Efficacy of the Müller Muscle-Conjunctival Resection for the Correction of Unilateral Ptosis following External Levator Operations in Patients with Bilateral Involutional Ptosis.

SUMMARY: Patients with aponeurotic blepharoptosis who are treated with external levator advancement may experience complications such as upper eyelid height asymmetry and often require revision surgery. The authors assessed the efficacy of Müller muscle-conjunctival resection in cases with upper eyelid height asymmetry following bilateral external levator advancement. The authors used retrospective analysis of 11 cases between September of 2016 and October of 2018 with eyelid asymmetry following bilateral external levator advancement. Following a positive phenylephrine test, these patients underwent unilateral Müller muscle-conjunctival resection revision surgery to treat the undercorrected eyelid. Preoperative and postoperative marginal reflex distance 1, symmetry outcomes, and clinical outcomes of patients were evaluated after the Müller muscle-conjunctival resection. The average patient age was 54.81 ± 3.95 years (range, 37 to 69 years; median, 56 years); seven patients (63.6 percent) were women. Hering dependency was seen in all patients before the external levator advancement. A total of three patients underwent bilateral external levator advancement simultaneously, and eight patients underwent bilateral external levator advancement sequentially. The phenylephrine test was positive in all patients before the Müller muscle-conjunctival resection. Symmetry outcomes were assessed after the revision surgery as perfect (<0.5 mm), good (≥0.5 to <1 mm), or fair (≥1 mm) in four patients, six patients, and one patient, respectively. An optimal correction was noted in 13 of the 22 eyelids after the revision surgery, whereas eight of the 22 eyelids had minimal undercorrection, and one eyelid had minimal overcorrection. Müller muscle-conjunctival resection revision surgery for treatment of the ptotic eyelid following bilateral external levator advancement is viable and may represent a new alternative among the limited revision techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

In vivo analysis of choroidal vascularity index changes in eyes with Fuchs uveitis syndrome.

BACKGROUND: This study aimed to investigate changes in the choroidal vascularity index (CVI) in eyes with Fuchs uveitis syndrome (FUS) and determine the effect of heterochromia on choroidal vascularity using binarisation of enhanced-depth imaging (EDI)-optical coherence tomography (OCT) images. METHODS: The study included the affected eyes (FEs) and unaffected fellow eyes (NFEs) of 24 patients with unilateral FUS and the eyes of 30 healthy controls (HCs). The subfoveal total choroidal area (TCA) and the luminal area (LA) were determined by binarised EDI-OCT images using Image J software (National Institutes of Health, Bethesda, MD). The CVI value was calculated by dividing the LA value by the TCA value. RESULTS: The CVI values were significantly lower in FEs (58.8 ± 3.7 %) compared to NFEs (62.3 ± 3.9 %, p = 0.002) and HCs (61.1 ± 3.7 %, p = 0.008). The mean LA was significantly narrower in FEs than in NFEs (p = 0.047) and HCs (p = 0.001). Additionally, the mean CVI values were significantly lower in eyes with heterochromia compared to those without heterochromia (p = 0.024) in the affected eyes of patients with FUS. CONCLUSION: This study shows that there are significant quantitative structural changes, especially in the luminal part of the subfoveal choroid, in eyes with FUS. The choroid seems to be more affected in the presence of heterochromia. These findings might support posterior involvement and the chronicity of the disease.

Evaluation of Lamina Cribrosa by Using Enhanced Depth Imaging Optical Coherence Tomography in Ocular Sarcoidosis during Quiescent Phase.

SIGNIFICANCE: Enhanced depth imaging optical coherence tomography is a useful method to allow for the evaluation of deep ocular structures, such as choroid and lamina cribrosa (LC), which are affected by ocular diseases. We hypothesized that choroidal and optic nerve inflammation in patients with ocular sarcoidosis (OS) might affect the LC structure. PURPOSE: This study aimed to evaluate changes in the LC and anterior LC depth (ALCD) in patients with OS. METHODS: Forty-eight eyes of 26 patients with OS who received the treatment of panuveitis and were in the quiescent phase for at least 6 months were included in the study. Thirty healthy subjects' randomly selected eyes were selected as a control group. Eyes with OS were divided into two subgroups according to the presence (OS eyes with glaucoma [OSWG], n = 23) or absence of glaucoma (OS eyes without glaucoma [OSWOG], n = 25). The LC thickness, ALCD, and peripapillary choroidal thickness were measured using enhanced depth imaging optical coherence tomography in eyes with OS and in controls. RESULTS: The mean LC thickness was found significantly thinner in both OSWG and OSWOG eyes compared with the healthy controls (P < .001 and P = .001, respectively). The mean ALCD was found significantly higher in OSWG eyes (462 ± 65 µm) compared with OSWOG eyes (417 ± 58 µm) and the healthy control eyes (397 ± 59 µm; P = .03 and P = .001, respectively). The average peripapillary choroidal thickness was found to be significantly thinner in OSWG eyes compared with the control eyes (P = .05). CONCLUSIONS: The present study revealed that OS is associated with a thinned LC independent of the presence of glaucoma. The degenerative changes in the LC, which is the transition point of the retinal nerve fibers, may cause long-term visual dysfunction in OS. These degenerative changes should be prevented by controlling inflammation with early diagnosis and treatment in patients with OS.

