Pseudoexfoliation syndrome and coronary artery ectasia.

AIMS: To determine whether pseudoexfoliation syndrome is associated with coronary artery ectasia or not. METHODS: This cross-sectional study was undertaken at Bulent Ecevit University's Ophthalmology Department with the participation of the Cardiology Department. Eighty consecutive patients who underwent coronary angiography and were classified into two groups-those diagnosed with a normal coronary artery (n=40) and those diagnosed with coronary artery ectasia (n=40)-were included in the study. Pseudoexfoliation was diagnosed if typical exfoliation material was found to be present on the anterior surface of the lens, the iris, or at the pupillary border on slit-lamp examination. Age, sex, presence of pseudoexfoliation material, hypertension, diabetes mellitus, hyperlipidemia rates, cigarette smoking history, and family history of coronary artery disease were compared between the two groups. The continuous variables were compared by using the independent sample t-test or the Mann-Whitney U-test, and the categorical variables were compared using Pearson's χ(2)-test or Fisher's Exact χ(2)-test for the two groups. RESULTS: There was no difference in demographic data of both groups. The presence of pseudoexfoliation material was more common in patients with coronary ectasia compared with controls [(n=21 (52.5%) vs n=8 (20%), P=0.005)]. In all patients, there was a higher glaucoma rate in the patients with pseudoexfoliation syndrome [n=7 (24.1%), 6 CAE (+), 1 CAE (-)] than in the normal patients [n=2 (3.9%), 2 CAE (-)] (P=0.010). CONCLUSIONS: In this study, we found a possible association of pseudoexfoliation and coronary artery ectasia. Coronary artery ectasia patients had higher prevalence of pseudoexfoliation.

Tear film osmolarity in patients with diabetes mellitus.

PURPOSE: To compare tear film osmolarity (TFO) between patients with diabetes mellitus (DM) and normal healthy individuals. METHODS: In this prospective case-controlled study, the TFO in 46 normal subjects (control group) and 55 patients with DM (study group) was evaluated. TFO in milliosmole (mOsm) was measured by using an auto-osmometer. The serum levels of glycosylated hemoglobin (HbA1c) and blood glucose in all participants were also measured. Mean outcome measures were TFO and its relationship with HbA1c level and duration of DM. RESULTS: Mean TFO was 320.40 ± 21.80 mOsm/l in the study group and 308.22 ± 18.16 mOsm/l in the control group (p < 0.001). The TFO values were significantly associated with duration of DM (r = 0.476, p < 0.001), but no significant correlation was found with HbA1c level (r = 0.225, p = 0.114). CONCLUSIONS: The study shows a significantly higher TFO in patients with DM than in the healthy controls. TFO also correlates with the duration of DM.

The triple classification of dry eye for practical clinical use.

PURPOSE: "Dry Eye is a condition produced by the inadequate interrelation between lacrimal film and ocular surface epithelium, and is caused by quantitative and qualitative deficits in one or both of them. It can be produced by one or combined etiologic causes, affecting one or several of the secretions of the glands serving the ocular surface, and producing secondary manifestations of different grades of severity". Clinicians need a practical classification to face diagnosis, prognosis and treatment. Dry eyes have many etiologies and pathogenesis, different affectation of the various dacryoglands and ocular surface epithelium, and diverse grades of severity. The specialists in xero-dacryology must know these three parameters to evaluate any case of dry eye, and to establish an adequate treatment. METHODS: To facilitate this, an open session in the 8th congress of the International Society of Dacryology and Dry Eye (Madrid, April, 2005) proposed modifying the Triple Classification of dry eye approved in the XIV congress of the European Society of Ophthalmology (Madrid, June, 2003). There was consensus of all conclusions. CONCLUSIONS: The following classification has been established: First, a classification of the etio-pathogenesis, distributed in ten groups: age-related, hormonal, pharmacologic, immunopathic, hyponutritional, dysgenic, infectious/inflammatory, traumatic, neurologic and tantalic. Second, a classification of the affected glands and tissues, which under the acronym of ALMEN includes the Aqueo-serousdeficient, Lipodeficient, Mucindeficient and Epitheliopatic dry eyes, and the Non dacryological affected exocrine glands (saliva, nasal secretion, tracheo-pharyngeal secretion, etc). And thirdly, a classification of severity, in three grades: Grade 1 or mild (symptoms without slitlamp signs), grade 2 or moderate (symptoms with reversible signs), and grade 3 or severe (symptoms with permanent signs).

Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome.

PURPOSE: To determine the retinal nerve fibre layer (RNFL) thickness in patients with obstructive sleep apnoea syndrome (OSAS) in order to investigate the possibility of detecting early signs of glaucoma in this population. METHODS: A total of 66 consecutive patients admitted for polysomnographic evaluation of suspected OSAS. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. Patients who had the disease were classified as having mild and severe OSAS, while patients who did not have the disease were classified as controls. All patients received physical, neurological, and ophthalmological evaluation including visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy with a three mirror contact lens, and fundus examination. After these examinations, patients with glaucoma and patients who had ophthalmological and/or systemic disease known to affect RNFL thickness were excluded from the study. The RNFL thickness was assessed with a scanning laser polarimeter (Nerve Fiber Analyzer GDx, Laser Diagnostic Technologies Inc., San Diego, CA, USA). RESULTS: A total of 34 patients with obstructive sleep apnoea (19 mild, 15 severe) and 20 age-matched controls were included in the study. The thickness of RNFL was reduced in patients with OSAS compared to controls. The decrease in RNFL was found to be correlated with the severity of sleep apnoea (r=0.78, P=0.01). CONCLUSIONS: The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL. Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.

