropriate evaluation of ADHD symptoms may prevent vision loss due to penetrating eye injuries in children. In addition, evaluation by a child psychiatrist of children presenting with penetrating eye injuries may prevent repetition of injuries.

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.

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.

Association transient receptor potential melastatin channel gene polymorphism with 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 transient receptor potential melastatin (TRPM) channel genes on the risk of POAG in a Turkish population. METHODS: Genomic DNA was extracted from the leukocytes of the peripheral blood, and 26 single nucleotide polymorphisms in the TRPM channel genes were analyzed in 179 patients with POAG and in 182 healthy controls of similar age by using the BioMark HD dynamic array system. RESULTS: There were marked changes in the genotype (TT, 26.8%; CT, 66.7%; CC, 6.5%) and allele (T, 60.1%; C, 39.9%) frequencies for the TRPM5 gene rs34551253 (Ala456Thr, in exon 9) polymorphism in patients when compared to the controls (TT, 11.3%; CT, 74.6%; CC, 14.1%, p = 0.0009; T, 48.6%; A, 51.4%, p = 0.0063). However, no associations with the other 25 polymorphisms studied were found. CONCLUSIONS: This is the first study to examine the involvement of TRPM channel gene variations in the risk of incident POAG. This study demonstrated that the TRPM5 gene rs34551253 (Ala456Thr) polymorphism may be associated with increased risk of developing POAG in the Turkish population.

Enhanced depth imaging optical coherence tomography findings in Behçet disease.

PURPOSE: Investigation of subfoveal choroidal thickness in Behçet disease (BD) with enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: The study included 35 patients with posterior uveitis (PU) associated with BD, 35 patients with BD without ocular involvement, and 30 healthy controls. RESULTS: There were no significant differences between the groups in terms of age, gender, axial length, or spherical equivalent refractive error. The mean subfoveal choroidal thickness was thinner in eyes with PU than in eyes without PU and healthy controls (p = 0.026). CONCLUSION: EDI-OCT is a beneficial test for evaluating choroid morphology in BD. Thinning of the subfoveal choroidal tissue has been observed in patients with BD-associated PU.

Comparison of intravitreal vancomycin and daptomycin application in experimental methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis in rabbits.

PURPOSE: To compare bactericidal activities of daptomycin and vancomycin in an experimental rabbit model of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis. METHODS: The right eyes of 19 New Zealand rabbits weighing 2 to 2.5 kg were used. Each eye was inoculated with 1000 colony-forming units (cfu) of MRSA into the vitreous cavity. 24 h after the inoculation, the rabbits were randomly distributed into three groups: control group (n = 5) was given 0.1 ml of balanced saline solution, daptomycin group 2 (n = 7) was given 0.2 mg/0.1 ml daptomycin and vancomycin group 3 (n = 7) was given 1 mg/0.1 ml vancomycin intravitreally. Clinical examination scores were recorded and vitreous aspirates were obtained for microbiological analysis on days 2 and 3 after MRSA inoculation. Rabbits were sacrificed, and the eyes were enucleated for histopathological examination. RESULTS: There was no difference between the daptomycin group, vancomycin group and control in terms of the clinical grading of endophthalmitis 24 h after the inoculation. In all treatment groups, mean number of cfu and histopathological scores were significantly lower compared to the control group. There was no difference between the daptomycin and vancomycin group in terms of the histopathological and clinical examination scores. Culture negativity achieved on day 3 was 71.4% and 57.1% in the daptomycin treatment group and the vancomycin treatment group, respectively. CONCLUSIONS: Although both daptomycin and vancomycin are effective in treatment of experimental MRSA endophthalmitis, daptomycin has superior bactericidal activity 72 h after inoculation.

Cyclosporine a 0.05% eye drops for the treatment of subepithelial infiltrates after epidemic keratoconjunctivitis.

