The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis.

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population / Associação entre degeneração macular relacionada à idade e níveis de vitamina D 25(OH) na população turca

ABSTRACT Purpose: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. Methods: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. Results: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. Conclusions: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

RESUMO Objetivo: A degeneração macular relacionada à idade é a causa mais comum de cegueira em países desenvolvidos e muitos fatores etiológicos têm-lhe sido atribuídos. O objetivo do presente estudo foi investigar a relação entre os níveis séricos de vitamina D e a degeneração macular relacionada à idade. Métodos: Os dados de 114 pacientes com degeneração macular relacionada à idade foram analisados retrospectivamente. Foram alocados no Grupo Controle 102 pacientes sem registro de outras doenças além do erro refrativo. A acuidade visual melhor corrigida, os achados do exame de fundo de olho e os da tomografia de coerência óptica de domínio espectral foram analisados. Os pacientes foram alocados em grupos de acordo com a classificação do Age-Related Eye Disease Study (Estudo da Doença Ocular Relacionada à Idade). Os níveis séricos de vitamina D 25(OH) foram medidos. A espessura foveal central e a espessura da coroide subfoveal foram medidas com tomografia de coerência óptica. Resultados: Os níveis de vitamina D 25(OH) em pacientes com degeneração macular relacionada à idade e em indivíduos saudáveis pareados por idade e sexo foram 14,6 ± 9,8 ng/mL e 29,14 ± 15,1 ng/mL, respectivamente. Os níveis de vitamina D foram significativamente menores no Grupo da Degeneração Macular relacionada à idade em comparação com o Grupo Controle (p>0,001). O valor da espessura da coroide subfoveal foi menor em pacientes com degeneração macular relacionada à idade (p>0,001). Foi encontrada uma fraca correlação positiva entre o nível de vitamina D 25(OH) e a espessura da coroide (r=0,357, p=0,01). O nível de vitamina D 25(OH), quando avaliado de acordo com os estágios da degeneração macular relacionada à idade, revelou ser menor na doença em estágio avançado (p=0,01). Constatou-se um risco aumentado de desenvolvimento de membrana neovascular da coroide e de fibrose sub-retiniana com a diminuição dos níveis de vitamina D. Conclusões: A diminuição significativa dos níveis de vitamina D 25(OH) na degeneração macular relacionada à idade em estágio avançado sugere a presença de uma correlação significativa entre a deficiência de vitamina D e o desenvolvimento dessa patologia. Mais estudos são necessários para investigar se a suplementação de vitamina D tem ou não influência no desenvolvimento e progressão da degeneração macular relacionada à idade.

Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population.

PURPOSE: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. METHODS: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. RESULTS: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. CONCLUSIONS: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients.

PURPOSE: To use optic coherence tomography (OCT) to evaluate idiopathic intracranial hypertension (IIH) patients with subclinical segmental optic atrophy despite being under apparently effective treatment. METHODS: IIH patients underwent an OCT examination including the peripapillary retina never fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, focal loss volume (FLV) and global loss volume (GLV) of the GCC, and total macular thickness measurements at presentation and at 3, 6, 9, and 12 months after the diagnosis. The obtained data were compared with healthy subjects. Subjects with and without subclinical segmental atrophy at the 12th month were compared according to the demographics, clinical findings, and the OCT parameters recorded at the beginning of the disease. RESULTS: Both eyes of 56 patients with papilledema due to IIH and 50 age- and sex-matched control subjects were included in this prospective case-control study. Regression of papilledema with regional axon loss on the peripapillary RNFL thickness map was found in 37 (33%) eyes in the IIH group. IIH patients with segmental atrophy had the following characteristics when compared to those without segmental atrophy at the beginning of the disease: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, thinner GCC layer, greater FLV and GLV loss, and severe visual field loss. CONCLUSIONS: Axonal loss occurred in the patients despite apparent treatment. It would be appropriate to follow-up with aggressive medical treatment those patients who present with the following characteristics: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, and thinner GCC.

Acute Corneal Hydrops in Keratoconus Patients with Graves' Orbitopathy.

