Lower Body Mass Index and Prognostic Nutritional Index Are Associated with Poor Posttransplant Outcomes in Lymphoma Patients Undergoing Autologous Stem Cell Transplantation.

INTRODUCTION: Pretransplant inflammatory and nutritional status has not been widely explored in terms of its impact on autologous hematopoietic stem cell transplantation (auto-HSCT) outcomes in lymphoma patients. We aimed to evaluate the impact of body mass index (BMI), prognostic nutritional index (PNI), and C-reactive protein to albumin ratio (CAR) on auto-HSCT outcomes. METHODS: We retrospectively analyzed 87 consecutive lymphoma patients who underwent their first auto-HSCT at the Adult Hematopoietic Stem Cell Transplantation Unit at Akdeniz University Hospital. RESULTS: The CAR had no impact on posttransplant outcomes. PNI ≤50 was an independent prognostic factor for both shorter progression-free survival (PFS) (hazard ratio [HR] = 2.43, p = 0.025) and worse overall survival (OS) (HR = 2.93, p = 0.021), respectively. The 5-year PFS rate was significantly lower in patients with PNI ≤50 than in patients with PNI >50 (37.3% vs. 59.9%, p = 0.003). The 5-year OS rate in patients with PNI ≤50 was significantly low when compared with patients who had PNI >50 as well (45.5% vs. 67.2%, p = 0.011). Patients with BMI <25 had higher 100-day transplant-related mortality compared with patients with BMI ≥25 (14.7% vs. 1.9%, p = 0.020). BMI <25 was an independent prognostic factor associated with shorter PFS and OS (HR = 2.98 [p = 0.003], HR = 5.06 [p < 0.001], respectively). The 5-year PFS rate was significantly lower in patients with BMI <25 than patients with BMI ≥25 (40.2% vs. 53.7%, p = 0.037). Similarly, the 5-year OS rate in patients with BMI <25 was significantly inferior compared to patients with BMI ≥25 (42.7% vs. 64.7%, p = 0.002). CONCLUSION: Our study confirms that lower BMI and CAR have negative impacts on auto-HSCT outcomes in lymphoma patients. Furthermore, higher BMI should not be considered an obstacle for lymphoma patients who need auto-HSCT; conversely, it could be an advantage for posttransplant outcomes.

Outcomes of stem cell mobilization and engraftment in patients with multiple myeloma according to CD56 expression status.

BACKGROUND: The molecular mechanism underlying the mobilization and engraftment of CD34+ cells is poorly understood. The most relevant factors in the regulation of stem cell release and engraftment include chemokines, adhesion molecules, and chemokine receptors. Previously, it was suggested that the absence of CD56 expression could be used as a predictive factor for mobilization failure at the time of diagnosis. Here, we investigated the effect of CD56 expression status on both mobilization and engraftment processes. Additionally, other factors affecting mobilization and engraftment efficacy were investigated. METHODS: Data from 79 multiple myeloma patients undergoing autologous stem cell transplantation between 2015 and 2020 were analyzed for peripheral stem cell mobilization and posttransplant neutrophil and platelet engraftment according to CD56 expression on myeloma cells. RESULTS: No difference in either the median number of CD34+ cells collected or time to engraftment was found between the CD56+ and CD56- groups. The age of the patients (p = 0.025) and peak number of circulating CD34+ cells in peripheral blood (p = 0.005) were important predictors for a higher number of collected CD34+ cells. The average time to recovery of leukocytes and platelets after transplantation was markedly correlated with the number of transplanted stem cells and peak number of circulating CD34+ cells in peripheral blood, respectively (p = 0.049 and p = 0.003). CONCLUSIONS: Our results indicated no effect of CD56 expression status on the mobilization and engraftment of PBSCs. Our results also support the notion that the peak number of circulating CD34+ cells in peripheral blood is clinically important for rapid platelet engraftment following HPC transplantation.

Recurrent arthritis as an unexpected side effect associated with azacitidine in a patient with myelodysplastic syndrome.

INTRODUCTION: Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. CASE REPORT: We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. MANAGEMENT AND OUTCOMES: The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. DISCUSSION: Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA.

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.

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.

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.

Change in Accommodation and Ocular Aberrations in Keratoconus Patients Fitted With Scleral Lenses.

