Patients satisfaction and clinical outcomes of binocular implantation of a new trifocal intraocular lens.

PURPOSE: To evaluate the clinical outcomes following bilateral implantation of PanOptix intraocular lens (IOL). METHODS: This study included consecutive patients scheduled to undergo cataract or refractive lens exchange surgery between October 2017 and June 2018 at two centers. Manifest refraction, uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA, 60 cm) and uncorrected near visual acuity (UNVA, 40 cm), defocus curves, presence of dysphotopsia, need for spectacles, presence of posterior capsule opacification and visual function were evaluated at 6 months after surgery. RESULTS: The IOL was implanted in 138 eyes of 69 patients. The mean binocular UDVA was 0.02 ± 0.05 logMAR, UIVA 0.06 ± 0.07 logMAR and UNVA 0.05 ± 0.07 logMAR. Defocus curve showed two peaks at 0.00 D and - 1.50 D. Complete spectacle independence was reported in 94.2% of the patients. The mean VF-14 test result was 97.7 ± 2.2 (93.2-100). Only one patient (1.4%) reported seeing bothersome halos. The presence of posterior capsule opacification was noted in seven eyes (10%), whereas Nd:Yag capsulotomy was required only in one eye. CONCLUSIONS: This trifocal IOL provided excellent visual outcomes at all distances with high spectacle independence and patient's satisfaction.

Subconjunctival bevacizumab in the impending recurrent pterygia.

The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5 mg/0.1 mL) were included in the study. Anterior segment photographs were taken prior to and at 1 week, 1, 3 and 6 months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2 ± 6.2 (31-60 years) and 16.8 ± 3.1 (12-22 months), respectively. The average number of injections was 2 ± 0.78 (1-3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1 week, 1, 3 and 6 months after the injection (p < 0.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery.

Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis.

Importance: Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic, sight-threatening inflammatory ocular surface disease. Due to the lack of unified terminology and diagnostic criteria, nonspecific symptoms and signs, and the challenge of differentiation from similar ocular surface disorders, PBKC may be frequently unrecognized or diagnosed late. Objective: To establish a consensus on the nomenclature, definition, and diagnostic criteria of PBKC. Design, Setting, and Participants: This quality improvement study used expert panel and agreement applying the non-RAND modified Delphi method and open discussions to identify unified nomenclature, definition, and definitive diagnostic criteria for PBKC. The study was conducted between September 1, 2021, and August 14, 2022. Consensus activities were carried out through electronic surveys via email and online virtual meetings. Results: Of 16 expert international panelists (pediatric ophthalmologists or cornea and external diseases specialists) chosen by specific inclusion criteria, including their contribution to scientific leadership and research in PBKC, 14 (87.5%) participated in the consensus. The name proposed was "pediatric blepharokeratoconjunctivitis," and the agreed-on definition was "Pediatric blepharokeratoconjunctivitis is a frequently underdiagnosed, sight-threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring." The diagnostic criteria included 1 or more suggestive symptoms accompanied by clinical signs from 3 anatomical regions: the eyelid margin, conjunctiva, and cornea. For PBKC suspect, the same criteria were included except for corneal involvement. Conclusions and Relevance: The agreements on the name, definition, and proposed diagnostic criteria of PBKC may help ophthalmologists avoid diagnostic confusion and recognize the disease early to establish adequate therapy and avoid sight-threatening complications. The diagnostic criteria rely on published evidence, analysis of simulated clinical cases, and the expert panel's clinical experience, requiring further validation with real patient data analysis.

Management of facial disfigurement in orbitotemporal neurofibromatosis.

A 19-year-old woman with type I neurofibromatosis requested reconstruction of her severe facial disfigurement caused by the plexiform neurofibroma of the right upper eyelid. Previously, she had glaucoma surgery for buphthalmus and enucleation with dermis fat transplantation. She was unable to wear prosthesis in the last year. Transverse palpebral resection of the lesion, lateral canthal reconstruction, and frontal sling ptosis surgery were performed at the same session. Postoperatively, the cosmetic appearance of the patient was markedly improved. No complication or progression was observed during 2 years follow-up. We believe that an individual-based surgical plan may give acceptable results in these challenging cases.

Successful treatment of necrotizing scleritis after conjunctival autografting for pterygium with amniotic membrane transplantation.

