Evaluation of eyelid features' changes before and after COVID-19 pandemic amongst healthcare and home office workers.

PURPOSE: To evaluate the eyelid features' changes after N95 face mask (FM) usage in healthcare workers through the new type of Coronavirus Disease 2019 (COVID-19) pandemic and make a comparison with home-office workers as a control group with a computer vision algorithm. MATERIALS AND METHODS: Sixty healthcare workers and forty control participants with similar demographic features included. Standardized biometric photographs which were taken before and after the COVID-19 pandemic, analyzed by the ImageJ program (NIH, Bethesda, Md.) software. The distances between the central light reflex on the cornea and the upper (UE) and lower eyelid (LE) were recorded as the marginal reflex distances. (MRD1, MRD2 respectively) Parameters of pretarsal show (PTS) of UE and brow pupil diameter (BPD) were analyzed for both of the eyes. RESULTS: There were no significant differences among the groups' measurements before the COVID-19 pandemic. In healthcare workers' group after the pandemic, values of MRD1, PTS, BPD showed a significant decrease in their right eye (p = 0.001, p = 0.002, p = 0.001 respectively) and same values reduced in the left eyes as well when compared with pre-pandemic measurements. (p = 0.048, p = 0.001, p = 0.001 respectively) PTS and BPD values were decreased for both right and left eyes of the controls. (p = 0.044, p = 0.001 and p = 0.001, p = 0.001 respectively) MRD1 measurements after the pandemic showed no difference either in the right or left eyes of the control group after the pandemic. (p = 0.071 and p = 0.065 respectively). DISCUSSION: Results showed that both BPD and PTS values decreased independently from the previous FM usage in both of the groups. Even though MRD1 values remained within the normal values, a significant decrease was detected in the healthcare workers group which suggested the cause was newly developed upper eyelid (UE) dermatochalasis after long hours of FM usage. Although it is hard to make a truly objective evaluation both usage of standardized biometric photographs and a computer-based measurement system makes the results reliable.

The comparison of corneal densitometry in cases with glaucoma following childhood cataract surgery and juvenile glaucoma.

PURPOSE: To compare the corneal densitometry (CD) in pediatric cases with glaucoma following childhood cataract surgery and juvenile open-angle glaucoma (JOAG). METHODS: This prospective comparative study involved 13 eyes with JOAG, 12 eyes with pseudophakic glaucoma, 13 eyes with aphakic glaucoma, and 15 control subjects. Pentacam HR Scheimpflug corneal topography was employed to evaluate corneal thickness (CCT) and CD values. RESULTS: The mean intraocular pressure (IOP) and CCT were significantly higher in aphakic glaucoma cases than the other groups (p = 0.001). In aphakic eyes, the mean CD values were higher in most of the anterior, center, and posterior layers of 0-2 mm, 2-6 mm, 6-10 mm, and total zones (p < 0.001 for all). In pseudophakic eyes, the mean CD values were statistically similar with that of aphakic eyes and higher than that of JOAG and control eyes in all layers of 0-2 mm zone and in anterior layer of 10-12 mm and anterior and total layers of 2-6 mm zones (p < 0.05 for all). The CD values demonstrated significant correlations with CCT values in both aphakic and pseudophakic eyes. However, a significant correlation of CD values with IOP was only demonstrated in aphakic eyes (p = 0.01 for all). CONCLUSION: The probable effects of childhood cataract surgery especially aphakia might cause corneal backscatter of light and increased CD in all layers in all zones of the cornea. Increased CD values and its correlation with CCT and IOP in aphakic glaucoma eyes may be of importance in clinical management.

Relationship between histopathological findings of patients with dermatochalasis and vitamin D deficiency.

