Evaluation of Corneal Densitometry and Endothelial Layer in Soft Contact Lens Users.

SIGNIFICANCE: Soft contact lens wear may lead to physiological changes in the cornea. Corneal densitometry is a new software tool that may detect these physiological changes by monitoring their effects on corneal transparency. PURPOSE: This study aimed to assess corneal densitometry values and corneal endothelium in patients using soft contact lenses. METHODS: The study included 36 eyes of 36 subjects with soft contact lens use (group 1) and 36 eyes of 36 healthy control subjects (group 2). Anterior segment parameters and corneal densitometry of all subjects were evaluated using Scheimpflug corneal topography (Pentacam; Oculus Inc., Wetzlar, Germany). A total corneal area of 12 mm was divided into four annular zones (0 to 2, 2 to 6, 6 to 10, and 10 to 12 mm) and into three regions as anterior, central, and posterior for densitometry examination. Cell density, cell distribution, and cell morphology (quadrangular, pentagonal, hexagonal, and other cell percentages) of the endothelial layer were examined in both groups using specular microscopy (Nidek CEM 530; Nidek Co., Gamagori, Aichi, Japan). RESULTS: In group 1, the mean duration of contact lens wear was 4.45 ± 2.15 years. The anterior segment parameters were not significantly different between the two groups (P > .05). The anterior 0- to 2- and 2- to 6-mm corneal densitometry values were significantly higher in group 1 compared with group 2 (23.2 ± 4.7 for group 1 and 17.3 ± 5.6 for group 2 [P = .03]; 22.4 ± 6.4 for group 1 and 17.8 ± 1.4 for group 2 [P = .03], respectively). There were no significant differences between the groups for corneal densitometry values between 6 and 12 mm, or for cell density, cell distribution, and cell morphology (P > .05). CONCLUSIONS: Although the cornea remains transparent in soft contact lens wearers, corneal densitometry may increase in the 0- to 6-mm annular zone of the anterior region.

Evaluation of retinal vessel density and foveal avascular zone measurements in patients with obstructive sleep apnea syndrome.

PURPOSE: To compare retinal capillary plexus vessel densities, choroidal thickness, optic disc vessel densities and foveal avascular zone measurements between normal subjects and subjects with obstructive sleep apnea syndrome (OSAS) using spectral-domain OCT angiography (OCTA). METHODS: Forty eyes of patients with overall OSAS, 20 eyes of patients with mild-moderate OSAS, 20 eyes of patients with severe OSAS on polysomnography and 21 controls were evaluated with the RTVue-XR Avanti OCTA (Optovue, Inc., Fremont, CA). Superficial and deep retinal capillary plexus vessel densities, choroidal thickness and foveal avascular zone (FAZ) parameters (area, diameter, acircularity index of the FAZ, foveal density-300) were measured for all subjects. RESULTS: Superficial capillary plexus vessel densities of the groups were similar. Deep capillary plexus (DCP) vessel densities of all three OSAS groups decreased in the parafoveal region (< 0.001). In the perifoveal region, DCP vessel densities were decreased in the Overall OSAS group (p = 0.023) and in the Severe OSAS group (p = 0.021), whereas it was similar in the Mild-moderate OSAS group. Choroidal thickness decreased in all three OSAS groups (p < 0.001). All FAZ measurements and foveal density-300 measurements were similar compared to the control group. CONCLUSION: Our findings indicate that in severe OSAS patients, deep parafoveal, perifoveal vascular densities decrease and the choroid layer becomes thinner. When evaluating a patient with OSAS, it should be kept in mind that there may be eye involvement due to the disease.

Efficacy of cyclic therapy with terpinen-4-ol in Demodex blepharitis : Is treatment possible by considering Demodex's life cycle?

PURPOSE: To describe the effectiveness of cyclic treatment with terpinen-4-ol, a tea tree oil component, on Demodex blepharitis. METHODS: The presence of Demodex was determined by eyelash rotation as proposed by Mastrota. Schirmer test, tear breakup time, ocular surface disease index, lid margin score, meibomian gland expressibility score, and Oxford grade were performed. Patients were advised to apply heat followed by terpinen-4-ol soaked wipes to eyelids twice a day for 2 weeks. At the end of 2 weeks, treatment was interrupted for 7-10 days. The same treatment was repeated once again. The patients were examined after the first and second cycle of treatment and after 1 year. RESULTS: There was a statistically significant improvement in Schirmer test (10.37 ± 4.73 and 13.13 ± 3.44 mm/5 min), tear breakup time (6.47 ± 3.31 and 7.6 ± 2.89 s), ocular surface disease index (47.94 ± 19.77 and 34.28 ± 13.40), lid margin score (3.2 ± 0.7 and 2.63 ± 0.71), meibomian gland expressibility scores (1.93 ± 0.64 and 1.4 ± 0.67), and Oxford grade (0.9 ± 0.8 and 0.5 ± 0.63) after the first cycle of treatment (p < 0.05). The improvement in symptoms and tear function tests of the patients after the second cycle was significantly better than in pre-treatment levels. At 12-month follow-up, symptoms of two patients (93%) relapsed. CONCLUSION: The administration of terpinen-4-ol to the eyelid margins in a cyclic manner in Demodex blepharitis is effective against adult and hatching Demodex and breaks the vicious cycle.

The effect of conjunctivochalasis detected by anterior segment optical coherence tomography on tear function in an elderly population.