PURPOSE: To report a case of necrotizing scleritis after pterygium surgery with conjunctival autografting (CA) and intraoperative Mitomycin C (MMC) and its treatment with amniotic membrane transplantation (AMT) and systemic steroid. METHODS: A 41-year-old woman who had recurrent nasal pterygium underwent pterygium excision with CA and intraoperative MMC. Two weeks after surgery, graft necrosis and necrotizing scleritis associated with severe pain and irritation were observed on her operated eye. RESULTS: Pulse steroid treatment (intravenous 1 g methylprednisolone for 3 days) was initiated and AMT was performed for ocular surface reconstruction. Over the next 2 weeks, the graft vascularization was complete and there was no complication which required further treatment. CONCLUSIONS: Necrotizing scleritis is a rare complication of CA with MMC. Systemic steroid therapy is necessary for subsiding ocular inflammation and AMT can be performed for ocular surface reconstruction.

Nasolacrimal duct obstruction: clinicopathologic analysis of 205 cases.

PURPOSE: To investigate the histopathological results of lacrimal sac biopsies in patients with primary acquired nasolacrimal duct obstruction. METHODS: In this prospective non-comparative study, 205 consecutive patients, who were diagnosed as primary acquired nasolacrimal duct obstruction, were included. Patients with history of trauma and/ or surgery in the periorbital area, punctum or canalicular obstruction were excluded from the study. Patients were evaluated for age, gender, history, and presenting symptoms. Lacrimal drainage system abnormalities were assessed. Lacrimal system irrigation, dacryocystography, and in selected cases dacryoscintigraphy was performed. All patients underwent external dacryocystorhinostomy. Biopsy specimens were obtained from the posterior inferior flap and examined by the same pathologist. RESULTS: Forty-seven male and 158 females with age ranging from 6 to 81 years (mean 47.5 ± 16.2 years) were included in the study. Only one patient had the diagnosis of chronic leukemia, others had no preexisting history of systemic disease. Pathologic examination revealed chronic inflammation (n= 178), fibrosis without inflammation (n= 19), normal mucosa (n= 4), and lymphoid hyperplasia (n= 1). Three patients had abnormal pathology: Lymphoproliferative disease in the patient with chronic leukemia, granulomatous inflammation, and basosquamous cell carcinoma. CONCLUSION: In primary nasolacrimal duct obstruction, pathological examination of the lacrimal sac revealed chronic inflammatory changes in most patients. Even though rare, malignant or systemic disease in patients with neither specific history nor clinical or radiological finding might be observed in these cases. Thus, we recommend taking biopsy if any suspicion of abnormality of the lacrimal sac exists.

Bilateral acute depigmentation of the iris: report of 26 new cases and four-year follow-up of two patients.

PURPOSE: To report new cases of bilateral acute depigmentation of the iris (BADI), a recently described clinical entity, and to report the 4-year follow-up of 2 patients that was published previously. DESIGN: A retrospective case series. PARTICIPANTS: Twenty-six Turkish patients who were diagnosed with BADI between 2006 and 2008 and 2 patients who were reported previously. METHODS: We reviewed the patients' charts and clinical photographs. Observation procedures included clinical examination, anterior segment color photography, laser flare photometry, and pupillometry. We performed an anterior chamber tap in 2 patients for polymerase chain reaction (PCR) to demonstrate the DNA of herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in the aqueous samples. MAIN OUTCOME MEASURES: Demographic features, presenting symptoms, laboratory findings, changes in iris stromal pigment and architecture, and time to resolution of pigment dispersion in the anterior chamber. RESULTS: Nineteen patients were female, and 7 patients were male. Mean age was 32.3+/-8.6 years. All had bilateral involvement. Twenty patients (76.9%) presented with photophobia and red eyes, and 4 patients (15.4%) presented with a recent change in eye color. Ten patients (38.5%) had flu-like symptoms preceding the onset of ocular symptoms. Diagnostic laboratory workup, viral serology, and PCR analysis of the aqueous humor were unrewarding. Diffuse depigmentation of the iris stroma from the collarette to the iris root was seen in 16 patients, and geographic areas of depigmentation were seen in 10 patients. There was heavy pigment deposition in the trabecular meshwork in all patients. Anterior chamber flare was elevated in eyes with circulating pigment. The pupil was not affected. Twenty patients received topical corticosteroids. Pigment dispersion resolved in 1 to 16 weeks (median, 9 weeks). The intraocular pressure was elevated in 8 steroid-treated eyes but was controlled with antiglaucomatous medications. In 2 patients reported previously, the depigmented iris stroma became repigmented after 4 years. CONCLUSIONS: Patients with BADI present with bilateral, symmetrical, nontransilluminating depigmentation of the iris stroma and pigment discharge into the anterior chamber. Young female persons are more commonly affected. The cause remains unknown. After 4 years, the ocular findings in 2 patients normalized.

Clinical factors associated with floppy iris signs: a prospective study from two centers.

