The effect of calcium channel blocker (CCB) treatment on retinal and choroidal vessels in a group of hypertensive patients.

PURPOSE: The present study was designed to observe the vasoreactivity in retina and choroid after calcium channel blocker (CCB) treatment in a group of hypertensive patients. METHOD: The study was based on 56 hypertensive patients (56 eyes) and 56 control subjects (56 eyes). Choroidal scans and the measurement of peripapillary retinal vessel diameters was performed at baseline and optical coherence tomography (OCT) scans were also performed at first month . Subfoveal choroidal thickness (SFCT) and the diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV) were compared between the groups. RESULTS: The baseline diameters of the STA, ITA were significantly decreased in the patient group compared with the control group (all p < .05). There was a significant increase at first month after the CCB treatment in comparison to baseline measurements (all p < .05). When compared with the controls, the diameter of venules showed a decrease at baseline but was not significant. After the treatment, the diameters of venules were insignificantly increased compared with baseline measurements (p = .178 and p = .275) and there were also no significant differences between the control group and the patient group in first month (all p > .05). The average choroidal thickness measurements of the hypertensive group was lower than the control group (p = .404) and there was a tendency to increase after the treatment (p = .055). CONCLUSION: This study demonstrates that, treatment with CCB seems to improve retinal arteries and has almost no affect on the choroidal thickness in newly diagnosed hypertensive patients.

Can toric IOL rotation be minimized? Toric IOL-Capsular Tension Ring suturing technique and its clinical outcomes.

PURPOSE: In this study, we aimed to evaluate the outcomes of the toric intraocular lens (IOL) and capsular tension ring (CTR) suturing technique in patients with cataract and astigmatism. METHODS: Group 1 comprised 37 eyes of 36 patients to whom the CTR-toric IOL complex was co-implanted after the CTR was sutured to the toric IOL haptic. Group 2 comprised 35 eyes of 33 patients in whom the toric IOL and CTR were implanted without suturing. Both groups were compared in terms of preoperative and postoperative astigmatism, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and IOL rotation. RESULTS: The mean rotation degree was 0.54° ± 2.29° in group 1 and 4.28° ± 8.84° in group 2 (p = .01). While there was no significant difference between the postoperative residual astigmatism and the estimated residual astigmatism in group 1, the postoperative residual astigmatism was statistically higher than the estimated residual astigmatism in group 2 (p = .47 and 0.000, respectively). The mean postoperative UCVA was 0.02 ± 0.04 (logMAR) in group 1 and 0.08 ± 0.13 (logMAR) in group 2 (p = .01). CONCLUSION: The toric IOL and CTR suturing technique provides excellent rotational stability and astigmatism correction.

Ganglion cell complex thickness changes in patients with different states of bipolar disorder.

OBJECTIVES: Neuroimaging studies in patients with bipolar disorder have suggested that a neuropathological process may be effective in this disease. Neurodegenerative changes in the retina can be followed by optical coherence tomography, a non-invasive imaging method that allows in vivo visualization of the retinal layers. The aim of this study was to investigate the possible differences in optical coherence tomography parameters during euthymic, manic, and depressive episodes in patients diagnosed with bipolar disorder. METHODS: A total of 150 patients with bipolar disorder were included in the study, divided into three groups (50 patients in a euthymic state, 50 patients in a manic state, and 50 patients in a depressive state) and compared with 50 healthy controls. Ganglion cell complex thickness was measured with automated macular segmentation software of spectral-domain optical coherence tomography. RESULTS: Ganglion cell complex thicknesses were thicker in all quadrants in patient groups than the control group but the differences were significant in perifoveal superior and perifoveal inferior quadrants (p < 0.001, p < 0.001). There were no differences in ganglion cell complex thickness among the patient groups (p > 0.05). CONCLUSION: The evaluation of ganglion cell complex thickness by spectral-domain optical coherence tomography may give a clue for monitoring neurodegenerative changes in patients with bipolar disorder.

Long-Term Results in Transcanalicular Laser and External Dacryocystorhinostomy.