BACKGROUND: To evaluate the treatment with topical 0.05% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEI). METHODS: We reviewed 16 patients (22 eyes) before and after the treatment with 0.05% CsA eye drops. All patients had been treated previously with topical corticosteroids without any improvement and also they had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected visual acuity (BCVA), evaluation of corneal subepithelial infiltrate scores (CSIS), intraocular pressure (IOP) prior to treatment and the last follow-up visit. RESULTS: Six males (37.5%) and 10 females (62.5%), mean age of 35.2 ± 16.6 years, were included. The patients' average topical CsA use duration was 5.1 ± 3.5 months (1 - 13 months). The average follow up time of the patients was 9.2 ± 4.7 months (4 - 22 months). One patient, although he didn't have a 0 scale of SCIS, did not show up for follow up examinations after six months. The mean BCVA (logarithm of the minimum angle of resolution) before and after the treatment were 0.15 ± 0.15 and 0.07 ± 0.07 respectively, CSIS 1.68 ± 0.89 and 0.23 ± 0.53 respectively, IOP 18.50 ± 3.82 and 16.86 ± 2.76 mmHg respectively. There were statistically significant improvements in BCVA (p=0.002), reduction of CSIS (p=0.002) and reduction of IOP (p<0.001) prior to treatment and the last follow-up visit. 18 eyes (81.9%) showed clinical improvement and 4 (18.1%) had decreased SEI which did not fully disappear during the treatment period. The eyes which reached CSIS score 0 (18 eyes) were treated with CsA for 1 - 13 months; while the eyes which had clinical improvement but had not CSIS score 0 (4 eyes) were decided to discontinue of CsA treatment in last follow-up visit. There were recurrences in 2 eyes 3 months after the treatment. Patients reported reduction in the severity of symptoms after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with topical 0.05% CsA treatment. CONCLUSIONS: Topical 0.05% CsA is a safe and effective alternative treatment in patients with SEI who do not respond to other treatment modalities or have undesired side effects from topical steroids.

An unusual case of hydroa vacciniforme with ocular involvement.

Hydroa vacciniforme (HV) is a sporadic, rare and idiopathic chronic photodermatosis characterized by recurrent vesicles and crust formation on a sun-exposed skin, typically resulting in vacciniform or varioliform scarring. Herein, we report on a 18-year-old boy who presented with rare ocular involvement in HV.

Botulinum toxin injections for blepharospasm prior to ocular surgeries.

PURPOSE: The aim of this study was to show the efficiency of preoperative botulinum toxin A (Botox A) in patients with benign essential blepharospasm who were to undergo ocular surgery with local anesthesia. MATERIALS AND METHODS: Twenty-eight benign essential blepharospasm patients who were administered unilateral Botox A prior to ocular surgery between January 2004 and May 2011 were included in this study. Eleven cases had pterygiums, ten had cataracts, and four had glaucomas, while the remaining three had aphakia. All cases' severity of spasm (stage 0-4) and eyelid closing forces (stage 1-4) were evaluated according to the Jankovic scale prior to the injection, at 3 days, 14 days, 1 month, and 3 months after Botox A injection. RESULTS: Of the patients enrolled in the study, 16 were female and 12 were male, with an average age of 55.52 ± 1.53 years (52-65). Average onset of the Botox injection's effect was 2.8 ± 0.9 (2-5) days. Its effect lingered for about 11.5 ± 3.6 (8-22) weeks. The severity of spasm and eyelid closing forces of all the patients enrolled were compared prior to the injection at 3 and 14 days and the first and third months after the injection. There were statistically significant differences between prior to the injection and 3 days (P = 0.001), 14 days (P < 0.001) and 1 month after the injection (P < 0.001). There was no statistically significant difference between prior to the injection and 3 months after the injection (P = 0.513). Fourteen days following the injection, the surgeries were successfully performed. CONCLUSION: Botox A administered prior to ocular surgery will control both blepharospasm and lower the risks that can be encountered before and during surgery, thus increasing the comfort of the patient and the surgeon.

Association between Thr21Met and Ser89Asn polymorphisms of the urotensin-II (UTS2) gene, diabetes mellitus, and diabetic retinopathy.