INTRODUCTION: The aim of this study was to evaluate conjunctivochalasis (CCH) and its relationship with tear meniscus and tear function in an elderly population. MATERIALS AND METHODS: This prospective, observational study included 144 eyes of 144 patients aged >65 years who were referred to our clinic for various reasons. The patients were separated into group 1 including 64 eyes of 64 patients with CCH and group 2 including 80 eyes of 80 patients without CCH. All patients in both groups underwent a full ophthalmological examination, and the presence of CCH, fluorescein tear break-up time (FTBUT) test, Schirmer test, ocular surface staining (Oxford grading score) and OSDI (Ocular Surface Disease Index) test results were recorded. Measurements of the conjunctivochalasis area (CCHA), tear meniscus height (TMH) and tear meniscus area (TMA) were taken using anterior segment optic coherence tomography (AS-OCT). RESULTS: Group 1 comprised 34 females and 30 males with a mean age of 71.15 ± 12.34 years. Group 2 comprised 43 females and 37 males with a mean age of 68.16 ± 6.05 years (p = 0.122). The CCH rate was 44.4% in all of the examined patients. The OSDI score and the ocular surface staining test were significantly higher (p < 0.05), and the FTBUT, TMH and TMA were significantly lower (p < 0.05) in group 1 than in group 2. The Schirmer I test results were not significantly different between the two groups. CONCLUSION: The prevalence of CCH is quite high in elderly individuals and may disrupt tear function in these patients.

Comparison of Corneal Densitometry Between Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty in Keratoconus Patients.

OBJECTIVES: Our aim was to compare corneal densitometry values in keratoconic eyes undergoing deep anterior lamellar keratoplasty with the "big bubble" and manual lamellar dissection techniques, as well as penetrating keratoplasty. MATERIALS AND METHODS: This retrospective study evaluated the postoperative outcomes of 31 eyes treated with big bubble-deep anterior lamellar keratoplasty, 23 eyes with manual lamellar dissectiondeep anterior lamellar keratoplasty, and 37 eyes with penetrating keratoplasty. Corneal densitometry, best corrected visual acuity, and other corneal tomographic parameters were recorded at 1, 6, 12, and 24 months postoperatively. The groups were compared with respect to the outcomes. RESULTS: There were no significant differences between the groups with respect to the anterior, central, and total corneal densitometry values at 0 to 2 mm and 2 to 6 mm. At 1 month postoperatively, the densitometric value in the posterior corneal layer of the 0- to 2-mm and 2- and 6-mm corneal zones was higher in the manual lamellar dissection-deep anterior lamellar keratoplasty group than in the big bubble-deep anterior lamellar keratoplasty and penetrating keratoplasty groups (P = .001). At 6, 12, and 24 months, the manual lamellar dissectiondeep anterior lamellar keratoplasty and penetrating keratoplasty groups had similar values in both zones in the posterior layer. The difference between manual lamellar dissection-deep anterior lamellar keratoplasty and big bubble-deep anterior lamellar keratoplasty in both zones in the posterior layer was statistically significant at 6, 12, and 24 months postoperatively (P < .05). The best corrected visual acuity of big bubble-deep anterior lamellar kerat oplasty and penetrating keratoplasty groups was better than that of the manual lamellar dissection-deep anterior lamellar keratoplasty group (P = .047). CONCLUSIONS: Corneal densitometry values may vary depending on the type of keratoplasty used in keratoconus patients. Higher densitometry values may affect visual quality in keratoplasty patients by decreasing or filtering the light that reaches the retina.

Clinical outcomes of ocular surface in patients treated with vitamin D oral replacement.

PURPOSE: To analyze the clinical outcomes of the ocular surface in patients with vitamin D deficiency after oral replacement. METHODS: A total of 40 patients with vitamin D deficiency were enrolled in the study. The patients received 50,000 units of oral vitamin D weekly over a period of 8 weeks. After 8 weeks, 1,500-2,000 units/d were administered for 24 weeks. Eyelid margin score, meibomian gland expressibility score, Oxford grading, Schirmer I test, tear breakup time, tear osmolarity, and the Ocular Surface Disease Index score were evaluated at baseline, and at 8, 12, and 24 weeks. RESULTS: The meibomian gland expressibility score, Schirmer I, tear breakup time, tear osmolarity, and Ocular Surface Disease Index score showed improvement 8 weeks after vitamin D supplementation (p<0.05). Compared with the pretreatment values, the eyelid margin score and Oxford grading were decreased at week 12 (p<0.05). CONCLUSION: Vitamin D replacement appears to improve ocular surface in individuals with vitamin D deficiency.

Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up.

PURPOSE: This study was performed to evaluate the outcomes of accelerated corneal cross-linking in keratoconic corneas with thinnest pachymetry values of <400 µm. METHODS: The study included 28 eyes of 24 patients. The uncorrected and best-corrected visual acuities (logMAR), flattest and steepest keratometric readings, central corneal thickness at the thinnest point, corneal higher-order aberrations, and contrast sensitivity were assessed before and at 1, 3, 6, 12, and 24 months after corneal cross-linking. RESULT: The mean best-corrected visual acuity and contrast sensitivity increased (p=0.02, p=0.03, respectively), whereas the mean uncorrected visual acuity did not significantly differ (p>0.05) at 24 months after corneal cross-linking, compared with measurements before corneal cross-linking. Although the mean flattest keratometric reading showed no significant change (p=0.58), the mean steepest keratometric reading was reduced when compared with its value before corneal cross-linking (p=0.001). No change was observed in the mean central corneal thickness at the thinnest point at 24 months after corneal cross-linking, compared with its value before corneal cross-linking (p=0.12). CONCLUSION: Accelerated corneal cross-linking in keratoconic eyes with thin corneas could halt the progression of keratoconus in corneas thinner than 400 µm at 24 months after treatment.