Prognostic factors of visual quality after transepithelial photorefractive keratectomy in patients with low-to-moderate myopia.

PURPOSE: The aim of this study was to evaluate visual quality after high-frequency transepithelial photorefractive keratectomy (t-PRK) by assessing the relationship between the operational parameters and the first-year postoperative corneal higher-order aberrations (HOAs). METHODS: This was a retrospective study of low-to-moderate myopic eyes treated with t-PRK. The files of 46 low-to-moderate myopic patients (90 eyes; myopia up to -5D) were included in the study. Eyes having a cylindrical refractive error more than 2D and the patients not having completed a 1-year follow-up were excluded from the study. Factors including age, preoperative mean spherical equivalent (MSE), mean keratometry (Km), central corneal thickness (CCT), scotopic pupil, optical zone (OZ), transition zone (TZ), ablation zone (AZ), central ablation depth (CAD), and static cyclotorsion correction (SCC) were analyzed for association with the first-year postoperative corneal HOAs. RESULTS: Corneal HOAs were found to be increased postoperatively with a 6-mm pupil (P < 0.05). The increased spherical aberration had a positive correlation with patient age, preoperative MSE, Km, TZ, and CAD, whereas it had a negative relationship with OZ and AZ (P < 0.05). The corneal coma had a significantly positive correlation with preoperative MSE and a significantly negative relationship with OZ (P < .05). CONCLUSION: Postoperatively induced corneal HOAs may affect patients' scotopic vision (night time driving, cinema) when the pupils get larger. The relationship between patient age, preoperative MSE, Km, CAD, TZ, OZ, AZ, and postoperative corneal HOAs underlines the need to consider the effects of these parameters on the final vision quality.

Complete blood count parameters and neutrophil-to-lymphocyte ratio values as markers for differentiation between systemic infectious and non-infectious uveitis.

PURPOSE: To compare complete blood count (CBC) parameters and neutrophil/lymphocyte ratio (NLR) between patients with infectious uveitis (IU) and those with non-infectious uveitis (NIU) during the first acute uveitis attack (AUA). METHODS: The records of 119 patients admitted with the first AUA between 2016 and 2019 and whose diagnosis was unknown at the time of admission were retrospectively reviewed. The patients were divided into two groups, IU and NIU according to diagnoses after ocular and systemic workup. The IU group was also divided into subgroups as uveitis associated with local ocular infections and systemic infections. The complete blood count and associated indices of patients calculated from samples taken during the attack were compared between the groups. RESULTS: A total of 60 NIU cases (mean age: 43.5 ± 11.6 years) and 59 IU cases (43.3 ± 14.7 years) were examined. Twenty-six of the NIU cases were female and 34 were male, while 32 of the IU cases were female and 27 were male. The localization of uveitis was similar in the IU and NIU groups (anterior: 11 vs. 18, intermediate: 3 vs. 6, posterior: 28 vs. 14, panuveitis: 17 vs. 22). The NLR values were significantly increased in patients with IU compared to those with NIU (p = 0.047). When the NLR is compared between NIU and subgroups of IU, this value was only found significantly increased in uveitis due to a systemic infection (n = 12) (p < 0.001). The mean white blood cell (WBC) count (p < 0.001) and neutrophil values (p < 0.001) were also observed significantly higher in the uveitis associated with systemic infectious diseases when compared with uveitis associated with local ocular infections and NIU group. CONCLUSION: In the current study, NLR values are compared with autoimmune uveitis and systemic infectious uveitis for the first time in patients with AUA. This ratio has been found significantly higher in uveitis associated with systemic infections. The use of CBC parameters and indices, especially the NLR, may be instrumental in assessing patients presenting with first AUA, particularly when there is no clear explanation or underlying cause.