Presented are 2 cases of acute corneal hydrops in keratoconus with Graves' orbitopathy (GO). Two patients (Case 1: female, 54 years old; Case 2: male, 33 years old) with coexisting keratoconus and GO demonstrated typical findings of acute corneal hydrops (ACH) in 1 eye during the active stage of orbitopathy. There was no history of trauma. The ACH healed with scarring after management with a therapeutic contact lens and medical treatment in each patient within 3 months and 5 months, respectively. The development of ACH in keratoconus patients has previously been reported to be associated with male gender, ethnicity, age, eye rubbing, trauma, rapidly progressive disease, atopy, and vernal conjunctivitis. GO involves ocular surface inflammation and fluctuation of intraocular pressure. Active GO can be a risk factor for ACH in keratoconus patients.

The effects of adjuvant hormonotherapy on tear functions in patients with breast cancer.

PURPOSE: Aromatase inhibitors (anastrozole, letrozole) and selective estrogen receptor modulators (tamoxifen) are widely used as adjuvant hormonal therapy in women with hormone receptor-positive breast cancer. We aimed to evaluate the effects of oral adjuvant hormonotherapy on tear functions in patients with breast cancer. METHODS: In this case-control study, we enrolled eligible patients with breast cancer who were receiving regular medical selective estrogen receptor modulator (tamoxifen, n:50), aromatase inhibitors (anastrozole, letrozole, n:50) and gender-matched healthy controls (n:50). Tear functions were measured and compared by the Schirmer test, fluorescein breakup time, corneal staining evaluated by Oxford grading scale and Ocular Surface Disease Index scores. RESULTS: Mean age was 49.95 (± 9.2), 51.52 (± 7.2) and 51.91 (± 10.3) in tamoxifen, aromatase inhibitors groups and controls (p = 0.426). Mean duration of BC diagnosis (p = 0.536) and drug use (p = 0.417) was not significant between two groups. Ocular Surface Disease Index scores were lower (p < 0.001), and fluorescein breakup time measurements were higher (p < 0.001) in controls. Schirmer test scores were higher in controls than aromatase inhibitors group (p < 0.001). According to the scores of all measurements, the differences between aromatase inhibitors and tamoxifen groups were statistically significant (p < 0.001). CONCLUSIONS: Our results demonstrated a high difference in all parameters in patients receiving aromatase inhibitors compared to tamoxifen group and controls. Aromatase inhibitors, which reduce estrogen levels in the blood, might affect the tear functions more than tamoxifen, which affects as antiestrogenic on estrogen receptors.

Validation and reliability of the Turkish version of Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8).

PURPOSE: Contact lens dry eye questionnaire-8 (CLDEQ-8) quantifies the disturbing symptoms with the aim of assessing the satisfaction and overall opinion of contact lens wearers. The aim of this study was to develop Turkish version and to evaluate the validity and reliability of the questionnaire. METHODS: CLDEQ-8 was translated into Turkish language, using the back translation methods. In a sample of 10 individuals, validation of translation was checked as pre-test evaluation. Turkish version of CLDEQ-8 questionnaire was conducted in 100 soft contact lens wearers. Validity was investigated using Rasch analysis and reliability by Cronbach's alpha (α) and person separation index (PSI). RESULTS: The participants were healthy other than refractive errors. Their mean age was 25.19 ± 7.03 years and male to female ratio was 14/86. All of them were silicone-hydrogel soft contact lens wearers. Their contact lens history was 3.13 ± 3.77 years and mean refraction error was -2.69 ± 1.64 diopters. The whole 8 items were consistent with the Rasch model (p > 0.05) and unidimensional (paired t test, p = 0.1). Both Cronbach's alpha and PSI values were higher than 0.7 (α = 0.873, PSI = 0.867). There were not functional differences in questionnaire items regarding overall age groups (Andersen LR test, p = 0.518). CONCLUSION: Turkish version of the CLDEQ-8 conforms to the Rasch model and provides the one dimensional assumption. The questionnaire has internal consistency, is valid and reliable in Turkish contact lens wearers.

Unilateral Painful Red Eye with Corneal Cysts Assessed with Corneal Confocal Microscopy: A Case Mimicking Acanthamoeba Keratitis.