PURPOSE: To compare the histopathological findings of patients who had been diagnosed with dermatochalasis (DC) and had undergone upper eyelid blepharoplasty (ULB) as well as those of controls (C-Group) according to their serum vitamin D (SVD) levels. METHODS: The prospective study included 136 upper eyelid skin from 68 patients who underwent surgery for DC and 53 upper eyelid skin from 53 patients who underwent levator surgery with ULB. The DC Group was then divided into 3 subgroups according to the marginal reflex distance (MRD4). The lymphatic vessel (LV) count and diameter of the largest LV (DLLV) were recorded, the stromal collagen bed (SCB) was observed, and its depth was measured, the interfibrillar edema was examined, and the elastic fiber and macrophage counts and recorded, respectively, and then all of these were evaluated. The SVD levels were compared between the DC patients and the C-Group. RESULTS: In comparison to the C-Group, significant changes were seen in the dilated LV, DLLV, SCB depth, interfibrillar edema, elastic fiber density, and macrophage count in the DC sub-Groups (P < 0.001 for all). While no difference was found between DC sub-Group 1 (MRD4 > 4 mm) and the C-Group (P > 0.05), a significant difference was found between DC sub-Group 2 (MRD4 2-4 mm) and DC sub-Group 3 (MRD4 < 2 mm) for all of the parameters (P < 0.05). A statistically significant difference was also found in the SVD levels between the DC sub-Group 1 and DC sub-Groups 2-3 (P < 0.017, P < 0.001 respectively). CONCLUSION: According to the results of this study, SVD level was significantly lower in DC group. Moreover, an increased LV count and diameter, decreased elastic fiber count, collagen fiber and stromal edema irregularity, and increased macrophage count were found to be associated with the SVD level.

Unilateral Ciliary Madarosis in a Child After Coronavirus Disease 2019 (COVID-19) Infection.

Coronavirus disease 2019 life-threatening signs have aroused a great deal of attention since the beginning of the pandemic. In the initial stages of the pandemic, the pediatric population was mostly protected, and the symptoms in affected children were mild. Here, the authors present a 7-year-old boy with left upper eyelid ciliary madarosis that developed 9 weeks after coronavirus disease 2019 infection. During comprehensive ophthalmologic examination, no conjunctival injection, chemosis, erythema, or crusts on the eyelids and no other meibomian gland disease findings were detected. Comprehensive laboratory workup was performed to exclude any other possible causes of ciliary madarosis. All laboratory parameters tested within normal limits. In addition to the patient's ocular surface and physical examination findings, laboratory results and the timing of the symptoms as well as spontaneous recovery at follow-up visits led the authors to conclude that telogen effluvium was to cause of the isolated, unilateral ciliary madarosis in this case.

Influence of Upper Eyelid Surgeries on Corneal Morphology Detected with Pentacam.

PURPOSE: To analyze the corneal morphological parameters before and one month after the upper eyelid (UE) blepharoplasty and external levator resection (ELR) for ptosis surgery. MATERIALS AND METHODS: Seventy eyes of 70 patients with dermatochalasis (50 eyes) and acquired aponeurotic ptosis (AAP) (20 eyes) included in this prospective study. Detailed ophthalmologic examination was performed including the best corrected visual acuity (BCVA), slit lamp examination and dilated fundoscopy. Measurements were made before and one month after the surgeries using Pentacam. Central corneal thickness (CCT), pupil center pachymetry (PCP) and thinnest pachymetry (TP), cornea front astigmatism (AST), flat keratometry (K1), steep keratometry (K2) and mean keratometry (Km) values were evaluated. RESULTS: Higher postoperative Km measurements were observed in dermatochalasis (p = 0.038) patients. Postoperative AST values were significantly lower in both dermatochalasis and ptosis cases (p = 0.034, p = 0.003, respectively). Increased PCP and TP were found in the AAP patients (p = 0.014, p = 0.015, respectively). DISCUSSION: UE blepharoplasty and ELR surgeries both lead to some significant changes on corneal structure post-operatively. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of the segmented inner retinal layers in exfoliation glaucoma.