Clinical outcomes of ocular surface in patients treated with vitamin D oral replacement / Resultados clínicos da superfície ocular em pacientes tratados com reposição oral de vitamina D

ABSTRACT Purpose: To analyze the clinical outcomes of the ocular surface in patients with vitamin D deficiency after oral replacement. Methods: A total of 40 patients with vitamin D deficiency were enrolled in the study. The patients received 50,000 units of oral vitamin D weekly over a period of 8 weeks. After 8 weeks, 1,500-2,000 units/d were administered for 24 weeks. Eyelid margin score, meibomian gland expressibility score, Oxford grading, Schirmer I test, tear breakup time, tear osmolarity, and the Ocular Surface Disease Index score were evaluated at baseline, and at 8, 12, and 24 weeks. Results: The meibomian gland expressibility score, Schirmer I, tear breakup time, tear osmolarity, and Ocular Surface Disease Index score showed improvement 8 weeks after vitamin D supplementation (p<0.05). Compared with the pretreatment values, the eyelid margin score and Oxford grading were decreased at week 12 (p<0.05). Conclusion: Vitamin D replacement appears to improve ocular surface in individuals with vitamin D deficiency.

RESUMO Objetivo: Analisar os resultados clínicos da superfície ocular em pacientes com deficiência de vitamina D após reposição oral. Métodos: Foram incluídos no estudo 40 pacientes com deficiência de vitamina D. Os pacientes receberam 50.000 unidades de vitamina D semanalmente por um período de oito semanas. Após esse período, 1.500-2.000 unidades/dia foram administradas por 24 semanas. Escores da margem palpebral, escores de expressibilidade da glândula meibomiana, classificação de Oxford, teste de Schirmer I, tempo de ruptura lacrimal, osmolaridade da lágrima e escore do Índice de Doenças da Superfície Ocular foram avaliados no início e após 8, 12 e 24 semanas. Resultados: O escore de expressibilidade da glândula meibomiana, Schirmer I, tempo de ruptura lacrimal, osmolaridade da lágrima e o Índice de Doenças da Superfície Ocular apresentaram melhoras após 8 semanas de suplementação de vitamina D (p<0,05). Comparado com os valores do pré-tratamento, o escore da margem palpebral e a classificação de Oxford diminuíram na 12ª semana (p<0,05). Conclusão: A reposição de vitamina D parece melhorar a superfície ocular em indivíduos com deficiência de vitamina D.

Accelerated corneal cross-linking with hypo-osmolar riboflavin in thin keratoconic corneas: 2-year follow-up / Cross-linking corneano acelerado com riboflavina hiposmolar em córneas ceratocônicas finas: 2 anos de acompanhamento

ABSTRACT Purpose: This study was performed to evaluate the outcomes of accelerated corneal cross-linking in keratoconic corneas with thinnest pachymetry values of <400 µm. Methods: The study included 28 eyes of 24 patients. The uncorrected and best-corrected visual acuities (logMAR), flattest and steepest keratometric readings, central corneal thickness at the thinnest point, corneal higher-order aberrations, and contrast sensitivity were assessed before and at 1, 3, 6, 12, and 24 months after corneal cross-linking. Result: The mean best-corrected visual acuity and contrast sensitivity increased (p=0.02, p=0.03, respectively), whereas the mean uncorrected visual acuity did not significantly differ (p>0.05) at 24 months after corneal cross-linking, compared with measurements before corneal cross-linking. Although the mean flattest keratometric reading showed no significant change (p=0.58), the mean steepest keratometric reading was reduced when compared with its value before corneal cross-linking (p=0.001). No change was observed in the mean central corneal thickness at the thinnest point at 24 months after corneal cross-linking, compared with its value before corneal cross-linking (p=0.12). Conclusion: Accelerated corneal cross-linking in keratoconic eyes with thin corneas could halt the progression of keratoconus in corneas thinner than 400 µm at 24 months after treatment.

RESUMO Objetivo: Este estudo foi realizado para avaliar os resultados do cross-linking corneano acelerado em córneas ceratocônicas com os valores mais baixos de paquimetria <400 µm. Métodos: O estudo incluiu 28 olhos de 24 pacientes. As acuidades visuais não corrigidas e melhor corrigidas (logMAR), leituras ceratométricas mais planas e íngremes, espessura corneana central no ponto mais fino, aberrações corneanas de mais alta ordem e a sensibilidade ao contraste foram avaliadas antes e em 1, 3, 6, 12 e 24 meses após a realização do do cross-linking. Resultados: A média da acuidade visual melhor corrigida e a sensibilidade ao contraste aumentaram (p=0,02, p=0,03, respectivamente), enquanto a média da acuidade visual não corrigida não diferiu significativamente (p>0,05) aos 24 meses após o cross-linking, comparada com medidas antes do procedimento. Embora a leitura da média da ceratometria mais plana não tenha apresentado alteração significativa (p=0,58), a leitura ceratométrica mais íngreme diminuiu quando comparada ao seu valor antes do cross-linking (p=0,001). Não foi observada alteração na média da espessura corneana central no ponto mais fino aos 24 meses após o cross-linking em comparação com seu valor antes do procedimento (p=0,12). Conclusão: O cross-linking corneano acelerado nos olhos ceratocônicos com córneas finas pode interromper a progressão do ceratocone nas córneas mais finas que 400 µm 24 meses após o tratamento.