A 28-year-old woman with a history of trauma to her right eye 2 months prior reported experiencing a stinging sensation and tearing in the morning since the injury occurred and the need to occasionally use an eye patch. Three days before presentation she had been prescribed a therapeutic contact lens (CL) with the diagnosis of a corneal epithelial defect. She described significant pain despite the CL. There was a corneal lesion with haze at the base surrounded by corneal edema. Corneal confocal images revealed hyperreflective cystic lesions that suggested Acanthamoeba keratitis (AK). However, the lesion healed within 10 days and the results of cultures taken before the initiation of treatment proved to be negative. The history of trauma and CL wear, the presence of severe pain, corneal findings, and the confocal microscopy detection of cysts led to a suspicion of AK in a differential diagnosis, but the final diagnosis was recurrent epithelial erosion based on the negative culture results, quick response to treatment, and the possibility of similar confocal findings in a healing epithelium. Since AK may cause loss of vision, suspicion should require that samples be obtained for microbiological study and close follow-up of the clinical course until a final diagnosis can be achieved.

The Effects of Adjuvant Tamoxifen Use on Macula Pigment Epithelium Optical Density, Visual Acuity and Retinal Thickness in Patients with Breast Cancer.

Purpose: We aimed to compare best corrected visual acuity, macular pigment optical density and macular thickness in patients with breast cancer, who received oral adjuvant hormone therapy.Materials and Methods: We enrolled consecutive eligible patients with breast cancer who were receiving regular medical tamoxifen treatment. The participants were divided into two groups as cases and controls. Best-corrected visual acuity and retinal thickness were examined. Macular pigment optical density was measured by fundus reflectometry using the one-wavelength reflection method. The output parameters included max optical density, mean optical density, volume and area of the right eye.Results: A total of 104 eyes, cases (n: 50) and controls (n: 54) were included in the study. Mean age in cases was 49.95 ± 9.2 years and 50.21 ± 9.3 years in controls (p = .151). The mean foveal optical density and the maximum optical density differed between cases (0.13 ± 0.03 density units (DU)/0.35 ± 0.07 DU) and controls (0.18 ± 0.04 DU/0.41 ± 0.06 DU) (p = .002/p = .009). Macular pigment optical density volume was 8102.84 ± 2412.67 in cases versus 8280.18 ± 2904.56 in controls (p = .034), and mean MPOD area was 59567.79 ± 11538.06 in cases versus 61748.14 ± 10591.19 in controls (p = .023). The best corrected visual acuity and retinal thickness were similar in both groups (p > .05).Conclusions: Patients in care of oral tamoxifen therapy were found to have significantly reduced macular pigment optical density. In addition, higher drug use duration correlated significantly with reduced macular pigment optical density, suggesting that the poor long-term effects may play a role in macular pigment absorption and incorporation in the retinal tissue.

Effects of chronic smoking on the meibomian glands.

PURPOSE: To evaluate the effects of chronic smoking on tear function tests and meibomian glands. METHODS: This prospective study included 40 volunteers with a long-term (> 5 years) cigarette smoking history (study group) and 43 non-smoking healthy individuals (control group). The symptoms of all the participants were scored using the Ocular Surface Disease Index (OSDI) questionnaire, and a detailed ophthalmological examination was performed including the tear breakup time (TBUT) and Schirmer test (with anaesthesia). The upper and lower lid meibomian glands were evaluated with meibography using the Sirius anterior segment analysis system (Sirius, CSO, Florence, Italy). RESULTS: The groups showed homogenous distribution in respect of age and gender (p > 0.05). The patients in the study group were determined with 22.59 ± 17.25 packet/year cigarette usage. The mean OSDI score was 36.67 ± 21.47 in the study group and 31.65 ± 15.60 in the control group (p = 0.64). The TBUT and Schirmer test values were determined as 9.65 ± 6.14 s and 8.90 ± 4.95 mm, respectively, in the study group and 11.23 ± 5.94 s and 13.08 ± 8.61 mm in the control group (p > 0.05). In the upper lid meibography, loss of 24.68 ± 16.54% was determined in the study group and 17.87 ± 7.06% in the control group (p = 0.01). No statistically significant difference was determined between the groups in respect of the lower lid meibomian gland loss: study group 14.70 ± 8.49% versus control group 12.48 ± 6.44% (p = 0.20). CONCLUSIONS: Smoking results in meibomian gland damage which may be a risk factor for dry eye. In cases of ocular surface disorders related to chronic smoking, meibomian gland damage should be taken into consideration.

Evaluation of the Ocular Surface in Different Contact Lens Replacement Schedules.