PURPOSE: To investigate the macular spectral domain optical coherence tomography (SD-OCT) measurements of the segmented inner retinal layers in patients with exfoliation syndrome (XFS), exfoliation glaucoma (XFG). METHODS: This prospective cross-sectional study included 28 eyes with XFS, 47 eyes with XFG, and 29 healthy controls. Thickness of the inner retinal layers, including retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) was obtained from the horizontal SD-OCT scans. Functional correlation of structural parameters was analyzed using the mean sensitivity (MS) values on 10-2 visual fields. RESULTS: The RNFL, GCL, and IPL were thinnest in eyes with XFG. Among these retinal layers, IPL was significantly thinner in eyes with XFS than healthy controls (p = 0.02) and the IPL thickness was significantly correlated with the corresponding MS scores on 10-2 visual fields (r = 0.492, p = 0.02) in eyes with XFS. Neither GCL nor RNFL thickness values demonstrated significant correlations with functional parameters in eyes with XFS (r = 0.377, p = 0.08; r = 0.212, p = 0.34). In eyes with XFG, the IPL thickness correlated with the visual field MS scores (r = 0.572, p = 0.0007), similar to the correlation of GCL (r = 0.585, p = 0.0005) thickness with visual field scores. CONCLUSIONS: Segmented analysis of the macular IPL thickness presented a significant correlation with the 10-2 visual field scores not only in eyes with XFG but also in eyes with XFS. With respect to early dendritic/synaptic alterations in animal models, larger and longitudinal studies are encouraged to determine the predictive value of the IPL thickness for conversion of XFS to XFG.

The influence of microorganisms on early relapses after external dacryocystorhinostomy.

PURPOSE: Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external dacryocystorhinostomy (DCR). METHODS: This prospective study included 50 patients. Evaluations were made before, on the first postoperative day and monthly after DCR. Nasolacrimal silicon tubes (NST) were removed after three months. Before the DCR, swab samples were taken from both hands and lower conjunctival fornices and from the lacrimal sac during the first DCR and from the relapsed cases during the second DCR. RESULTS: Growth was observed in 90 (45%) cultures out of 200 and a total of 23 different strains were identified altogether. Staphylococcus aureus (40%) and Streptococcus pneumoniae (28%) were dominantly isolated which were all resistant to penicillin, tetracycline and erythromycin. Lacrimal syringing (LS) was successful in patients (100%) on the first postoperative day. After three months, before NST removal, purulent discharge from the punctum was observed in five patients, and blockage was detected by LS. S. pneumoniae was isolated from all five patients' obstructed side conjunctival cultures. Additionally, from their lacrimal sac, S. pneumoniae (4 patients), Capnocytophaga gingivalis, and Candida spp. (1 patient) strains were isolated. S pneumoniae was isolated in four out of five patients from the ipsilateral conjunctival and lacrimal sac cultures which obtained from the subsequent DCR. CONCLUSION: Our results showed that S. pneumoniae was an isolated and persistent strain in cases with early recurrence even after a successful DCR.

Optical coherence tomography angiography findings in pediatric patients with graves ophthalmopathy.

PURPOSE: The aim of this study was to evaluate peripapillary, macular microvascular structure, and retinal nerve fiber layer (RNFL) thickness profile in children with Graves Ophthalmopathy (GO). MATERIAL AND METHODS: Thirty-six eyes of 18 children with GO were prospectively compared with 40 eyes of 20-age and sex-matched controls. The severity and activity of the disease were evaluated according to the criteria of the European Group on Graves' Ophthalmopathy (EUGOGO) and Clinical Activity Score (CAS). After complete ophthalmologic and endocrinologic examination, all patients underwent optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) measurements. Retinal nerve fiber layer (RNFL) thickness, macular superficial capillary plexus (SCP), deep capillary plexus (DCP), foveal avascular zone (FAZ) area, acircularity index (AI) of the FAZ and peripapillary microvascular structure were analyzed. RESULTS: The mean age was 12.1 ± 2.4 years in the GO group and 11.2 ± 2.6 years in healthy control group (p = 0.11). Duration of disease was 8.9 ± 4.2 months in the GO group. All patients in GO group had mild and inactive ophthalmopathy. In temporal inferior quadrant, RNFL thickness was significantly thinner in the GO group compared to the control group (p = 0.03). No significant difference was seen between groups both peripapillary and macular microvascular structure (all p > 0.05). CONCLUSION: GO has no effect on optic nerve thickness, peripapillary and macular vascular parameters except inferior temporal RNFL in children.