Evaluation of Peripapillary and Subfoveal Choroid Thickness in Asymptomatic Carotid Artery Stenosis.

OBJECTIVE: In this study, it aims to investigate the effect of asymptomatic carotid artery stenosis on peripapillary and subfoveal choroid thickness using enhanced depth imaging optical coherence tomography. PATIENTS AND METHODS: While investigating for coronary artery disease, 76 patients with asymptomatic carotid artery stenosis and 35 patients with normal carotid artery (total = 111) were evaluated. Patients according to the degree of stenosis were divided into four categories as non-stenosis (n = 35), mild (n = 26), moderate (n = 27) and severe stenosis (n = 23). Subfoveal and peripapillary choroid thickness, ocular perfusion and intraocular pressures of all patients were measured using a Fourier-domain optical coherence tomography after general ophthalmological examination. In addition, hypertension, hyperlipidemia, and whether there is a relationship between smoking status and choroid thickness was compared. RESULTS: As the degree of carotid artery stenosis increased, subfoveal and peripapillary choroidal thickness decreased significantly. However, no changes were detected in ocular perfusion and intraocular pressure values (p=0.935, p=0.519). Decrease in peripapillary and subfoveal choroid thickness values was found to be particularly between the group with severe stenosis and the group with control and mild stenosis (p = 0.003, p = 0.001). In addition, as the degree of carotid stenosis increased in patients with hypertension and smoking, peripapillary choroid thickness was found to be thinner (p=0.003). CONCLUSION: We believe that the possibility of carotid artery stenosis should be considered in cases with decreased choroid thickness. In addition, we think that even if it is asymptomatic, in cases with severe carotid stenosis, in the presence of choroidal thinning, a chance of surgical intervention should be given to the stenosis.

Evaluation of changes in choroidal vascularity during acute anterior uveitis attack in patients with ankylosing spondylitis by using binarization of EDI-optical coherence tomography images.

BACKGROUND: To evaluate the effect of the first acute anterior uveitis (AAU) attack on the choroid by using an image binarization tool on images from enhanced depth imaging (EDI)-optical coherence tomography (OCT) scans in patients with ankylosing spondylitis (AS). METHODS: In this study, three groups were formed: uveitic eyes (UE; n = 20) of patients with AS, the non-uveitic eyes (NUE; n = 20) of these patients, and the eyes of healthy controls (n = 20). EDI-OCT images were obtained during the first AAU attack and at three months after treatment in patients with AS. An image binarization tool (ImageJ software; Bethesda, MD USA) was used on EDI-OCT images to determine choroidal structures. Choroidal vascularity index (CVI) was defined as the ratio of luminal area to total subfoveal choroidal area. RESULTS: Compared to the convalescent period, CVI was found to be significantly increased in UE (63.2 ± 2.87 vs. 60.9 ± 5.2 %, p = 0.045) and NUE (63.8 ± 5.67 vs. 61.5 ± 4.3 %, p = 0.039), while stromal area (SA) was found to be significantly reduced only in UE (0.487 ± 0.19 vs. 0.569 ± 0.18, p = 0.012) in the attack period. CONCLUSIONS: Changes in the CVI values of UE and NUE groups in the first AAU attack shows that there is underlying choroidal inflammation in patients with AS. It also seems that SA is the most affected choroidal structure in eyes suffering from an attack. The present study revealed that CVI measurements can be used for follow-up and the determination of treatment response in AS patients with AAU attack.

Optic Nerve Head Changes in Patients with Optic Neuritis Secondary to Multiple Sclerosis: A Comparison of the Affected and Fellow Healthy Eyes.

OBJECTIVE: To evaluate the thickness of lamina cribrosa (LC) in patients with multiple sclerosis (MS) using optical coherence tomography (OCT) and the effect of optic neuritis (ON) attack on these measurements during the remission period. METHODS: The study included 20 cases diagnosed with relapsing-remitting MS with a history of ON attacks affecting one eye and in remission of MS and ON attacks for at least three months, and 28 randomly selected eyes of age- and sex-matched healthy controls. In the MS group, the eyes affected by ON attack were assigned as Group 1 (MS+ON), their fellow unaffected eyes as Group 2 (MS-ON), and healthy control eyes as Group 3. The LC, peripapillary retinal nerve fiber layer (ppRNFL), and subfoveal choroidal thickness measurements were made by using OCT in all cases, and results were compared between the groups. RESULTS: The mean LC thickness in MS+ON and MS-ON groups was significantly lower than the control group (p<0.001). There was no significant difference between MS+ON and MS-ON groups in terms of mean LC thickness (p=0.073). The mean ppRNFL in the MS+ON and MS-ON groups was statistically significantly lower than the control group (p=0.003, p=0.035, respectively). CONCLUSIONS: It is noteworthy that LC is significantly affected in eyes with MS who have not had a history of ON attack. Evaluation of the LC measurements can be important for early detection of optic nerve damage in patients with MS.