OBJECTIVES: This study was an examination of the long-term results of transcanalicular laser (TCL) and external (EX) dacryocystorhinostomy (DCR). METHODS: Patients who had undergone TCL-DCR or EX-DCR between 2009 and 2013 were invited for long-term follow-up in 2019. All of the patients who responded had an ophthalmic examination and were assessed using lacrimal irrigation. An intranasal evaluation was performed when the irrigation test had non-patent results. TCL procedures were performed with a diode laser (980 nm). Ostium cleansing with a suction unit and a nasal endoscope was performed in the first week. In EX-DCR procedures, an anterior flap was created and tented to the orbicularis oculi muscle. A silicon tube was implanted in both methods and removed at 4-6 months. RESULTS: A total of 74 EX-DCR patients were assessed. The lacrimal irrigation test was negative in 5 cases. The functional success rate was 93.2% with a follow-up of 8 years. A total of 63 patients who had undergone TCL-DCR were evaluated and the irrigation test was negative in 9 patients. The functional success rate was 85.7% with a follow-up of 7 years. The difference in the success rate was statistically insignificant with a p value of 0.09. CONCLUSION: The long-term success rates of both EX-DCR and TCL-DCR were high.

Effectiveness of Selective Laser Trabeculoplasty as Initial or Adjunctive Treatment for Primary Open-Angle Glaucoma.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of selective laser trabeculoplasty (SLT) at lowering intraocular pressure (IOP) as initial or adjunctive treatment in patients with primary open-angle glaucoma (POAG). METHODS: This was a prospective, comparative study. A total of 162 eyes of 81 patients with bilateral POAG were evaluated. The patients were categorized into 2 groups. SLT was performed as an adjunctive treatment in 42 POAG patients (Group 1, 84 eyes) and as initial treatment in 39 POAG patients (Group 2, 78 eyes). RESULTS: The mean baseline IOP and post-SLT IOP for the entire study group was 23.3±4.8 mm Hg and 14.6±2.7 mm Hg, respectively. The mean percentage reduction of IOP post-SLT at the final visit was 34.5% in Group 1 and 40.5% in Group 2. The number of medications used in the Group 1 before SLT was 2.11±0.88 (range: 1-4), while after SLT, medication use decreased to 0.9 ±0.15 (range: 0-3). The mean length of follow-up was 49.85±8.2 weeks (range: 24-78 weeks). CONCLUSION: SLT can be used effectively as a primary or an adjunctive therapy for the treatment of POAG. It was also effective at reducing the quantity of medications used. The reduction in IOP was similar in the primary and adjunctive group for up to 1 year of follow-up.

An evaluation of peripapillar choroidal thickness in patients receiving systemic isotretinoin treatment.

PURPOSE: Oral isotretinoin (13-cis retinoic acid, 13-cis RA) was approved for severe acne treatment by the FDA in 1982. The ocular side effects associated with oral isotretinoin use are mostly dose-dependent. Numerous ocular pathologies affect peripapillary choroidal layer primarily or indirectly. OBJECTIVE: Evaluation of the peripapillary choroidal layer in the patients receiving oral isotretinoin therapy may aid in explaining the pathophysiology of ocular side effects. METHODS: In this study, peripapillary choroidal thickness was assessed in the patients receiving oral isotretinoin treatment via optical coherent tomography technique. RESULTS: Significant difference was found in the superotemporal and temporal areas. CONCLUSION: Oral isotretinoin treatment may affect the thickness of the peripapillary choroidal layer.

Ocular penetration of topically applied 1% tigecycline in a rabbit model.

AIM: To evaluate ocular penetration of topically applied 1% tigecycline. METHODS: Forty-two New Zealand White rabbits were divided into 3 groups. A 50 µL drop of 1% tigecycline was administered in group 1. In groups 2 and 3, the drop was administered every 15min for 60min (keratitis protocol). Aqueous humor samples in groups 1 and 2 were collected under general anesthesia at 15, 30, 45, 60, 120, and 180min after the last drop. All animals in group 3 were euthanatized. Cornea, vitreous and blood samples were collected 60 and 120min after the last drop. Tigecycline concentrations were measured using high performance liquid chromatography-mass spectrometry (LC-MS/MS). RESULTS: The peak aqueous humor tigecycline concentration [mean 0.73±0.14 mg/L (SD) and 2.41±0.14 mg/L, respectively] occurred 45min after topical drug application in groups 1 and 2. Group 3 mean values in the cornea, and vitreous, were 3.27±0.50 µg/g, and 0.17±0.10 mg/L at 60min and 3.17±0.77 µg/g and 0.20±0.07 mg/L at 120min, respectively. Tigecycline serum concentrations were negligible. CONCLUSION: Tigecycline levels in the aqueous humor in groups 1 and 2, and in the cornea in group 3 exceeded the minimum inhibitory concentrations of most gram-positive organisms that cause bacterial keratitis and endophthalmitis.