The histopathological findings in excised upper eyelids of patients with dermatochalasis following collagen cross-linking treatment.

PURPOSE: To evaluate the histopathological effects of collagen cross-linking (CCL) on excised skin samples of patients undergoing upper eyelid blepharoplasty due to dermatochalasis. METHODS: This study examined 74 excised eyelid skin samples from 37 dermatochalasis patients. Following an upper eyelid blepharoplasty, CCL with hypotonic riboflavin (0.1%) was applied. Both treated (right eyelid, CCL group) and untreated eyelid specimen (left eyelid, non-CCL group) sections were stained with hematoxylin-eosin and Masson's trichrome. The sections were evaluated for the following parameters: the collagen status (parallel, oblique, and perpendicular), the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers. RESULTS: There were no statistically significant differences in the collagen status, the distance between collagen fibers, the diameter of collagen fibers, and the length of collagen fibers between the CCL and non-CCL groups (p > 0.05 for all). Although the lack of statistically significant differences, the structure of the treated eyelid collagen fibers was more parallel in 48% of the participants than in the untreated ones. For male patients, a statistically significant shorter distance between collagen fibers was observed in the CCL group (8.05 ± 2.04 µm) compared to the non-CCL group (9.97 ± 2.33 µm) (p = 0.042). CONCLUSION: In this study, more parallel collagen structures and tightly packed collagen fibers were detected in eyelid samples following CCL treatment. The authors note that the results of this study may be promising for further research, so the effect of CCL therapy on the eyelid may be an interesting subject for the treatment of non-severe or surgically inadequately corrected dermatochalasis.

The effect of limbal autograft location at primary pterygium excision on anterior and posterior corneal astigmatism: a comparative prospective study.

PURPOSE: The aim of the study is to evaluate the effect of limbal autograft location on corneal astigmatism in inferior and superior conjunctival autografted pterygium surgery. METHODS: Patients were divided into 2 groups as diagnosed with primary pterygium and planned to receive surgical treatment. Pterygium surgery was performed on 25 patients with superior and 25 patients with inferior limbal autograft who have similar epidemiologic features. Cornea anterior and posterior surface keratometry (K) 1, K2, Kmax, peripheric radius (Rper) (the mean radius of curvature of the 7.0-9.0 mm ring area), refractive astigmatism and axis values, were examined. Corneal irregularity indices were the index of surface variance (ISV), index of vertical asymmetry (IVA, mm), index of height asymmetry (IHA, µm), index of height decentration (IHD, µm). The data were compared pre- and postoperative and the effect of graft location on results was evaluated. RESULTS: K1 which is from the values of the cornea front face has risen after surgery both of superior and inferior groups (p = 0.011). However, no postoperative significant difference was detected in terms of the change. Otherwise, both groups have changed regarding astigmatism and Rper (p < 0.001), but no postoperative significant difference was found in terms of the change. There were not any differences between groups regarding the changes of postoperative back face values. Although there were significant decreases in ISV, IVA, and IHD values in both groups in terms of all corneal surface indices, there was no significant difference between the lower and upper groups in terms of postoperative results (p > 0.05). CONCLUSION: The effects of pterygium surgery with limbal autograft provide significant improvement on corneal astigmatism. However, we think that the location of the conjunctiva has no effect, but in cases where the bulbar conjunctiva needs to be preserved or cannot be used, the choice of the lower bulbar conjunctiva can achieve successful results.

Microvascular and structural alterations in the optic nerve head of advanced primary open-angle glaucoma compared with atrophic non-arteritic anterior ischemic optic neuropathy.