Intermediate Uveitis as the Initial and Only Presentation of Syphilis

We report a patient with unilateral syphilitic intermediate uveitis without dermatological, neurological, or any systemic involvement. He presented to our clinic with complaints of eye floaters and worsening visual acuity in the left eye. He had intermediate uveitis and cystoid macular edema in that eye and both venereal disease research laboratory and microhemagglutination assay for Treponema pallidum serological tests were confirmatory for syphilis. Ocular manifestations of syphilis have variable presentations, and it should be considered when diagnosing unexplained ocular inflammatory diseases, even if the patient's recent history and systemic evaluation are not compatible.

Vision-Related Quality of Life Before and After Deep Anterior Lamellar Keratoplasty.

OBJECTIVES: To determine changes in the vision-related quality of life in patients undergoing deep anterior lamellar keratoplasty (DALK) by using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: Thirty-five patients who were scheduled for DALK between March 1, 2013, and March 1, 2014 were asked to complete the NEI VFQ-25. NEI VFQ-25 was administered again at 6 months and at 1 year postoperatively. Data on patients' age, sex, preoperative diagnosis, preoperative and postoperative best-corrected visual acuity, and postoperative astigmatism were recorded. RESULTS: Successful DALK with the Anwar big bubble technique was achieved in 23 of 35 (65.7%) patients. The indications for surgery were keratoconus in 15 patients (62.2%), stromal corneal dystrophies in 4 (17%), and corneal scar in 4 (17%). The mean preoperative NEI VFQ-25 composite score (55.2±19.7) improved significantly (76.9±11.6) at 6 months after DALK and continued to improve (84.3±6.6) at 1 year postoperatively (Friedman test, P=0.001). All NEI VFQ-25 subscale item scores increased significantly after surgery. The patients' age was significantly correlated with the NEI VFQ-25 subscale score of mental health at 6 month and at 1 year postoperatively (r=0.92, P=0.008 and r=0.94, P=0.005, respectively). There was a negative relationship between postoperative astigmatism at 1 year and NEI VFQ-25 ocular pain, social functioning, peripheral vision, and mental health subscale scores (r=-0.76, P=-0.07; r=-0.53, P=0.2; r=-0.53, P=0.27; r=-0.80, P=0.05). CONCLUSION: Vision-related quality of life improved significantly after DALK and continued to improve after suture removal.

Correlation of Dry Eye Workshop Dry Eye Severity Grading System With Tear Meniscus Measurement by Optical Coherence Tomography and Tear Osmolarity.

OBJECTIVES: To compare tear meniscus measurements obtained by optical coherence tomography (OCT) and tear osmolarity with dry eye severity according to the Dry Eye Workshop (DEWS) classification system. METHODS: Forty-four eyes of 22 patients with dry eye disease (DED) were recruited in this prospective study. In all eyes, ophthalmic examination was performed in the same order as follows: Ocular Surface Disease Index (OSDI) survey, tear film osmolarity measurement with TearLab Osmolarity System, tear meniscus measurements by OCT, corneal fluorescein staining scoring, conjunctival lissamine green staining scoring, tear film breakup time assessment, and anesthetized Schirmer test. Dry eye disease severity was graded according to the DEWS dry eye severity grading system, and the patients were divided into two groups. Group 1 composed of the patients with grades 1 and 2 DED, and group 2 composed of the patients with grades 3 and 4 DED. RESULTS: The mean tear osmolarity value was significantly higher in group 2 (318.9±12.8 mOsm/L) than in group 1 (308.1±8.5 mOsm/L) (P<0.01). The mean tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) values were significantly lower in group 2 (172.9±73.5 µm, 121.57±46.2 µm, and 0.013±0.012 mm, respectively) than in group 1 (218.5±70.2 µm, 157.94±49.1 µm, and 0.022±0.013 mm, respectively) (P=0.05, P=0.02, and P=0.026, respectively). There was a negative correlation between TMH and OSDI at the level of 45% (r=-0.450; P<0.05), between TMD and OSDI at the level of 47% (r=-0.470, P<0.05), and lastly between TMA and OSDI at the level of 48.5% (r=-0.485, P<0.05). There was no correlation between OSDI and tear osmolarity (P>0.05). CONCLUSIONS: Both tear osmolarity and tear meniscus OCT measurements comply with the DEWS grading system, and they can be used in the diagnosis and follow-up of dry eye patients in addition to conventional tests.