The effect of diabetes on vitreous levels of adiponectin and inflammatory cytokines in experimental rat model.

BACKGROUND: Diabetic retinopathy is one of the most common eye diseases faced by diabetic patients. It is a slow-progressing complication that results from damage to the blood vessels of the retina. OBJECTIVES: To investigate the role of adiponectin and inflammatory cytokines in the vitreous of diabetic rats. MATERIAL AND METHODS: The study was conducted in 3-4-month-old male albino Wistar rats (180-240 g). The animals were divided into 2 groups (n = 40 in each group): the diabetes group and the control group. A single dose of streptozotocin (STZ) (45 mg/kg) in citrate buffer (0.1 M; pH 4.5) was intraperitoneally (ip.) injected into the diabetes group rats. A single dose of citrate buffer was injected ip. into the control group rats. All subjects were sacrificed under intramuscular (im.) Na-thiopental (50 mg/kg) anesthesia. The rats' eyelids were opened with an eye speculum and vitreous samples were collected with 20G needles 4 mm posterior to the limbus. The levels of vitreous adiponectin, tumor necrosis factor α (TNF-α), interferon γ (INF-γ), and matrix metalloproteinase (MMP)-2 and -9 were determined using a solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of adiponectin, TNF-α, INF-γ, MMP-2, and MMP-9 in the rat vitreous were significantly higher in the diabetes group than in the control group (p < 0.05). CONCLUSIONS: Elevated adiponectin, TNF-α, and INF-γ levels in the vitreous may be diagnostically useful in diabetic retinopathy, and inflammatory cytokines in the vitreous may be pathogenically important in this concentration.

Intense regulated pulse light for the meibomian gland dysfunction.

PURPOSE: To assess the effect of intense regulated pulse light (E-Eye; E-Swin, France) on the treatment of meibomian gland dysfunction. SETTING: Health Sciences University, Ankara Numune Training and Research Hospital, Department of Ophthalmology. METHODS: A total of 26 patients underwent intense pulsed light treatment (E-Eye; E-Swin), with homogeneously sequenced five light pulses delivered to one eye at 1, 15, and 45 days following baseline evaluation. At each visit, subjective clinical parameters (ocular surface disease index questionnaire and standard patient evaluation of eye dryness questionnaire) and objective clinical parameters (Schirmer I test scores, tear break-up times, Oxford grading, lid margin abnormality score, secretion quality and expressibility degree) were recorded. The subjective and objective parameters at Days 15 and 45 were compared with baseline values. RESULTS: Patients underwent three sessions of intense pulsed light treatment. Schirmer test and tear break-up time improved significantly from baseline to Day (D) 45 (8.53 ± 4.31 mm vs 12.6 ± 3.14 mm, 4.53 ± 1.33 sn vs 11.07 ± 2.87 sn, p = 0.003 and p < 0.001). Ocular surface disease index and standard patient evaluation of eye dryness scores improved from baseline to D15 and baseline to D45 (all with p < 0.05). All the subjects reported reduced symptoms by D45. There were no cases of adverse ocular effects. There was no significant change in Oxford grading, lid margin abnormality score, secretion quality, and expressibility degree. CONCLUSIONS: Intense regulated pulse light seems a safe treatment procedure for meibomian gland dysfunction, improving tear film quality and reducing symptoms of dry eye.

Comparison study of two different topical lubricants on tear meniscus and tear osmolarity in dry eye.

PURPOSE: To compare the effect of single-drop administration of two different ophthalmic solutions on tear meniscus and tear osmolarity in patients with mild to moderate dry eye disease. METHODS: This prospective study comprised of 122 patients with mild to moderate dry eye disease. These patients received a single dose of either unpreserved trehalose 3%, hyaluronic acid 0.15%, carbomer 0.25% (THHA, Thealoz Duo Gel) (Group 1) or hyaluronic acid 0.3% (HA) (Group 2) gel-based lubricants. Tear meniscus (height and depth) were measured using anterior segment optic coherence tomography (AS-OCT) at baseline and 10, 60, 120, and 240 min. after instillation. Tear osmolarity, Schirmer I test, tear break-up time (TBUT), gel properties, and patient comfort were evaluated 240 min. after instillation. RESULTS: Tear meniscus height (TMH) and tear meniscus depth (TMD) showed a significant increase with both lubricants compared to the baseline (p < 0.001). This effect remained significant for up to 60 min. and 120 min. for the THHA and HA 0.3% solutions, respectively (p < 0.05, for both). Mean comfort duration was 115.1 ±â€¯20.1 min. in Group 1 and 148.3 ±â€¯49.0 min in Group 2 (p < 0.001). Tear osmolarity, Schirmer I test, and TBUT were similar between the baseline and 240 min. for each group. CONCLUSIONS: The results of this study demonstrate that 0.3% HA remains on the ocular surface for longer than TH-HA. The longer ocular residency time also seems to correlate with a longer patient comfort duration.

Comparison of optical coherence tomography angiography results of adult patients with Familial Mediterranean fever and healthy individuals.