PURPOSE: This cross-sectional study compared the peripapillary vessel density (VD), peripapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters between eyes with atrophic non-arteritic anterior ischemic optic neuropathy (NAION) and eyes with advanced primary open-angle glaucoma (POAG) matched for visual field mean deviation. METHODS: Peripapillary VDs and RNFL thicknesses in the peripapillary region, and 4 sectors (superior, inferior, nasal, and temporal), and scanning laser ophthalmoscopy parameters of the ONH were evaluated with optical coherence tomography angiography (OCTA) among 21 atrophic NAION cases, 26 advanced POAG cases, and 30 age- and sex-matched healthy controls. RESULTS: The POAG eyes had lower peripapillary VDs in all areas compared with the NAION eyes, which was most marked in the inferior and nasal sectors (p=0.005 for both). RNFL loss was similar between the 2 groups in all areas, except for a preserved thickness in the inferior sector in NAION eyes (p=0.01). Peripapillary VD demonstrated stronger correlations with global RNFL thickness in the peripapillary region in the NAION eyes compared with that of the POAG eyes (r=0.91 p<0.00001, r=0.42 p=0.03 respectively). In multivariate analysis, the peripapillary VD correlated with age and RNFL thickness in the POAG eyes while it correlated with SSI and RNFL thickness in the NAION eyes. CONCLUSIONS: A tendency for a lower peripapillary VD despite similar visual field mean deviation values may infer a more prominent role of the vascular regression in POAG compared with NAION.

Evaluation of aqueous humor and serum clusterin levels in patients with glaucoma.

BACKGROUND: To compare the aqueous humor (AH) and the serum clusterin levels of patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), and primary open-angle glaucoma (POAG) with each other and with an age- and sex-matched control group. METHODS: This prospective, cross-sectionalstudy evaluated 92 eyes from 92 adult cases of uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation. The cases were divided into PEX, PEXG, POAG, and control groups. Serum samples were taken from the antecubital vein just before the surgery, and the AH samples were aspirated at the beginning of the surgery. Kruskal-Wallis H, One-way ANOVA, Mann-Whitney U with Bonferroni correction and Chi-Square tests were used for statistical analysis. RESULTS: The serum clusterin levels were the highest in the PEXG group, but no statistically significant differences were observed between the groups (p=0.633). The mean AH clusterin levels were 286.79±29.64 µg/mL in the PEXG group, 263.92±31.70 µg/mL in the PEX group, 272.59±49.71 µg/mL in the POAG group, and 193.50±62.38 µg/mL in the control group (p< 0.001). This came out to be 1.48 times increase for the PEXG group, 1.36 for the PEX group, and 1.41 for the POAG group when compared with the control subjects. CONCLUSIONS: A higher level of clusterin in the anterior chamber was found to be associated with PEX and PEXG. In addition, a high level of anterior chamber clusterin in POAG, which is a new finding, showed that this molecule might be important not only in pseudoexfoliation, but also other types of glaucoma like POAG.

Pupillary and Anterior Chamber Changes Following Upper Eyelid Blepharoplasty.

PURPOSE: This study investigated the preoperative and postoperative pupillary and anterior chamber (AC) characteristics of patients undergoing upper eyelid blepharoplasty. METHODS: This prospective, cross-sectional study examined 32 eyes from 20 dermatochalasis patients. Following a detailed ophthalmological examination, quantitative pupillometry and Scheimpflug corneal topography were used to evaluate the pupil and AC characteristics of eyes on the day of operation and postoperative days 1 and 7. Static and dynamic pupillometry characteristics, including scotopic, mesopic, low photopic, and high photopic pupil diameter (PD), resting diameter, amplitude, latency, duration, and velocity of pupil contraction, and latency, duration, and velocity of pupil dilation, were measured. Additionally, AC volume, depth, and angle parameters were analyzed. RESULTS: There were significant differences between scotopic, mesopic, and resting PD and the amplitude of pupil contraction. Pairwise comparisons showed that postoperative day 1 scotopic, mesopic, and resting PD and amplitude of pupil contraction measurements were significantly higher than preoperative measurements (p = 0.008, p < 0.001, p = 0.006, and p = 0.033, respectively). Additionally, scotopic and resting PD were significantly lower on postoperative day 7 compared with postoperative day 1 (p = 0.001 and p = 0.041, respectively). However, there were no significant differences in AC parameters. CONCLUSIONS: This study revealed that static and dynamic pupil measurements changed following blepharoplasty, with postoperative increased PD occurring particularly under low-light conditions. Therefore, low-light environments should be avoided following blepharoplasty, and patients with angle-closure risk factors should be closely monitored in the early postoperative period.