Measurement of Subfoveal Choroidal Thickness in Pseudoexfoliation Syndrome Using Enhanced Depth Imaging Optical Coherence Tomography.

BACKGROUND/AIM: Pseudoexfoliation (PSX) syndrome is associated with blood flow disturbances; however, its exact effect on choroidal blood flow and thickness remains to be elucidated. This study compared subfoveal choroidal thickness in normal eyes and in eyes with PSX using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This prospective, cross-sectional study included 35 eyes of 35 patients (20 males, 15 females) with unilateral or bilateral PSX and 26 eyes of 26 healthy volunteers (13 males, 13 females). Besides a comprehensive ocular and physical examination, all subjects underwent EDI-OCT examination using an Optovue RTVue OCT device (Optovue Inc., Fremont, Calif., USA). RESULTS: The mean choroidal thickness (CT) and ocular perfusion pressure (OPP) were lower in the PSX group than in the healthy controls (249.4 ± 46.3 vs. 282.5 ± 55.8 µm, p = 0.014 and 40.7 ± 5.8 vs. 44.3 ± 4.3 mm Hg, p = 0.007, respectively). In addition, both systolic blood pressure and diastolic blood pressure measurements were lower among the PSX patients. However, no correlation was found between CT and OPP. CONCLUSION: The findings of this study suggest that PSX is associated with an overall thinning of the subfoveal choroid and a significant decrease in OPP. Future studies are warranted to further examine these relations.

Evaluation of macular thickness change after inferior oblique muscle recession surgery.

PURPOSE: This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery. MATERIALS AND METHODS: Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12), inferior oblique recession surgery alone; Group II (n = 12), inferior oblique plus horizontal muscle surgery; Group III (n = 14), horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT) device preoperatively and on the first postoperative day to measure macular thickness. RESULTS: Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05) and Group II (P < 0.01). In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016), with significantly lower changes in Group III. CONCLUSION: Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness.

Assessing the effects of ketorolac and acetazolamide on macular thickness by optical coherence tomography following cataract surgery.

We aimed to evaluate the efficacy of topical ketorolac 0.5 % solution and oral acetazolamide 250 mg/day delivery during the first month after uneventful phacoemulsification surgery by measuring the macular thickness using optical coherence tomography. Our nonmasked randomized prospective study comprised 87 eyes of 80 patients. Complete follow-up was achieved on 84 eyes of 77 eligible patients. Postoperatively, the patients were divided into three groups. One group received ketorolac 0.5 %, the other group received acetazolamide 250 mg/day, and the control group was given no agent. Macular thickness and volume were measured at 1 week and 1 month after surgery by optical coherence tomography. Foveal thickness, parafoveal thickness, and perifoveal thickness were determined to be significantly elevated at postoperative 1 week and 1 month in the control group. Foveal, perifoveal, and parafoveal volumes were also significantly high at postoperative week 1 and month 1 in the control group. There was no significant difference between the ketorolac and acetazolamide groups. The correlation analysis between best-corrected visual acuity, and volume and thickness revealed a negative correlation in the acetazolamide group. Use of acetazolamide after cataract surgery is as effective as ketorolac on macular thickness and volume.

Corneal biomechanical properties in patients with recurrent anterior uveitis.

PURPOSE: This study aimed to investigate the biomechanical changes in cornea in patients with recurrent anterior uveitis in comparison to healthy controls. METHODS: Eighty-five eyes in 51 patients with inactive recurrent anterior uveitis (25 male, 26 female) and 34 eyes of 34 age-matched control subjects (16 male, 18 female) were included. The following measurements were done and compared between patients and controls: corneal hysteresis, corneal response factor, intraocular pressure, and central corneal thickness. RESULTS: Patients had significantly lower mean corneal hysteresis (8.57 ± 1.60 versus 10.91 ± 1.41, p = .001) and corneal resistance factor (9.24 ± 1.68 versus 11.56 ± 1.46, p = .001) when compared to controls. Among patients, corneal hysteresis and corneal resistance factor did not correlate with duration of the disease or number of attacks per year. CONCLUSIONS: Anterior uveitis seems to be associated with impaired biomechanical strength of the cornea, although no correlations with the duration of illness or attack frequency could be determined.