PURPOSE: To evaluate the effects of different contact lens (CL) replacement schedules and different CL materials on the ocular surface and tear function. METHODS: Daily disposable hydrogel CLs were given to group 1 (n = 22), daily disposable silicone hydrogel CLs were given to group 2 (n = 25), and reusable silicone hydrogel CLs were given to group 3 (n = 24). Tear function tests and inflammatory cytokine [interleukin (IL)-6, IL-8, IL-17A, and matrix metalloproteinase (MMP)-9] levels were evaluated before and at 1 and 3 months after CL usage. Impression cytology was evaluated before and at 3 months after CL usage. RESULTS: At the first and third months of CL usage, a statistically significant difference was determined between the groups in the levels of IL-6, IL-8, and IL-17A in tears, with the lowest levels in group 1 and the highest levels in group 3 (all P < 0.05). At the third month of CL usage, the levels of these cytokines (in picograms/milliliter) were 6.06 ± 0.83, 78.18 ± 12.42, 61.69 ± 13.95, and 37.71 ± 5.95 in group 1 and 8.04 ± 0.89, 107.34 ± 14.40, 68.63 ± 13.72, and 46.26 ± 6.50 in group 3, respectively. A statistically significant decrease was determined over time in the Schirmer test in group 1, in only the tear breakup time in group 2, and in the tear breakup time and Schirmer test in group 3 (all P < 0.05). A statistically significant increase was determined over time in the levels of IL-6, IL-8, IL-17A, and MMP-9 in all groups. In the third month, a significant progression was observed in the Nelson grade (P < 0.05) in all groups. CONCLUSIONS: The wear of daily disposable CLs can be considered to cause less damage to the ocular surface and less increase in proinflammatory cytokine levels.

Evaluation of optic nerve head changes with optic coherence tomography in patients with idiopathic intracranial hypertension.

In the case of mild papilledema, fundoscopy findings may sometimes be insufficient, leading to false and misleading indices in the diagnosis of early-stage idiopathic intracranial hypertension (IIH). This study aims to evaluate these patients through optic coherence tomography (OCT). The study included 54 individuals diagnosed with IIH and 48 healthy individuals in the control group. All patients underwent neurological and ophthalmologic examinations. Opening pressure values of patients' cerebrospinal fluid (CSF) were recorded. We measured the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell complex, cup volume, and the optical disc area, as well as the neuroretinal rim in both groups. A total of 108 eyes from the patient group and 96 eyes from the control group were evaluated. It was found that the mean value of the RNFL thickness of the IIH patients was greater than the control group in the following eight segments: superior nasal, superior temporal, inferior nasal, inferior temporal, nasal superior, nasal inferior, temporal superior, and temporal inferior (p < 0.01 for all). In contrast to the control group, the disc and rim area values of the patient group were higher (p < 0.01), while the cup volume was smaller (p < 0.01) than in the control group. In the patient group, a positive correlation was observed between the papilledema grade and the RNFL thickness (r = 0.64, p < 0.01), CSF opening pressure (r = 0.59, p < 0.01), disc area (r = 0.68, p < 0.01), and rim area (r = 0.70, p < 0.01). Furthermore, RNFL thickness, CSF opening pressure (r = 0.61, p < 0.01), disc area (r = 0.71, p < 0.01), and rim area (r = 0.71, p < 0.01) values were determined to be positively correlated to each other. OCT is believed to contribute to the diagnosis of IIH, by providing reliable data on optical cup volume, optical disc and rim area, and a greater RNFL thickness.

Office-Based Diagnosis of Demodex Using Smartphone.

Demodex is an important pathogen in ophthalmology. It is believed to cause a variety of eyelid and eyelash diseases. Currently, light microscopes are being used for imaging demodex. However, microscopes are not available everywhere. Also, it is not cost-effective to perform light microscopy in every case. In this case, we demonstrate a new method: imaging demodex using cell phone. A 90-diopter noncontact double aspheric lens was attached to the posterior camera of the smartphone with clear tape. An eyelash of a patient with blepharitis was removed. A video was taken using smartphone. There was a moving demodex parasite in the root of the eyelash. A clear video image could be taken using the smartphone. A smartphone and a 90-diopter lens are adequate for the imaging and diagnosis of demodex.

Does Dry Eye Affect Repeatability of Corneal Topography Measurements?