Smoking effect on peripapillary and macular microvascular structure in inactive Graves' ophthalmopathy.

OBJECTIVE: The aim of this study was to evaluate the smoking effect on peripapillary and macular microvascular structure in patients with inactive Graves' ophthalmopathy (GO) and to compare these structures with those of healthy control subjects. METHODS: A total of 34 healthy participants (control group), 22 inactive GO patients with smoking (smoker group) and 19 inactive GO patients with non-smoking (non-smoker group) were recruited in this prospective study. After detailed ophthalmological examination, vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), retinal peripapillary capillary (RPC) and foveal avascular zone (FAZ) area, and acircularity index (AI) of the FAZ were analysed with optical coherence tomography angiography (OCTA) for each eye. RESULTS: Vessel density in the total peripapillary; superior and inferior sectors of RPC were significantly lower in inactive GO patients with smoking (p < 0.05 for all sectors) compared to control group. Besides, the FAZ AI was significantly higher in smoker and non-smoker inactive GO groups compared to healthy subjects (p = 0.0001, p = 0.0001, respectively). No significant difference was found in the FAZ area, and all SCP, DCP macular measurements between groups (p > 0.05 for all). CONCLUSION: OCTA findings of lower peripapillary VD in the smoker group show smoking effect on the optic disc head microvasculature in inactive GO patients. These results could reflect early subclinical optic disc vasculature damage in smoker inactive GO subjects.

Evaluation of the optic nerve head vessel density in the patients with asymmetric pseudoexfoliative glaucoma: an OCT angiography study.

PURPOSE: To evaluate vascular microcirculation changes of the optic nerve head (ONH) in the patients with asymmetric pseudoexfoliative glaucoma (XFG) using optical coherence tomography angiography (OCTA) and to compare vessel density (VD) results with healthy individuals. METHODS: This prospective study enrolled 120 eyes in total. The eyes were divided into 3 groups: 40 glaucomatous and 40 non-glaucomatous fellow eyes without clinically pseudoexfoliation material (XFM) of patients with asymmetric XFG, and 40 healthy eyes as controls. The optic disc region was evaluated with OCTA (Optovue, Inc., Fremont, CA). VD was assessed as the ratio of the area formed by the vessels in 3 different regions: (1) inside disc; (2) in the peripapillary area defined as a 1-mm wide elliptical annulus around the disc; and (3) in the whole image defined as a 4-mm wide papillary region. RESULTS: There were significant decreases in VD values of all regions in XFG eyes compared to fellow and control eyes (p < 0.05 for all comparisons). The mean VD values of peripapillary area and whole image were lower in the non-glaucomatous fellow eyes compared with control eyes (p = 0.011 and p = 0.015, respectively). The receiver operating characteristic analysis for differentiating fellow eyes from healthy eyes had highest area under the curve and sensitivity at 90% specificity for superior-hemi (0.811, 65.2%), followed by ppVD (0.775, 61.8%) and whole image (0.743, 55.9%). CONCLUSIONS: OCTA as a novel imaging may be a valuable structural test in diagnosis and follow-up of glaucoma.

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis.