Effect of topical cyclopentolate on post-operative pain after pterygium surgery.

OBJECTIVES: The aim was to evaluate the effectiveness of topical cyclopentolate following pterygium surgery for post-operative ocular pain. METHODS: All participants had nasal pterygium and underwent pterygium excision and conjunctival autografting with fibrin glue. Participants were randomised into two groups. Participants in group 1 received one per cent cyclopentolate eye drops and artificial tears upon completing surgery and were prescribed self-administered drops three times daily for three days, while participants in group 2 received a control (artificial tears) in a manner identical to group 1. Data were gathered regarding post-operative pain intensity experienced during each of the three days. Pain was graded from zero to 10 according to a visual analogue scale, in which zero signified no pain and 10 signified severe, unbearable pain. RESULTS: This study analysed data regarding 38 participants in group 1 and 40 participants in group 2. Results were defined as median with interquartile range (IQR); median of the pain scores at days one, two and three were as follows, respectively: 4 (IQR 2), 2.5 (IQR 1) and 2 (IQR 1.25) for group 1 and 5 (IQR 1), 3 (IQR 1.75) and 3 (IQR 1) for group 2. Pain scores were significantly lower for group 1 compared with group 2 at days one, two and three (p < 0.05). CONCLUSIONS: Topical cyclopentolate seems to be effective and well tolerated following pterygium surgery for post-operative ocular pain.

The Modified Technique of External Dacryocystorhinostomy in the Management of Complicated Nasolacrimal Duct Obstruction.

AIM: To evaluate the outcome of the modified technique of external dacryocystorhinostomy (EDCR) with a "U"-shaped single flap that was fixed on to the orbicularis muscle with combined silicone tube in dacriostenosis. In cases with decreased visibility because of excessive bleeding during surgery, a small sac size, and difficulty of mutual suturing between nasal mucosal and sac flaps related to distance. METHODS: This retrospective study included 118 patients with a nasolacrimal duct obstruction who underwent the modified technique of EDCR. The modified EDCR procedure envisions the creation of anastomosis of the single anterior "U"-shaped flaps suturing anterior flaps of the lacrimal sac and nasal mucosa. The sutured flap was fixed on to the orbicularis muscle. The silicone tube intubation was performed on all patients. RESULTS: The average age of the patients was 39 ±â€Š19.2 (9-70) years, including 94 women and 24 men. The average follow-up time was 18 ±â€Š4.5 (9-36) months. Total 112 eyes (94.9%) showed a patent lacrimal system to irrigation, whereas 6 eyes (5.1%) had recurrence of epiphora and not patent lacrimal system to irrigation by the end of the first surgeries. The same surgery was planned for these patients. The patent lacrimal system was achieved in 3 of these 6 eyes. The overall success rate of the surgical procedure used in this study was 97.4%. CONCLUSIONS: This modified technique of EDCR with a "U"-shaped single anterior flaps that was fixed on to the orbicularis muscle with combined silicone tube simplifies the surgical procedure and is effective in the management of nasolacrimal duct obstruction.

Daptomycin versus Vancomycin in an Enterococcus faecalis Endophthalmitis Rabbit Model.