Objectives: The purpose of this study was to assess the repeatability of corneal topography measurements in dry eye patients and healthy controls. Materials and Methods: Participants underwent consecutive corneal topography measurements (Sirius; Costruzione Strumenti Oftalmici, Florence, Italy). Two images with acquisition quality higher than 90% were accepted. The following parameters were evaluated: minimum and central corneal thickness, aqueous depth, apex curvature, anterior chamber volume, horizontal anterior chamber diameter, iridocorneal angle, cornea volume, and average simulated keratometry. Repeatability was assessed by calculating intra-class correlation coefficient. Results: Thirty-three patients with dry eye syndrome and 40 healthy controls were enrolled to the study. The groups were similar in terms of age (39 [18-65] vs. 30.5 [18-65] years, p=0.198) and gender (M/F: 4/29 vs. 8/32, p=0.366). Intra-class correlation coefficients among all topography parameters within both groups showed excellent repeatability (>0.90). Conclusion: The anterior segment measurements provided by the Sirius corneal topography system were highly repeatable for dry eye patients and are sufficiently reliable for clinical practice and research.

Comparison of Electrocoagulation and Conventional Medical Drops for Treatment of Conjunctivochalasis: Short-Term Results.

OBJECTIVES: To compare the effectiveness of electrocoagulation and conventional medical drops for treatment of conjunctivochalasis using anterior segment-optical coherence tomography (AS-OCT). MATERIALS AND METHODS: Forty eyes of 20 patients with bilateral conjunctivochalasis were included in this prospective study. Twenty eyes of 10 patients were assigned to Group 1 and underwent electrocoagulation. The other 20 eyes of 10 patients were assigned to Group 2 and received conventional medical treatment consisting of non-steroidal antiinflammatory drop (topical 0.5% ketorolac tromethamine) 4 times a day and artificial tears (0.15% sodium hyaluronate) 6 times a day for 4 weeks. Before and 4 weeks after treatment, all patients were evaluated by slit-lamp biomicroscopy, tear film break-up time (TBUT) test, and ocular surface disease index (OSDI) questionnaire. Tear meniscus height (TMH), tear meniscus area (TMA), and conjunctivochalasis area (CCA) were measured with AS-OCT. RESULTS: In Group 1, posttreatment values of TMH, TMA, and TBUT were significantly higher (p<0.001, p=0.006, and p<0.001, respectively), while CCA and OSDI scores were significantly lower than pretreatment values (p<0.001 for both values). In Group 2, only OSDI decreased significantly between pretreatment and posttreatment values (p<0.001). The other parameters did not change significantly after treatment (p>0.05 for all values). CONCLUSION: Electrocoagulation is an effective modality for treatment of conjunctivochalasis.

An overlap case of Parry-Romberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity.

Parry-Romberg syndrome (PRS) may overlap localized scleroderma (morphea) lesions with linear depression (en coup de sabre [ECDS]). Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

Interexaminer Reliability of Meibography: Upper or Lower Eyelid?

OBJECTIVES: To investigate the interexaminer reliability of meibography evaluation and the impact of eyelid selection for the procedure. METHODS: Meibography images of 30 subjects' right eye, including both lids, were evaluated by three clinicians. Meibomian gland (MG) dropout was noted with respect to both percentage and grading (0-4). The examiners' (E1, E2, and E3) consistency was assessed by the intraclass correlation coefficient for MG loss percent and weighted kappa for grading. Correlations between the meibography findings and the fluorescein tear break-up time (FBUT), ocular surface disease index (OSDI) questionnaire, and noninvasive tear break-up time (NIBUT) data were also analyzed. RESULTS: The patients' mean age was 49.2±13.4 years, and the male/female ratio distribution was 15/15. Mean FBUT was 9.6±3.1 sec. OSDI and NIBUT were not correlated with meibography findings. FBUT measurements were correlated with the MG loss assessments of all examiners for the upper lid (Spearman correlation test, E1: r=-0.617, P<0.001; E2: r=-0.428, P<0.018; E3: r=-0.429, P=0.018) but not for the lower lid. Weighted kappa statistics based on MG dropout grading revealed moderate-to-good agreement for the upper lid (E1-E2: κ=0.516, P<0.001; E1-E3: κ=0.621, P<0.001; E2-E3: κ=0.650, P<0.001) and fair-to-moderate agreement for the lower lid (E1-E2: κ=0.212; E1-E3: κ=0.272; E2-E3: κ=0.530). CONCLUSIONS: Meibography is an objective tool for the detection of MG loss. Because of the correlation with FBUT and better interexaminer agreement on dropout by grading, the upper lid might be the preferred lid to make an evaluation.