PURPOSE: To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis (FHI)-related glaucoma in 1-year follow-up period. METHODS: This retrospective study included 50 eyes with FHI-related glaucoma those had underwent initial trabeculectomy with MMC (0.2 mg/ml-3 min). Thirty-one of them had single-dose bevacizumab injection (1.25 mg/0.05 ml) into the bleb area just at the end of the surgery, while 19 eyes did not have. The intraocular pressure (IOP) and the mean number of anti-glaucomatous medications were evaluated. The IOP value ≤ 21 mmHg was defined as complete or qualified surgical success in terms of using medical anti-glaucomatous treatment. Bleb height and vascularity were evaluated with Indiana bleb grading system. Paired sample t test, t test, Chi-square and Kolmogorov-Smirnov tests were used for statistical analysis. RESULTS: The preoperative IOP values of bevacizumab and without bevacizumab groups were 32.8 ± 4.5 mmHg and 32.8 ± 4.5 mmHg, respectively, and they decreased to 17.5 ± 4.6 mmHg and 17 ± 5.2 mmHg at the final visit (p < 0.001 for all values). There were no significant differences in postoperative IOP and the number of medications between the groups at the final visit. In bevacizumab group, complete success was achieved in 100% within the third month but decreased to 22.5% (complete) and 74.1% (qualified) at the first year. In the other group (without bevacizumab group), complete success was achieved in 94.7% within the third month but decreased to 15.8% (complete) and 84.2% (qualified) at the first year. CONCLUSION: Initial trabeculectomy with MMC and subconjunctival bevacizumab injection was found to have lower rates of complete success with relatively acceptable qualified success rates in the management of FHI-related glaucoma. Subconjunctival bevacizumab was not found to have additional effect to improve the surgical success.

The effect of topical latanoprost on corneal clarity; 1-year prospective study†.

Purpose: Quantitatively investigate the effects of topical latanoprost on the corneal optical density parameters by using Scheimpflug system. Materials and methods: New cases of primary open-angle glaucoma treated with topical latanoprost as first-line treatment were enrolled in this prospective study. Corneal densitometry measurements obtained with the Scheimpflug system (Pentacam; Oculus, HR) at baseline and 1st, 3rd, 12th months after topical latanoprost treatment. For densitometry analysis, the 12-mm diameter area of the cornea was subdivided into 4 concentric radial zones and also into anterior, central, and posterior layers based on corneal depth. Pre and post-treatment values were compared statistically by a paired sample t-test. Results: The mean age of 18 female (66.7%) and 9 male (33.3%), totally 27 cases were 59.48 ± 10.1 years. There was no statistically significant difference between pretreatment and 1st-month post-treatment corneal densitometry values in all regions (p > 0.05 for all). Corneal densitometry values began to decline at 3rd month after treatment. The decrease continued until the 12th month of the beginning of the treatment and was significant in all zones except 2-6 mm of the anterior and central zones (p = 0.23, p = 0.08, respectively). Conclusion: Long-term administration of topical latanoprost may cause decrease in corneal densitometry measurements. Further prospective studies with a longer follow-up period are required to clarify the relationship between prostaglandin analogues and their effects on the cornea transparency.

Initial trabeculectomy with 5-fluorouracil with or without subconjunctival bevacizumab in the management of pseudoexfoliation glaucoma.