PURPOSE: To evaluate possible role of the UTS2 gene polymorphisms (Thr21Met and Ser89Asn) in the genetic susceptibility to diabetic retinopathy (DR) in a Turkish population. METHODS: Total number of 280 patients with DR (nonproliferative DR 170 and proliferative DR 110), 291 nondiabetic healthy controls, and 113 diabetic controls (without DR) were included to this study. The detection of UTS2 gene polymorphisms was achieved with PCR-RFLP technique. The Discovery Studio 2.1 program was used for molecular modeling analysis. RESULTS: Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms of the UTS2 gene were associated with the risk of developing diabetes and DR. M21M genotype frequencies were high in PDR (8.9% in diabetic control vs. 54.6% in PDR, P = 0.0092) group. Increases in 21M allele frequency (52.7% in diabetic control vs. 76.4% in PDR, P < 0.0001) frequency in PDR group were detected. However, there were no changes in genotype and allele frequencies for T21M in NPDR group. There were decreases in the S89N genotype (23.9% in diabetic control vs. 13.5%) and 89N allele frequencies (11.9% in diabetic control vs. 6.8%) in NPDR group. However, S89S genotype (76.1% in diabetic control vs. 86.4%) and 89S allele frequencies (88.1% in diabetic control vs. 93.2%) were high in NPDR group. Three haplotypes (MN, MS and TS) were associated with NPDR patients (P < 0.001), but only MN (P < 0.001) and TS haplotypes (P = 0.018) were associated in PDR group. Molecular modeling analysis showed that these two polymorphisms changed the 3D structure of UTS2, and provided interactions with neighboring residues. CONCLUSION: The associations between Thr21Met and Ser89Asn polymorphisms in the UTS2 gene and DR strongly suggest that these SNPs may be an important a risk factor for the development of DR in Caucasians, and could be candidate markers for earlier diagnosis and targets for DR therapy.

Efficiency of endoscopic imaging in repetitive probing following unsuccessful probing.

PURPOSE: To show the efficiency of repetitive probing performed with intranasal endoscopic imaging in cases who underwent unsuccessful probing and the accompanying nasal pathologies. METHODS: Eighty-four eyes of the 64 patients in whom primary probing was found to be unsuccessful were included in the study. Cases were divided into 3 groups, depending on the number of unsuccessful attempts (1 [group 1], 2 [group 2], and 3 [group 3] unsuccessful probings). Diagnosis of congenital nasolacrimal duct obstruction was confirmed by history taking, clinical examination, and fluorescence disappearance test. All cases underwent nasal endoscopic-assisted probing and were followed up on the first week, first month, and third month following the procedure. RESULTS: There were 50 eyes in group 1, 23 in group 2, and 11 in group 3. The causes of failure that were determined with endoscopy were as follows: functional insufficiency 8.3%, lower nasal concha tension 4.7%, thin membrane in Hasner valve 3.6%, thick membrane and fibrosis in the distal side of the duct 21.4%, probe progressed submucosally on the nasal wall 33.3%, different exit location in the nose 20.2%, nasal mucosa ballooning in the distal side of the duct 4.7%, mucocele 2.4%, and nasal polyposis 1.2%. The success rate in the groups was estimated as 86% in the first group, 69.5% in the second group, and 54.5% in the third group. CONCLUSIONS: Performing the repetitive probings via nasal endoscopy provided information about the location and the shape of the obstruction and the opportunity to approach, according to the cause of the failure.

Penetrating keratoplasty in congenital hereditary endothelial dystrophy.

PURPOSE: To compare the results of penetrating keratoplasty (PK) in a series of congenital hereditary endothelial dystrophy (CHED) patients operated at amblyogenic years and at later ages. METHODS: Records of 65 eyes of 35 CHED patients who underwent PK were reviewed retrospectively. Visual results and graft clarity rates were compared between patients operated after (group 1) and before (group 2) 12 years of age. Results were also compared between eyes with and without nystagmus. RESULTS: Group 1 consisted of 47 eyes (24 patients), whereas group 2 consisted of 18 eyes (11 patients). Thirteen patients (54%) in group 1 and 10 patients (91%) in group 2 had nystagmus. Mean ages at surgery were 26.4 and 7.6 years in group 1 and group 2, respectively. Mean follow-up period was 101.0 months in group 1 and 59.7 months in group 2. Group 1 cases had better graft clarity rates than group 2 cases (P = 0.023). Postoperative best-corrected visual acuities (BCVAs) were 20/80 or better in 39 eyes of group 1 (83%) and in 5 eyes of group 2 (28%). Visual outcomes were found significantly better in group 1 cases (P < 0.001). In group 1, 76% of eyes with nystagmus and 91% of eyes without nystagmus had BCVAs of 20/80 or better. In group 1, both preoperative and postoperative BCVAs were found significantly better in eyes without nystagmus (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Delayed keratoplasty seems to offer better graft outcomes and visual prognosis to CHED patients, even in the presence of nystagmus.