Corneal confocal microscopy and dry eye findings in contact lens discomfort patients.

OBJECTIVES: To evaluate the corneal confocal microscopy and dry eye findings in patients with contact lens discomfort. METHODS: The study included 3 groups of participants: Contact lens wearers using silicone hydrogel soft contact lenses who are symptomatic (CLD, n=15) or asymptomatic (ACL, n=11) and non-wearers as controls (n=14). Duration of contact lens wear, Ocular Surface Disease Index (OSDI) questionnaire responses, fluorescein tear break-uptime (FBUT), and corneal confocal microscopy findings were recorded. RESULTS: Mean age was 25.7±8.2 years and male/female ratio was 7/33. Demographic findings were similar regarding the groups. CLD patients had a longer lens use history than ACL (median 5 vs 2 years, p<0.001). OSDI scores were higher in CLD group than ACL or controls (p<0.001, p=0.002). FBUT was significantly lowest in CLD group, compared to controls and ACL (p<0.001, p=0.039). FBUT was also lower in ACL patients compared to controls (p=0.036). There was no difference between basal epithelium cell counts between all 3 groups. Anterior stromal activated keratocyte numbers were similar between contact lens using groups but was lower in controls (p=0.005). However, dendritiform cells in the sub-basal nerve layer were higher in CLD group compared to controls but similar to ACL (p<0.001, p=0.058). Graded sub-basal nerve tortuosity was more prominent in CLD group than the ACL (p=0.014). CONCLUSION: Patients with CLD had been wearing contact lenses for longer than those without symptoms. OSDI and FBUT scores were worse in CLD patients. In contact lens discomfort patients, there were increased dendritiform cells, indicating intensified inflammatory status of the cornea.

The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients.

OBJECTIVES: The aim of our study was to detect the presence of conjunctivochalasis (CCh) in obstructive sleep apnea (OSA) patients. METHODS: We included 54 subjects (41 OSA patients and 14 control subjects) in the study. All the patients were assessed regarding the presence and stage of CCh. RESULTS: The patients were grouped according to their apnea-hypopnea index as determined during nocturnal polysomnography in our laboratory as mild (12 patients), moderate (16 patients), and severe (13 patients) OSA. The CCh rate was 87.8% in the OSA group and 57.1% in the control group (P=0.022). Mean CCh stage was 1.58±1.24, 2.38±0.88, and 2.15±0.98 in the mild, moderate, and severe OSA groups, respectively, and 0.71±0.72 in the control group (P=0.0001). CONCLUSIONS: The moderate and severe OSA groups were associated with higher rates and more advanced stages of CCh. We believe that detailed conjunctival assessment is necessary for patients with complaints such as burning, stinging, and foreign body sensation, which we frequently confront in daily practice. In particular, young patients diagnosed with CCh must be carefully assessed regarding sleep apnea. In light of the above findings, we suggest that patients with ocular surface symptoms that are not relieved by topical medical treatment should be assessed for CCh and OSA. Longitudinal studies monitoring the response of CCh to OSA treatment are needed to clarify the relationship between CCh and OSA.

OCULAR FINDINGS IN A PATIENT WITH ECTODERMAL DYSPLASIA.

PURPOSE: Ectodermal dysplasia (ED) results from abnormal development of the ectodermal layer. Although coexistence of ED and retinal pathology has been described, concomitance with retinal venous tortuosity has not been reported in the literature. METHODS: Case report. RESULTS: We report the case of a 23-year-old man with ED with bilateral retinal venous tortuosity, trichomegaly, meibomian gland dysfunction, and dry eye. Although the coexistence of ED with trichomegaly and meibomian gland dysfunction has been previously reported, to the best of our knowledge, this is the first reported case of retinal venous tortuosity associated with ED. CONCLUSION: Coexistence of retinal venous tortuosity and ED may be the consequence of a genetic mutation affecting cellular signaling pathways during retinal angiogenesis.