PURPOSE: The aim of this study is to assess the macular ultrastructure measuring by optical coherence tomography angiography in adult patients with Familial Mediterranean fever. METHODS: Participants were 62 Familial Mediterranean fever patients and 54 healthy individuals in control group with similar age and sex. The superficial and deep vascular plexus structures covering the central fovea in an area of 6 mm × 6 mm were measured using AngioVue images taken with optical coherence tomography angiography. Vasculature structure, foveal avascular zone, acircularity index of foveal avascular zone (the ratio of the perimeter of foveal avascular zone and the perimeter of a circle with the equal area), and superficial and deep retinal plexus densities were measured. RESULTS: The inferior deep vascular density was measured: 49.17% ± 8.59% in Familial Mediterranean fever patients, 55.56% ± 5.92% in the control group. The deep inferior-hemi vascular density was measured: 48.59% ± 10.34% in Familial Mediterranean fever patients, 56.54% ± 8.05% in the control group. Deep inferior and deep inferior-hemi vascular density was significantly reduced in Familial Mediterranean fever patients compared with healthy controls (p = 0.04 and p = 0.03, respectively). CONCLUSION: The vascular abnormalities in optical coherence tomography angiography show subclinical signs of microangiopathy in Familial Mediterranean fever patients. This observation, which can be obtained only through optical coherence tomography angiography, may be an ocular hallmark for Familial Mediterranean fever disease.

Penetrating keratoplasty in patients with traumatic corneal scarring.

BACKGROUND: To evaluate the results of penetrating keratoplasty (PK) due to trauma-related corneal scarring. METHODS: We evaluated 24 eyes of 24 patients who underwent PK due to trauma-related scarring of the cornea between May 2010 and June 2016. The postoperative visual acuity, graft transparency, and complications were evaluated. RESULTS: The patients were divided into two groups. In group 1, 14 eyes of patients with traumatic corneal scars and retinal detachment underwent PK, pars plana vitrectomy, and intravitreal silicone administration with the help of temporary keratoprosthesis. Group I included five females and nine males with an average age of 39.15+-13.32 (min 8-max 73) years. An intraocular foreign body was removed from five of the eyes. The mean visual acuity was 3.01+-0.013 (3.10-1.00) logMAR after the surgery, 1.36+-0.23 (3.10-0.80) at the postoperative first month, and 1.18+-0.03 (3.10-0.70) at the end of the first year after the removal of keratoplasty sutures. During the follow-up of patients, two eyes (14.2%) lost light sensation, eight eyes (57.1%) developed postoperative glaucoma, nine eyes (64.2%) had graft rejection, and one patient (7.1%) developed keratitis. In one eye (7.1%), the cornea was scraped using ethylenediaminetetraacetic acid due to silicone-related band keratopathy. In group 2, ten eyes with trauma-related corneal scars underwent PK. This group included two females and eight males with an average age of 29.23+-12.03 (11-63) years. The mean visual acuity was 2.98+-0.68 (3.10-1.00) logMAR before the surgery, 0.58+-0.22 (1.80-0.30) at the postoperative first month, and 0.50+-0.17 (1.80-0.10) at the end of the first year. One eye (10%) with iridodialysis developed glaucoma. Rejection was not seen in any of the patients. A statistically significant difference was observed in both groups with regard to visual acuity before operation, at 1 and 12 months after operation, and at 12 months for graft transparency rates (p=0.015, p=0.021, p=0.001, respectively). CONCLUSION: In cases of eye injuries due to trauma, the eyes subjected to combined vitrectomy and PK had poor visual prognosis and high graft rejection rate compared to those subjected to PK as the only treatment.

Association between systemic activity index and dry eye severity in patients with primary Sjögren syndrome / A associação entre o índice de atividade sistêmica e a severidade do olho seco em pacientes com síndrome de Sjögren primária