PURPOSE: To evaluate the accommodative response to different accommodative stimulus and to determine the changes in ocular higher-order aberrations with accommodation in keratoconus patients fitted with mini scleral lenses. MATERIAL AND METHODS: The study included 15 keratoconus patients wearing mini scleral lenses (Misa Scleral Lens-Microlens, Arnhem, the Netherlands) and 15 keratoconus patients wearing rigid gas permeable lenses. Hartmannn Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) was used for the evaluation of accommodation. Accommodative responses to the accommodative stimulus ranging from 0.5 to 5.0 diopters (D) with intervals of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total higher-order aberrations (HOAs, third to sixth orders) at baseline, at 2.5 D stimulus, and at 5 D stimulus were also recorded. RESULTS: Although accommodative response to accommodative stimulus of 0.5 to 2.5 D (with 0.5 D intervals) was similar in both groups, accommodative response to accommodative stimulus of 3.0 to 5.0 D was significantly lower in keratoconus group wearing mini scleral lenses. The coma, spherical, trefoil aberrations, and the RMS of total HOAs at baseline, at 2.5 D stimulus, and at 5 D stimulus were not significantly different between the groups. However, changes in the coma and trefoil aberrations and RMS of total HOA with 2.5 D and 5.0 D stimulus were significant only in the RGP group. CONCLUSIONS: Accommodative response to increasing accommodative stimulus was found to be impaired in keratoconus patients wearing mini scleral lenses.

Surgical outcomes of patients with iridocorneal endothelial syndrome: a case series.

The purpose of this study is to report the intermediate-term surgical outcomes of patients with iridocorneal endothelial syndrome-related glaucoma. The medical records of four patients (five eyes) surgery (Ahmed glaucoma valve implantation surgery and EX-PRESS mini shunt) were retrospectively reviewed. Median follow-up after glaucoma surgery was 24 (15-36) months. The preoperative intraocular pressure was significantly reduced from a median of 33 (22.5-36) mmHg on a median of 4 (4-5) glaucoma medications to a median of 12 (10.5-14.5) mmHg on a median of 2 (0-2) medications at last follow-up after surgery (p = 0.043 for IOP and p = 0.042 for glaucoma medications). Median preoperative visual acuity [0.016 (0.008-0.1)] did not change significantly when compared to median visual acuity at last follow-up [0.016 (0.004-0.5)] (p = 0.59). Intraocular pressure control in patients with iridocorneal endothelial syndrome is challenging and may require multiple operations and revisions. Some modifications during glaucoma drainage implant surgery and use of EX-PRESS mini shunt in certain cases could offer an advantage in these patients.

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.

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.

Complications of therapeutic plasma exchange: A retrospective, single-center study of 2505 procedures performed in 338 patients over 15 years.

INTRODUCTION: Therapeutic plasma exchange (TPE) may involve complications. We aimed to review the demographic data, indications, technical information, and complications. METHODS: Data for TPE procedures (TPEPs) performed between 2004 and 2018 were retrospectively. RESULTS: This study covered 2505 TPEPs performed on 338 patients; 55% of them were female (n = 186), and the median age was 36 years (range, 11-93 years). Most TPEPs were administered for hematological (40.6%) indications. The incidence of complications on the first procedure was 3.2% (n = 80); only 16 procedures (0.6%) were failed. The complication incidence was 19.8% (n = 497), with 789 total complications. Most of the complications were patient-related (90.4%), and the most of them were urticaria (29.1%), occlusion (3.2%), and faulty systems (1.01%), respectively. The use of only fresh frozen plasma as replacement fluid caused a higher complication rate (22.1%, p < 0.01). CONCLUSION: The number of TPEPs is increasing every day. Hematologic indications for TPE and the use of fresh frozen plasma may increase the risk of complications.

The Prevalence of Positive Donor Corneoscleral Rim Culture and its Association with Ocular Infection After Transplantation.