PURPOSE: To compare bactericidal activities of daptomycin (DAP) and vancomycin (VAN) in an experimental rabbit model of Enterococcus faecalis endophthalmitis. MATERIALS AND METHODS: The right vitreous cavities of 24 New Zealand rabbits were inoculated with 100 colony-forming units of E. faecalis; and after 24 h, rabbits were randomly divided into three groups. DAP group (n = 8, 0.2 mg/0.05 ml intravitreally), VAN group (n = 8, 1 mg/0.05 ml intravitreally) and balanced salt solution group (BSS, n = 8, 0.05 ml intravitreally). Clinical examination scores were recorded, and vitreous aspirates were obtained for microbiological analysis on days 0, 1, 2, 3 and 4. Rabbits were sacrificed, and the eyes were enucleated for histopathological assessment. RESULTS: There was no difference between the DAP, VAN and BSS groups in terms of the clinical grading of endophthalmitis 24 h after the inoculation. The bacterial counts were similar between the VAN and DAP groups except on day 1, where it was significantly lower than those in the VAN group (p = 0.003). On day 4, 62% of the eyes treated with DAP, and 50% of the eyes treated with VAN were sterilized. All of the eyes from the BSS group showed increasing bacterial growth from day 0 to day 4. There was no difference between the DAP and VAN groups in terms of the histopathological and clinical examination scores, while they were significantly lower than those in the BSS group. CONCLUSIONS: This study demonstrates evidence of the effectiveness of DAP for the treatment of experimental E. faecalis endophthalmitis.

Peripapillary choroidal thickness in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the peripapillary choroidal thickness of patients with chronic obstructive pulmonary disease (COPD) via enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIALS AND METHODS: A total of 80 patients with COPD (80 eyes) and 50 control subjects (50 eyes) were enrolled. Choroidal scans and the retinal nerve fiber layer (RNFL) thickness were obtained for all eyes using OCT. RESULTS: The average peripapillary choroidal thickness measurements of the COPD group (147.58 ± 53.53 µm) were lower than the control group (160.84 ± 44.73 µm) (p = 0.068). Inferior segment thicknesses were significantly thinner than the other segments (p < 0.05). Subfoveal choroidal thickness and RNFL thickness measurements of the COPD group were also lower than those of the control group (p = 0.111). CONCLUSION: Hypoxia in COPD seems to affect the choroidal thickness. Thinning of the choroid may be attributed to increased vascular resistance and reduced blood flow in patients with COPD. The possible effects of the disease to the eye may be clarified through the role of the choroidal vasculature in the blood supply of the anterior optic nerve head.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction.

PURPOSE: To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction. METHODS: We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4). RESULTS: The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01). CONCLUSION: Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction / A influência do tamanho e forma da capsulotomia por laser de Nd:YAG sobre a acuidade visual e refração

ABSTRACTPurpose:To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction.Methods:We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4).Results:The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01).Conclusion:Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

RESUMOObjetivo:Avaliar a influência do tamanho e forma da capsulotomia a laser de Neodímio: Ítrio-Alumínio-Granada (Nd:YAG) na acuidade visual e refração.Métodos:Oitenta e cinco olhos de 67 pacientes, com opacificação de cápsula posterior (PCO), que tinham sido submetidos a capsulotomia por laser de Nd:YAG, foram avaliadas retrospectivamente. A idade foi 57,57 ± 9,26 (média ± desvio padrão), variação 38-75 anos. O intervalo médio entre a cirurgia e a capsulotomia a laser de Nd:YAG foi 26,09 ± 7,08 (variação 10-38) meses. Os pacientes foram divididos em 4 grupos de acordo com a forma e o tamanho da capsulotomia. O grupo 1 incluiu pacientes com forma cruzada e tamanho igual ou menor do que 3,5 mm de abertura capsulotomia, Grupo 2, forma cruzada e tamanho maior do que 3,5 mm, Grupo 3, forma circular e tamanho igual ou menor do que 3,5 mm e Grupo 4, forma circular e tamanho superior a 3,5 mm.Resultados:A quantidade média de energia utilizada e tiros aplicadas foram significativamente maiores no Grupo 4 (p=0,00) e significativamente menores no grupo 1 (p=0,00). O equivalente esférico (SE), antes e após o procedimento, foi significativamente mais elevado no Grupo 1 (p=0,026, p=0,011). Não houve diferença estatística entre os grupos em relação à acuidade visual melhor corrigida (BCVA) e pressão intraocular (IOP) antes do procedimento (p=0,44, p=0,452) e após o procedimento (p=0,108, p=0,125). O número de pacientes com sintomas de moscas volantes foi significativamente maior no grupo 4 (P=0,001) e significativamente inferior no grupo 1 (p=0,001). SE e IOP após o procedimento não foram estatisticamente diferentes daqueles antes do procedimento (p=0,074, p=0,856, respectivamente) em todos os grupos. BCVA após o procedimento foi significativamente melhor do que antes do procedimento (p=0,00) em todos os grupos.Conclusões:Em conclusão, para complicações mínimas e máximas funções visuais, o tamanho ótimo capsulotomia deve ser igual a ou menor do que 3,5 mm e deve ser em forma cruzada.