ABSTRACT Purpose: The aim of the present study was to compare the severity of ocular and systemic findings among patients with primary Sjögren syndrome. Methods: The study followed a prospective controlled design and comprised two groups; the test group included 58 eyes of 58 patients newly diagnosed with primary Sjögren syndrome with poor dry eye test findings and the control group included 45 right eyes of 45 healthy age- and sex-matched individuals. The ocular surface disease index score, tear osmolarity, Schirmer I test without anesthesia, fluorescein tear breakup time, and cornea-conjunctiva staining with lissamine green (van Bijsterveld scoring) were used to examine tear function in the patients via a complete ophthalmological examination. The results were graded and classified on the basis of a Dry Eye WorkShop report and results of the corneal and conjunctival staining test, Schirmer's test, and fluorescein tear breakup time test. Discomfort, severity and frequency of symptoms, visual symptoms, conjunctival injection, eyelid-meibomian gland findings, and corneal-tear signs were interpreted. Disease activity was scored per the EULAR Sjögren's syndrome disease activity index (ESSDAI) via systemic examination and laboratory evaluations, and the EULAR Sjögren's syndrome patient-reported index (ESSPRI) assessed via a survey of patient responses. Results: Mean patient age was 48.15 ± 16.34 years in the primary Sjögren syndrome group and 44.06 ± 9.15 years in the control group. Mean fluorescein tear breakup time was 4.51 ± 2.89s in the primary Sjögren syndrome group and 10.20 ± 2.39 s in the control group. Mean Schirmer I test result was 3.51 ± 3.18 mm/5 min in the primary Sjögren syndrome group and 9.77±2.30 mm/5 min in the control group. Mean ocular surface disease index score was 18.56 ± 16.09 in the primary Sjögren syndrome group, and 19.92 ± 7.16 in the control group. Mean osmolarity was 306.48 ± 19.35 in the primary Sjögren syndrome group, and 292.54 ± 10.67 in the control group. Mean lissamine green staining score was 2.17 ± 2.76 in the primary Sjögren syndrome group, and 0.00 in the control group. Statistically significant differences were found berween the primary Sjögren syndrome group and control group in terms of fluorescein tear breakup time, Schirmer's test, lissamine green staining, and osmolarity tests (p=0.036, p=0.041, p=0.001, and p=0.001 respectively). The Dry Eye WorkShop score was 2.15 ± 0.98, the EULAR Sjögren's syndrome disease activity index score was 11.18 ± 4.05, and the EULAR Sjögren's syndrome patient-reported index score was 5.20±2.63. When potential associations of the Dry Eye Workshop Study scores and osmolarity scores with the Eular Sjögren's syndrome disease activity index scores were evaluated, the results were found to be statistically significant (p=0.001, p=0.001 respectively). Conclusion: The results showed an association between dry eye severity and systemic activity index in primary Sjögren syndrome patients.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a gravidade dos achados oculares e sistêmicos entre pacientes com síndrome de Sjögren primária. Métodos: O estudo seguiu um delineamento prospectivo controlado e compreendeu dois grupos; o grupo de teste incluiu 58 olhos de 58 pacientes recém-diagnosticados com síndrome de Sjögren primária com resultados deficientes no teste de olho seco e o grupo controle incluiu 45 olhos direitos de 45 indivíduos saudáveis pareados idade e sexo. A contagem do índice de doença da superfície ocular, osmolaridade lacrimal, teste de Schirmer I sem anestesia, tempo de ruptura da fluoresceína e coloração córnea-conjuntiva com verde de lissamina (índice de van Bijsterveld) foram utilizados para examinar a função lacrimal dos pacientes através de exame oftalmológico completo. Os resultados foram classificados com base em um relatório da "Dry Eye Workshop" e resultados do teste de coloração da córnea e conjuntiva, teste de Schirmer e teste do tempo de ruptura da fluoresceína. Desconforto, gravidade e frequência dos sintomas, sintomas visuais, injeção conjuntival, achados das glândulas palpebrais e sinais da córnea foram interpretados. A atividade da doença foi avaliada pelo índice de atividade da doença da síndrome de Sjögren EULAR por meio de exame sistêmico e avaliações laboratoriais, e o índice relatado pelo paciente da síndrome de Sjörgen EULAR avaliado através de uma pesquisa das respostas dos pacientes. Resultados: A média de idade dos pacientes foi de 48,15 ± 16,34 anos no grupo da Síndrome de Sjörgen primária e 44,06 ± 9,15 anos no grupo controle. O tempo médio de ruptura da fluoresceína foi de 4,51 ± 2,89 s no grupo síndrome de Sjögren primária e 10,20 ± 2,39 s no grupo controle. O resultado do teste de Schirmer I médio foi de 3,51 ± 3,18 mm/5 min no grupo síndrome de Sjögren primária e de 9,77 ± 2,30 mm/5 min no grupo controle. O índice médio de doença da superfície ocular foi de 18,56 ± 16,09 no grupo síndrome de Sjögren primária e 19,92 ± 7,16 no grupo controle. A osmolaridade média foi 306,48 ± 19,35 no grupo síndrome de Sjögren primária e 292,54 ± 10,67 no grupo controle. O resultado médio de coloração com lissamina verde foi de 2,17 ± 2,76 no grupo síndrome de Sjögren primária e 0,00 no grupo controle. Diferenças es­tatisticamente significativas foram encontradas entre o com sín­­drome de Sjögren primária e o grupo controle em termos de tempo de ruptura da fluoresceína lacrimal, teste de Schirmer I, coloração com lissamina verde e osmolaridade (p=0,036, p=0,041, p=0,001, p=0,001 respectivamente). O índice Estudo do Olho Seco foi de 2,15 ± 0,98, o índice de atividade da doença da síndrome de Sjögren EULAR foi de 11,18 ± 4,05 e a pontuação do índice relatado pelo paciente EULAR Sjögren foi de 5,20 ± 2,63. Quando associações potenciais do Estudo do Olho Seco e o índice da osmolaridade foram comparados a pontuação de índice de atividade da doença da síndrome de Sjögren EULAR, os resultados foram estatisticamente significantes (p=0,001, p=0,001 respectivamente). Conclusão: Os resultados mostraram uma associação entre a gravidade do olho seco e o índice de atividade sistêmica em pacientes com síndrome de Sjögren primária.

The optical coherence tomography angiography findings of rheumatoid arthritis patients taking hydroxychloroquine.

PURPOSE: The aim of this study is to measure retinal vessel density and thickness of the macula by optical coherence tomography angiography in patients with rheumatoid arthritis taking hydroxychloroquine. METHODS: The study included 40 patients with rheumatoid arthritis taking hydroxychloroquine and 20 age-, gender-, and axial length-matched control subjects. Patients were divided into two groups according to the duration of hydroxychloroquine use. Twenty four of the patients were taking hydroxychloroquine for more than 5 years (Group 1), and the rest of 16 were taking hydroxychloroquine for less than 5 years (Group 2). A total of 20 age- and gender-matched volunteers with similar axial length were selected as Group 3. All of the patients underwent optical coherence tomography angiography, and 3 mm × 3 mm scanning mode was chosen for analyzing vascular density and morphological characteristics on the choriocapillaris layer. In addition, Humphrey visual field 10-2 was evaluated in each subject. RESULTS: The temporal deep vascular density was measured as 48.13% ± 8.5% in Group 1, 54.42% ± 10.3% in Group 2, and 60.35% ± 13.1% in Group 3. Deep temporal and deep hemi-inferior vascular density was significantly lower in Group 1 in comparison with Group 3 (p = 0.041 and p = 0.046, respectively). Visual field testing was normal in all patients. CONCLUSION: The optical coherence tomography angiography findings showed that the parafoveal deep temporal and deep hemi-inferior vascular plexus density was reduced in patients taking hydroxychloroquine for more than 5 years despite having normal perimetry. This observation, which can be obtained only through optical coherence tomography angiography, may be relevant to the early findings of hydroxychloroquine toxicity.