Otolaryngological findings in congenital nasolacrimal duct obstruction and implications for prognosis.

AIM: To investigate otolaryngological abnormalities associated with congenital nasolacrimal duct obstruction (CNLDO) and their effect on the prognosis. METHODS: 65 consecutive cases of CNLDO were followed up with routine otorhinolaryngological examination with tympanometry. RESULTS: Otitis media with effusion (OME) and uvula bifida were detected in 44.6% and 9.2% of the children, respectively. Medical treatment and probing were less effective in patients with OME (p<0. 05). CONCLUSIONS: OME and uvula bifida are significant anomalies associated with CNLDO and the former has a marked effect on the prognosis. This finding may help to determine the patients who will need further treatment after massage and probing.

Congenital lacrimal fistula.

PURPOSE: Congenital lacrimal fistula is a rare abnormality of the lacrimal system. The patients may be asymptomatic but treatment of those with symptoms such as epiphora and dacryocystitis is still controversial. METHODS: The clinical findings, methods of surgical treatment and results were evaluated in seven patients (four male, three female) with congenital lacrimal fistula. Three were asymptomatic, types of surgical treatment were fistula excision with dacryocystorhinostomy (DCR) (two cases), fistula excision with conjunctival DCR (one case) and closed fistula excision alone (one case). RESULTS: Three of the four patients who underwent surgery had relief of symptoms. The fistula recurred in the case that had undergone fistula excision alone. CONCLUSIONS: It is difficult to design controlled studies to detect which method is superior for the treatment of lacrimal fistula, considering the small number of cases in the literature. We recommend treating each case according to its own characteristics.

Lacrimal sac dilatation in balloon dacryocystoplasty.

The authors report a case of balloon dacryocystoplasty in a patient who had a dilated lacrimal sac found in conventional surgery. A 52-year-old woman presented with persistent epiphora after a failed balloon dacryocystoplasty. She underwent an external dacryocystorhinostomy. The lacrimal sac was found to be dilated at its lower part, adjacent to the nasolacrimal ductus. Flaps were created more superiorly than usual. The operation was unsuccessful after 3 months. Previous balloon dacryocystoplasty, which is reported to be a harmless procedure, may pose some difficulty in subsequent conventional surgery.

Corneal topography in patients with congenital ptosis.

PURPOSE: To determine the effect of congenital ptosis on corneal shape, and to assess the role of these topographic changes in the development of amblyopia. METHODS: Twenty-two patients with congenital ptosis were examined and a corneal topographic examination performed in both the ptotic and normal eyes. The qualitative corneal classification was done according to the colour-coded topographic maps. The surface regularity index (SRI) and the surface asymmetry index (SAI) were used as quantitative descriptors of the study. RESULTS: Ptotic eyes had an increased incidence of astigmatism, bow tie pattern on corneal topography, corneal asymmetry (SAI, p < 0.05) and corneal irregularity (SRI, p < 0.05). Lack of mirror-image symmetry with the fellow eye was higher in amblyopic eyes. CONCLUSION: Eyes with congenital ptosis have an increased incidence of astigmatism and a bow tie pattern on corneal topography. These features are associated with the presence of amblyopia.

Adjunctive use of mitomycin C on endoscopic lacrimal surgery.

AIMS: Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation. METHODS: Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR. RESULTS: The postoperative follow up period was 9-27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates. CONCLUSIONS: Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Histopathologic effects of mitomycin-C on endoscopic transnasal dacryocystorhinostomy.

BACKGROUND AND OBJECTIVES: The antimetabolite mitomycin-C is now being used in endoscopic transnasal dacryocystorhinostomies to prevent the closure of osteotomies. PATIENTS AND METHODS: A 0.5-mg/ml solution of mitomycin-C was applied to the osteotomy site for 2 1/2 minutes intraoperatively. Specimens from four patients were collected during surgery and at 15 days, 1 months, 3 months, and 6 months after surgery. The specimens were examined under light and electron transmission microscopy and were compared with control specimens. RESULTS: Light microscopy showed attenuated epithelium with intracytoplasmic vacuoles. Subepithelial connective tissue was looser and hypocellular. Electron microscopy confirmed these findings and demonstrated swelling of mitochondria, dilatation of endoplasmic reticulum, and chromatin-dense granules in nuclei of fibroblasts. CONCLUSION: By causing a decrease in density and cellularity of mucosa, topical use of mitomycin-C may enhance the success of surgery; however, further studies are necessary to determine the ultimate potential of this agent for this procedure.

Papillary adenocarcinoma of the ciliary body simulating retinoblastoma.

PURPOSE: To report a 2 1/2-year-old boy who had papillary adenocarcinoma of the ciliary body that simulated retinoblastoma. METHOD: Initially treated for congenital glaucoma, the patient was referred with a white mass involving the iris, chamber angle, and ciliary body. RESULTS: Enucleation of the right eye, which was initially diagnosed as retinoblastoma, showed a papillary adenocarcinoma of the ciliary body epithelium involving the posterior chamber, iris, anterior chamber, and trabeculum. CONCLUSION: Adenocarcinoma of the ciliary body must be included in the differential diagnosis of tumors originating from the ciliary body in young children.