Effect of nepafenac eye drops on pain associated with pterygium surgery.

OBJECTIVE: To assess the effects of nepafenac ophthalmic suspension 0.1% for control of pain in patients undergoing pterygium surgery. METHODS: This randomized, double-masked placebo-controlled study included 62 adults undergoing pterygium surgery. Patients were randomly assigned to receive nepafenac ophthalmic suspension 0.1% or balanced salt solution placebo. They were asked to assess the level of pain using an 11-point numeric rating scale at 6, 12, 24, 48, and 72 hr after surgery. Patients also were evaluated daily for the progression of corneal epithelial healing until complete closure was observed. RESULTS: Except at 72 hr after surgery, the patients reported significantly less pain in eyes receiving nepafenac than in eyes receiving placebo. There was no statistical difference between the two groups in corneal epithelial healing. CONCLUSIONS: Treatment with nepafenac ophthalmic suspension 0.1% significantly reduced postoperative pain compared with placebo after pterygium surgery.

The effect of rebreathing and hyperventilation on retinal and choroidal vessels measured by spectral domain optical coherence tomography.

OBJECTIVE: The purpose of this study was to examine the vasoreactivity in retina and choroid of the healthy eyes in response to experimentally altered partial arterial pressure of carbon dioxide (PaCO(2)) using a non-invasive technique, spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: The study included non-smoking participants between 18 and 35 years of age, having visual acuity of 20/20 and with no systemic and ocular diseases. At baseline, the participants breathed room air (normocapnia). Hypocapnia was created with the help of hyperventilation; for this, the participants were instructed to draw deep and quick breaths, resulting one breathing cycle per 2 s. To create hypercapnia subjects rebreathed from a 5 l bag at least 3 min. Choroidal thickness and retinal artery diameter were measured at baseline, and hyperventilation and rebreathing conditions by SD-OCT. RESULTS: Twenty eyes of 20 healthy subjects were included in this study. Their mean age was 24.90 ± 5.32 years. Hyperventilation caused a significant reduction in choroidal thickness, compared with baseline, at all points; whereas rebreathing caused no significant change at all points. The mean diameters of the arteries were 151.80 ± 7.88 µm, with a significant decline to 148.90 ± 7.25 µm at hyperventilation condition and a significant increase to 153.50 ± 7.88 µm at rebreathing condition (p = 0.018, p = 0.043, respectively). CONCLUSION: This study demonstrated that, SD-OCT was a useful tool in measuring the ocular vascular response under hypercapnia and hypocapnia conditions. These findings may be helpful for further understanding the physiological nature of ocular blood flow and this preliminary study provides a basis for future studies.

Clearance of intravitreal daptomycin in uveitis-induced rabbit model.

PURPOSE: To investigate the elimination rate of daptomycin after intravitreal injection in uveitis-induced rabbits. MATERIALS AND METHODS: Intravitreal injection of the single dose of 200 µg/0.05 mL daptomycin was administered to rabbits starting 24 h after induction of uveitis by an intravitreal endotoxin injection. Aqueous humor and vitreous humor samples of eight eyes per time point were collected at selected time intervals (1, 3, 6, 24, 48, 72 and 96 h), and the in vitreous half-life was calculated. Daptomycin concentrations in vitreous and aqueous humor were assayed with high-performance liquid chromatography. RESULTS: The vitreous concentration was noted to decline slowly with time. The mean vitreous concentration was 23.25 ± 10.99 µg/mL and 11.10 ± 3.33 µg/mL at 96 h in inflamed and normal eyes, respectively. The vitreous daptomycin concentration showed an exponential decay with a half-life of 25.67 h in normal eyes and 34.6 h in inflamed eyes. The aqueous levels of daptomycin in normal eyes were low but remained significantly higher than those of inflamed eyes. CONCLUSIONS: Given that the injected dose corresponds to several times the minimum inhibitory concentrations of organisms most involved in endophthalmitis, and that therapeutic levels are present up to 96 h after injection, intravitreal daptomycin should be considered for the treatment of endophthalmitis caused by Gram-positive bacteria.