The efficacy of topical interferon alpha 2b treatment in refractory vernal keratoconjunctivitis.

PURPOSE: This study aimed to investigate the efficacy and safety of a 2-month topical interferon alpha 2b treatment in patients with refractory vernal keratoconjunctivitis. METHODS: Twelve (10 male, 2 female) patients with refractory vernal keratoconjunctivitis received topical treatment with one million IU/mL interferon alpha 2b 4 times a day for 2 months. Symptom and ophthalmological examination scores were assessed at baseline and during follow-up. RESULTS: No significant complications or side effects associated with the use of topical interferon alpha 2b were observed. Symptom scores for itching, tearing, photophobia, and total symptom score, and objective scores for corneal lesion, hyperemia, chemosis, papillary hypertrophy, secretion, and total examination score significantly improved during the 2-month treatment. Improvements were maintained after discontinuation of the treatment for most parameters. CONCLUSIONS: Topical interferon alpha 2b treatment seems to offer a safe and effective alternative for the treatment of refractory vernal keratoconjunctivitis for a brief period.

Unilateral lacrimal fistula in a patient with uterus didelphys and renal agenesis.

A 30-year-old female patient presented to our clinic because of lacrimation from an orifice close to the left lower eyelid. Ocular examinations and analyses revealed uterus didelphys and unilateral renal agenesis associated with a left lacrimal fistula. The patient underwent fistulectomy and external dacryocystorhinostomy. We decided to report on this patient owing to the unusual concurrent systemic abnormalities.

Effect of ketorolac add-on treatment on intra-ocular pressure in glaucoma patients receiving prostaglandin analogues.

BACKGROUND/AIMS: While topical ocular hypotensive agents cause secretion of endogenous prostaglandin (PG), systemic and topical non-steroidal anti-inflammatory agents inhibit its production; thus, they may interfere with therapeutic efficacy. This study aimed to investigate the effect of add-on treatment with ketorolac on intra-ocular pressure (IOP)-lowering effects of three different PG analogues. METHODS: This study included 30 adult bilateral glaucoma patients who had been receiving PG analogues for primary open-angle glaucoma (n = 25) or pseudoexfoliation glaucoma (n = 5). Ketorolac tromethamine 0.5% and placebo drops were administered to the right and left eyes of the patients, respectively, 4 times a day for 1 week. IOP measurements were performed at baseline, within the first 4 h after application, on days 1, 3 and 7, and 1 and 7 days after discontinuation of the treatment. RESULTS: Eyes receiving ketorolac had significantly lower IOP throughout the treatment period (p < 0.001). Patients who were on latanoprost, travoprost and bimatoprost did not differ with regard to the change in IOP (p = 0.780). After discontinuation, pressures became similar on day 1 (p = 0.796) and day 7 (p = 0.314). CONCLUSION: In glaucoma patients, ketorolac significantly enhances the IOP-lowering effects of latanoprost, travoprost and bimatoprost.

The effect of topical 0.05% cyclosporine on recurrence following pterygium surgery.

PURPOSE: To investigate the role of postoperative topical 0.05% cyclosporine A (CsA) eye drops (Restasis(®), Allergan Pharmaceutical) in the prevention of recurrence among patients with primary pterygium treated with bare-sclera technique. METHODS: In this prospective randomized controlled study, 36 eyes (34 patients) with primary pterygium were randomized into two groups: Group I comprised 18 eyes (18 patients), and Group II comprised 18 eyes (16 patients). Bare sclera technique was performed in both groups. In Group I, 0.05% CsA was administered postoperatively at 6-hour intervals for 6 months, and Group II did not receive any cyclosporine treatment. The patients were assessed for recurrence, side effects, and complications at postoperative 1 and 7 days as well as each month during the following year. Conjunctival advances which showed a limbus higher than 1 mm were recognized as recurrence. RESULTS: Recurrence occurred in four patients (22.2%) in Group I and in eight (44.4%) patients in Group II. CONCLUSION: Postoperative application of low-dose CsA can be effective for preventing recurrences after primary pterygium surgery.

Usher syndrome associated with Fuchs' heterochromic uveitis: a case report.

We report a case of Usher syndrome in association with unilateral Fuchs' heterochromic uveitis.