Association between systemic activity index and dry eye severity in patients with primary Sjögren syndrome.

PURPOSE: The aim of the present study was to compare the severity of ocular and systemic findings among patients with primary Sjögren syndrome. METHODS: The study followed a prospective controlled design and comprised two groups; the test group included 58 eyes of 58 patients newly diagnosed with primary Sjögren syndrome with poor dry eye test findings and the control group included 45 right eyes of 45 healthy age- and sex-matched individuals. The ocular surface disease index score, tear osmolarity, Schirmer I test without anesthesia, fluorescein tear breakup time, and cornea-conjunctiva staining with lissamine green (van Bijsterveld scoring) were used to examine tear function in the patients via a complete ophthalmological examination. The results were graded and classified on the basis of a Dry Eye WorkShop report and results of the corneal and conjunctival staining test, Schirmer's test, and fluorescein tear breakup time test. Discomfort, severity and frequency of symptoms, visual symptoms, conjunctival injection, eyelid-meibomian gland findings, and corneal-tear signs were interpreted. Disease activity was scored per the EULAR Sjögren's syndrome disease activity index (ESSDAI) via systemic examination and laboratory evaluations, and the EULAR Sjögren's syndrome patient-reported index (ESSPRI) assessed via a survey of patient responses. RESULTS: Mean patient age was 48.15 ± 16.34 years in the primary Sjögren syndrome group and 44.06 ± 9.15 years in the control group. Mean fluorescein tear breakup time was 4.51 ± 2.89s in the primary Sjögren syndrome group and 10.20 ± 2.39 s in the control group. Mean Schirmer I test result was 3.51 ± 3.18 mm/5 min in the primary Sjögren syndrome group and 9.77±2.30 mm/5 min in the control group. Mean ocular surface disease index score was 18.56 ± 16.09 in the primary Sjögren syndrome group, and 19.92 ± 7.16 in the control group. Mean osmolarity was 306.48 ± 19.35 in the primary Sjögren syndrome group, and 292.54 ± 10.67 in the control group. Mean lissamine green staining score was 2.17 ± 2.76 in the primary Sjögren syndrome group, and 0.00 in the control group. Statistically significant differences were found berween the primary Sjögren syndrome group and control group in terms of fluorescein tear breakup time, Schirmer's test, lissamine green staining, and osmolarity tests (p=0.036, p=0.041, p=0.001, and p=0.001 respectively). The Dry Eye WorkShop score was 2.15 ± 0.98, the EULAR Sjögren's syndrome disease activity index score was 11.18 ± 4.05, and the EULAR Sjögren's syndrome patient-reported index score was 5.20±2.63. When potential associations of the Dry Eye Workshop Study scores and osmolarity scores with the Eular Sjögren's syndrome disease activity index scores were evaluated, the results were found to be statistically significant (p=0.001, p=0.001 respectively). CONCLUSION: The results showed an association between dry eye severity and systemic activity index in primary Sjögren syndrome patients.

Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction.

Purpose: To evaluate the results of tear functions in acne rosacea. Methods: This prospective study includes 64 eyes of 32 acne rosacea patients without blepharitis and meibomian gland dysfunction and 90 eyes of 45 patients as control group. Tear functions of all were evaluated with ocular surface disease index (OSDI) questionnaire, and measurements of tear osmolarity were performed by using TearLab, Schirmer I tests without anesthesia and fluorescein tear break-up time (TBUT). Results: The mean Schirmer test result was 12.53 ± 6.54 in study group and 16.21 + 7.52 mm/5 min in control group (p = 0.28). The mean TBUT in study group was 8.21 ± 4.01 and in control group was 18.03 ± 6.45 s (p = 0.02). Mean tear osmolarity in study group was 304.77 ± 15.59and in control group was 275.23 + 28.52 mOsms/L (p = 0.03). Mean OSDI score in study group was 27.51 ± 16.73 and was 18.15 ± 7.05 in control group (p = 0.38). Conclusions: Our study demonstrated lower dry eye tests before the appearance of clinical signs of meibomian gland disease in acne rosacea.

Corneal stromal depth of the demarcation line in 'accelerated corneal cross-linking' with different concentrations of riboflavin solutions.

PURPOSE: The aim of this study is to compare the effect of different riboflavin solutions (hypotonic and isotonic) used during accelerated corneal cross-linking (CXL) on the mean depth of the demarcation line (DDL) formed in corneal stroma. METHODS: This prospective, cross-sectional study included 38 eyes of 26 patients. All patients underwent accelerated CXL due to progressive keratoconus. When the corneal epithelium was removed, 17 eyes of 12 patients with corneal thickness < 400 µm were categorized as Group 1, and 21 eyes of 14 patients with corneal thickness > 400 µm as Group 2. Hypotonic riboflavin was applied to Group 1 patients, and isotonic riboflavin to Group 2 patients. Anterior segment optical coherence tomography was performed on all patients by two independent observers at the end of the first and third months. RESULT: Group 1 included 5 male and 7 female patients with an average age of 25.1 ± 8.0 years, whereas Group 2 included 7 male and 7 female patients with an average age of 31.8 ± 10.12 years. At the end of the first month, the mean DDL in Group 1 and Group 2 was 180.32 ± 10.26 and 287.21 ± 15.01 µm, respectively. This difference was statistically significant (p < 0.05). CONCLUSION: Application of different riboflavin solutions was observed to have an effect on measured corneal thickness after saturation and the depth of the demarcation line. The use of hypotonic riboflavin results in swelling of the cornea and more superficial localization of the stromal demarcation line after CXL.

Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas / Desempenho visual das lentes esclerais e seu impacto na qualidade de vida de pacientes com córneas irregulares

ABSTRACT Purpose: We aimed to evaluate the visual quality performance of scleral contact lenses in patients with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism, and their impact on quality of life. Methods: We included 40 patients (58 eyes) with keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism who were examined between October 2014 and June 2017 and fitted with scleral contact lenses in this study. Before fitting scleral contact lenses, we noted refraction, uncorrected distance visual acuity, spectacle-corrected distance visual acuity, uncorrected contrast sensitivity, and spectacle-corrected contrast sensitivity. We performed corneal topography on and applied a questionnaire that included the National Eye Institute Visual Functioning Questionnaire to all participants. We recorded corrected contrast sensitivity and corrected distance visual acuity on the third month after fitting scleral contact lenses and requested that subjects repeat the National Eye Institute Visual Functioning Questionnaire. Results: The mean age of patients was 28.12 ± 13.19 years. Mean logMAR uncorrected distance visual acuity, spectacle-corrected distance visual acuity, and corrected distance visual acuity with scleral contact lenses were 0.91 ± 0.21 (0.40-1.80), 0.57 ± 0.12 (0.10-1.80), and 0.16 ± 0.02 (0.00-1.30), respectively. We observed significantly higher corrected distance visual acuity with scleral contact lenses compared with uncorrected distance visual acuity and spectacle-corrected distance visual acuity (p<0.05). Mean uncorrected contrast sensitivity, spectacle-corrected contrast sensitivity and CCS with scleral contact lenses were 0.97 ± 0.12 (0.30-1.65), 1.16 ± 0.51 (0.30-1.80), and 1.51 ± 0.25 (0.90-1.80), respectively. Significantly higher contrast sensitivity levels were recorded with scleral contact lenses compared with those recorded with uncorrected contrast sensitivity and spectacle-corrected contrast sensitivity (p<0.05). We found the National Eye Institute Visual Functioning Questionnaire overall score for patients with scleral contact lens treatment to be significantly higher compared with that for patients with uncorrected sight (p<0.05). Conclusion: Scleral contact lenses are an effective alternative visual correction method for keratoconus, pellucid marginal degeneration, and post-keratoplasty astigmatism. A significant increase in visual acuity and contrast sensitivity can be obtained with scleral contact lenses in patients with irregular corneas.

RESUMO Objetivo: Avaliar o desempenho da qualidade visual das lentes de contato esclerais em pacientes com ceratocone, degeneração marginal transparente e astigmatismo pós-ceratoplastia e seu impacto na qualidade de vida. Métodos: Foram incluídos 40 pacientes (58 olhos) com ceratocone, degeneração marginal transparente ou astigmatismo pós-ce­ratoplastia que foram examinados entre outubro de 2014 e junho de 2017 e adaptados com lentes de contato esclerais neste estudo. Antes de ajustar as lentes de contato esclerais, registrou-se refração, acuidade visual à distância não corrigida, acuidade visual à distância corrigida por óculos, sensibilidade ao contraste não corrigida e sensibilidade ao contraste corrigida por óculos. Rea­lizamos topografia da córnea e aplicamos um questionário que incluía o Questionário de Funcionamento Visual do National Eye Institute para todos os participantes. Registramos a sensibilidade ao contraste corrigida e corrigimos a acuidade visual à distância no terceiro mês após a adaptação das lentes de contato esclerais e solicitamos aos participantes que repetissem o Questionário de Funcionamento Visual do National Eye Institute. Resultados: A idade média dos pacientes foi de 28,12 ± 13,19 anos. A acuidade visual à distância não corrigida logMAR média, a acuidade visual à distância corrigida por óculos e a distância visual corrigida com as lentes de contato esclerais foram 0,91 ± 0,21 (0,40-1,80), 0,57 ± 0,12 (0,10-1,80), 0,16 ± 0,02 (0,00-1,30), respectivamente. Observamos uma acuidade visual à distância corrigida significativamente maior com lentes de contato esclerais em comparação à acuidade visual à distância não corrigida e à acuidade visual à distância corrigida por óculos (p<0,05). Sensibilidade ao contraste médio não corrigido, sensibilidade ao contraste corrigida por óculos e CCS com lentes de contato esclerais foram 0,97 ± 0,12 (0,30-1,65), 1,16 ± 0,51 (0,30-1,80), 1,51 ± 0,25 (0,90-1,80), respectivamente. Significativamente maiores níveis de sensibilidade ao contraste foram registrados com lentes de contato esclerais em comparação com aqueles registrados com sensibilidade ao contraste não corrigida e sensibilidade ao contraste corrigida por óculos (p<0,05). Descobrimos que a pontuação geral do Questionário de Funcionamento Visual do National Eye Institute para pacientes em tratamento com lentes de contato esclerais é significativamente maior em comparação com pacientes com visão não corrigia (p<0,05). Conclusão: As lentes de contato esclerais constituem um método alternativo eficaz de correção visual alternativa para o ceratocone, degeneração marginal transparente e o astigmatismo pós-ceratoplastia. Um aumento significativo na acuidade visual e sensibilidade ao contraste pode ser obtido com lentes de contato esclerais em pacientes com córneas irregulares.