Objectives: The aim of the study was to determine the prevalence of positive corneoscleral donor rim cultures and to report keratitis and endophthalmitis after keratoplasty. Methods: Eye bank records and medical records of patients who underwent keratoplasty between September 1, 2015, and December 31, 2019, were retrospectively reviewed. Patients who had routine donor-rim culture taken during surgery and followed up for at least 1 year in the post-operative period were included in the study. Results: A total of 826 keratoplasty procedures were performed. A total of 120 (14.5%) cases had a positive donor corneoscleral rim culture. Positive bacterial cultures were obtained from 108 (13.7%) of the donors. Bacterial keratitis was observed in one patient (0.83% of recipients) who had a positive bacterial culture. Positive fungal cultures were obtained from 12 (1.45%) donors, of whom one (8.33% of recipients) developed fungal keratitis. Endophthalmitis was observed in one patient whose culture result was negative. Both bacterial and fungal culture results were similar in penetrating and lamellar surgical procedures. Conclusion: Although the donor corneoscleral rims have a high positive culture result, the rate of bacterial keratitis and endophthalmitis is low, the risk of infection is high in patients with a fungal positive donor rim. Closer follow-up of patients with fungal positive donor corneo-scleral rim result and initiation of aggressive antifungal treatment when infection occurs will be beneficial.

Simultaneous posterior eyelid ptosis repair and strabismus surgery: a single-stage approach.

PURPOSE: Blepharoptosis with coexisting strabismus can be observed in adults, and both these conditions affect cosmetic appearance and have psychosocial effects. Both also commonly require surgery, which is typically performed using a sequential approach. This study aimed to evaluate the efficacy of simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and strabismus surgery in adult patients with ptosis and coexisting strabismus. METHODS: Patients with ptosis and coexisting strabismus who underwent simultaneous Müller's muscle-conjunctival resection with or without tarsectomy and horizontal strabismus surgery were retrospectively evaluated. Analysis included measurement of the angle of deviation in prism diopters, margin reflex distance, eyelid height asymmetry, and complications following surgery. Success of Müller's muscle-conjunctival resection with or without tarsectomy was defined as a margin reflex distance of ≥3.5 and ≤5 mm with a difference between the two upper eyelids of <1 mm. Strabismus success was defined as alignment with ±10 prism diopters of orthotropia. RESULTS: The patients comprised three women and five men with a mean age of 37.12 years (range, 22-62 years). The strabismus stage of the surgery was performed first in all patients. Upper eyelid symmetry outcomes were assessed as perfect (<0.5 mm) in four patients and good (≥0.5 mm, <1 mm) in four patients. Success of Müller's muscle-conjunctival resection with or without tarsectomy was achieved in six of eight patients (75%), and strabismus success was achieved in all patients. No revision eyelid or strabismus surgery was required following simultaneous surgery in any of the patients. CONCLUSION: Müller's muscle-conjunctival resection with or without tarsectomy combined with strabismus surgery may be an alternative approach for use in patients with ptosis and coexisting strabismus.

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.

Is it really important to form a big bubble in DALK to enhance the visual acuity?

OBJECTIVES: The aim of this study was to investigate the prognosis of visual acuity (VA) in the patients with keratoconus, who underwent deep anterior lamellar keratoplasty (DALK) with a successful big bubble or lamellar dissection. METHODS: Sixty-eight eyes of 60 patients with keratoconus, who underwent DALK using the big-bubble technique, were enrolled in this retrospective comparative study. The VA and refractive errors were assessed before the operation and, thereafter, at months 1, 3, 6, and 12 after the operation (1) in the patients who achieved a big-bubble formation, and in those who required layer-by-layer lamellar dissection (2) to reach the Descemet membrane. RESULTS: Successful big bubble was achieved in 50 eyes (73.5 %) (group 1), and lamellar dissection was performed in 18 eyes (26.5 %) (group 2). The mean follow-up period was 22.4±6.2 months in group 1 and 23.7±7.8 months in group 2 (P=0.562). Although best-corrected visual acuity (BCVA) values observed at months 1 and 3 were significantly higher in group 1 than in group 2 (P=0.016 and P=0.024, respectively), there was no statistically significant difference between the two groups for BCVA values observed at months 6 and 12 (P=0.412 and P=0.528, respectively). CONCLUSIONS: Although the visual recovery was delayed in the early postoperative follow-up because of residual stroma in lamellar dissection, the final results were comparable between the achievement of big-bubble formation and lamellar dissection.