PURPOSE: To investigate the outcomes of trabeculectomy with 5-fluorouracil (5-FU) with or without subconjunctival bevacizumab in the surgical management of pseudoexfoliation glaucoma (PXG). METHODS: This retrospective study consisted of 49 cases with PXG who underwent initial trabeculectomy with 5-FU. The cases were divided into two age- and sex-matched groups. In 23 cases, subconjunctival bevacizumab was injected (1.25 mg/0.05 mL) at the end of the surgery and in 26 of them the surgery was performed without bevacizumab. The groups were evaluated for the postoperative differences of the intraocular pressure (IOP) and the number of the anti-glaucomatous medications. Independent t, Kolmogorov-Smirnov and Chi square tests were used for statistical analysis. RESULTS: The mean preoperative IOP was 30.91 ± 4.50 mmHg under the mean number of 2.4 ± 0.7 drops in bevacizumab group. The IOP decreased to 10.22 ± 2.63 mmHg (first week), 10.91 ± 1.88 mmHg (first month), 12.35 ± 2.5 mmHg (3rd month), 12.65 ± 2.35 mmHg (sixth month) and 12.7 ± 1.9 mmHg at the final visit. The mean preoperative IOP was 31.27 ± 5.60 mmHg under the mean number of 2.3 ± 0.7 drops in without bevacizumab group. The IOP decreased to 10.08 ± 2.59 mmHg (first week), 11.00 ± 1.87 mmHg (first month), 12.81 ± 2.04 (3rd month), 13.62 ± 2.21 mmHg (sixth month) and 12.9 ± 2.4 mmHg at the final visit. In both groups, IOP reduced significantly postoperatively. There were no significant differences between the preoperative and the postoperative IOP values. CONCLUSION: The additional benefit of single dose of intraoperative bevacizumab was not observed in trabeculectomy with 5-FU in PXG.

Comparison of anterior segment parameters and axial lengths of myopic, emmetropic, and hyperopic children.

PURPOSE: To compare the anterior segment parameters of myopic, hyperopic, and emmetropic children by using optical biometry. METHODS: This prospective cross-sectional study included 150 eyes of 150 children between 6 and 16 years old. The eyes were divided into three groups according to their spherical equivalent (SE) refractive error values as myopic [between - 1.0 and - 6.0 diopter (D)], emmetropic (between + 0.50 and - 0.50 D), and hyperopic (between + 1. 0 and + 3.0 D). Axial length (AL), central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), and mean keratometry (K mean) measurements were obtained by an optical biometry (LenStar LS 900, Haag Streit Diagnostics) were compared between the groups. RESULTS: There were no statistically significant differences regarding the ages and genders of the participants between the groups (p > 0.05). The mean SE refractive error values were - 2.20 ± 0.71 D in myopic, - 0.08 ± 0.49 D in emmetropic, and + 2.06 ± 0.53 D in hyperopic eyes. The mean AL values were 24.50 ± 0.69, 23.41 ± 0.61, and 22.33 ± 0.61 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean ACD values were 3.94 ± 0.22, 3.78 ± 0.23, and 3.45 ± 0.20 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). The mean LT values were 3.56 ± 0.20, 3.43 ± 0.17, and 3.31 ± 0.12 mm, respectively, in myopic, emmetropic, and hyperopic eyes (p < 0.001). There were no significant differences in the other parameters between the groups. CONCLUSIONS: Refractive errors are the main factors those affect anterior segment parameters and AL in children and the most severely affected parameters were found to be the AL, ACD, and LT values.

The effect of trabeculectomy on serum brain-derived neurotrophic factor levels in primary open-angle glaucoma.

PURPOSE: We aimed to investigate the effect of trabeculectomy on serum brain-derived neurotrophic factor (BDNF) levels. Our secondary goal was to compare serum and aqueous humor (AH) BDNF levels in primary open-angle glaucoma (POAG) and control subjects. METHODS: This prospective, cross-sectional study consists of 20 eyes of with advanced-stage POAG who had trabeculectomy and 19 eyes of age- and sex-matched control healthy subjects who had cataract surgery. Serum and AH samples were obtained preoperatively in trabeculectomy group and control subjects. Serum samples were obtained at the third postoperative month in both groups. RESULTS: The aqueous humor and serum levels of BDNF at the surgery day were found to be strongly positive correlated (r = 0.868; p < 0.001). Serum and AH BDNF levels of POAG cases were significantly lower than control subjects at the surgery day (respectively p = 0.038, p = 0.011). In POAG cases, serum BDNF levels significantly increased at the third month after trabeculectomy while there was not a significant difference in control subjects with cataract surgery (p < 0.001; p = 0.717 respectively). CONCLUSION: Trabeculectomy was found to have a positive effect on serum BDNF levels in POAG cases.