Effects of contact lenses on the ocular surface in patients with keratoconus: piggyback versus ClearKone hybrid lenses.

OBJECTIVE: Because patients with keratoconus tend to wear contact lens for a long period of time, they are more prone to ocular surface changes induced by the lenses. This study aimed to compare immunohistochemical changes induced by two different types of contact lenses in patients with keratoconus. METHODS: Twenty-four contact lens-naive keratoconus patients (30 eyes) were included in this prospective study. Group 1 comprised 14 eyes (12 patients) wearing piggyback lenses, and group 2 comprised 16 eyes (12 patients) wearing ClearKone hybrid lenses. The patients were analyzed for bulbar conjunctival impression cytology, tear interleukin-6 (IL-6) and IL-8 levels, and confocal microscopic changes of the cornea before and 6 months after wearing contact lenses. RESULTS: Six months after wearing contact lenses, the groups demonstrated similar epithelial metaplasia rates, tear IL-6 and IL-8 levels, and similar confocal microscopy findings (P>0.05 for all intergroup comparisons). Among the parameters tested in this study, only IL-6 and IL-8 levels and posterior keratocyte density on confocal microscopy showed an increase after 6 months when compared with baseline values but at a similar degree in the two groups. CONCLUSIONS: This small sample was not able to demonstrate a difference between the two types of lenses with regard to the variables examined, and further larger trials would be required to determine if differences truly exist or not. However, clinicians may still consider patient comfort and vision in selecting the lens type in patients with keratoconus.

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.

Intravitreal dexamethasone implant results in the treatment of non-infectious uveitis.

OBJECTIVE: The objective of this study was to evaluate the efficacy of intravitreal dexamethasone implant in non-infectious uveitic macular edema. METHODS: Between April 2013 and February 2017, 27 eyes of 21 patients were included in the study at Haydarpasa Numune Training and Research Hospital. The files of patients who underwent intravitreal dexamethasone implantation for non-infectious uveitic macular edema and followed up at least 6 months were retrospectively reviewed. The patients were evaluated in terms of best-corrected visual acuity (BCVA) and central macular thickness (CMT) before and at the 1st, 3rd, and 6th months after injection and the need for re-injection. RESULTS: Twenty-seven eyes of 21 patients were included in the study. The mean age of the patients was 39.2±11.7 years. The mean monitoring time was 24.15±10.08 months. In patients who received single-dose intravitreal dexamethasone implant, the decrease in CMT measurements and improvement in BCVA measurements at 1, 3, and 6 months after injection compared to baseline was found to be statistically significant (p=0.001 for each). Recurrence was detected in 33.3% (n=9) of the cases during follow-up; in cases with recurrence, second implants were repeated after an average of 9.67±3.12 months. The third dexamethasone implantation was applied due to the second relapse of four cases from nine relapsing cases. Third implants were performed at an average of 12.50±4.79 months. During the follow-up period, the most common complications in our patients were cataract (37%) and increased intraocular pressure (40.7%). CONCLUSION: Intravitreal dexamethasone implantation is an effective and reliable treatment option in non-infectious uveitic macular edema. There was no difference between the first dose and re-implantations in terms of efficacy and safety.

Sarcoidosis Presenting with Bilateral Optic Disc Edema as the Initial Presentation.

Sarcoidosis is a chronic, progressive, granulomatous inflammatory disease of unknown etiology that affects multiple organ systems. Granulomatous anterior uveitis is the most common eye finding, and optic nerve involvement at presentation is rarely seen. Here, we report a 43-year man referred to our clinic with eye pain, decreased vision, floaters and bilateral papillitis, vitritis and cystoid macular edema. The level of serum angiotensin-converting enzyme, thoracic computed tomography and transbronchial needle aspiration biopsy of lymph nodes were confirmatory for sarcoidosis. In this case, sarcoidosis initially presented with bilateral papillitis and vitritis without granulomatous uveitis, and successful results were obtained with methylprednisolone and immunosuppressive treatment without any relapse or systemic involvement of sarcoidosis. Sarcoidosis should be considered in patients presenting with optic nerve inflammation, even when granulomatous inflammation or vasculitis are not present, which are specific for ocular sarcoidosis. Key Words: Edema, Optic disc, Papillitis, Sarcoidosis.