BACKGROUND AND OBJECTIVE: To evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, and alpha-1 adrenergic blocker (A1AB) use. PATIENTS AND METHODS: Five hundred patients were included in this prospective study. Intraoperative adverse events, such as pupillary constriction, iris billowing, and iris prolapse from the wound, were noted. Multinomial regression analysis was used to evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, pupil diameter, and A1AB use. RESULTS: Pupil constriction was significantly associated with pseudoexfoliation (P < .001). Diabetes mellitus was associated with pupil constriction and iris billowing (P = .005 and .003, respectively). Hypertension was associated with pupil constriction (P = .021). Intraoperative floppy iris syndrome was strongly associated with A1AB use and male gender (P < .001 and .039, respectively). CONCLUSION: Intraoperative floppy iris syndrome was observed in 2.8% of patients and was strongly related to A1AB use, particularly in smaller pupil diameters. Pseudoexfoliation, diabetes mellitus, and hypertension were not associated with intraoperative floppy iris syndrome.

p53 expression in pterygium in two climatic regions in Turkey.

PURPOSE: To assess accumulation of p53 protein in samples of primary pterygium from people living in two different climatic regions in Turkey. MATERIALS AND METHODS: Group 1 included 101 pterygium specimens from people in Adana located in southern Turkey. Group 2 included 39 pterygium specimens from people in Ankara, located in the middle of Turkey. Climatic conditions throughout the year are sunnier and warmer in Adana than they are in Ankara. The control group (Group 3) included 30 specimens of conjunctiva that had been excised during cataract surgery from 30 patients without pterygium. The pterygial specimens and control conjunctiva were studied by immunohistochemistry using antibodies against p53 protein. Pearson's chi-square test was used to compare the p53 immunoreactivity. RESULTS: The p53 immunoreactivity in Groups 1 and 2 was greater than it was in the control group ( P 0.001). There were no differences in p53 immunoreactivity between Groups 1 and 2 ( P= 0.060). CONCLUSION: The p53 immunoreactivity was not correlated with ultraviolet irradiation exposure. The p53 immunoreactivity in our pterygium specimens suggests that pterygium could be a result of uncontrolled cell proliferation.

Comparison of Mix-and-Match Implanted Bifocal IOLs and Bilateral Implanted Trifocal IOLs After Femtosecond Laser-Assisted Cataract Surgery.

PURPOSE: To compare the visual performance of mix-and-match implanted bifocal intraocular lenses (IOLs) and bilateral implanted trifocal IOLs from the same manufacturer with the same IOL platform after femtosecond laser-assisted cataract surgery (FLACS). METHODS: This prospective, comparative, non-randomized study included patients who underwent FLACS (LenSx; Alcon Laboratories, Inc., Fort Worth, Texas) with bilateral implantation of bifocal IOLs (ReSTOR +2.50 D/+3.00 D; Alcon Laboratories, Inc.) or trifocal IOLs (PanOptix; Alcon Laboratories, Inc.). Visual acuities, manifest refraction, defocus curve, contrast sensitivity, quality of life measured by the Visual Function Index (VF-14), and spectacle independence were assessed at 6 months after surgery. RESULTS: A total of 70 eyes of 35 patients were included in this study. There was no difference in patient demographics and preoperative measurements between groups (P > .05). There was no difference in uncorrected distance visual acuity and corrected distance visual acuity outcomes between groups (P > .05), but uncorrected intermediate visual acuity and uncorrected near visual acuity outcomes were significantly better in the PanOptix group (P < .01). Correspondingly, the binocular defocus curve of the PanOptix IOLs showed significantly better visual acuity between -1.00 and -3.00 diopters compared to the ReSTOR IOLs (P < .05). The PanOptix group showed higher contrast sensitivity scores than the ReSTOR group for 12 and 18 spatial frequencies in photopic conditions and for 18 spatial frequencies in mesopic conditions (P < .05). The average VF-14 score was similar between groups (P = .78). None of the patients required spectacles. CONCLUSIONS: Bilateral implanted PanOptix IOLs seem to provide better intermediate and near vision, defocus curve, and contrast sensitivity compared to mix-and-match implanted ReSTOR IOLs. However, similar vision-related quality of life and spectacle independence were achieved with both IOLs. [J Refract Surg. 2019;35(9):559-564.].

Role of corneal nerves in ocular surface homeostasis and disease.

Corneal nerves are key components of the physiological system that controls ocular surface homeostasis. The cornea is primarily innervated by the ophthalmic branch of the trigeminal nerves (cranial nerve V), which distend bilaterally from the pons. The nasociliary branch (afferent) of the ophthalmic nerve is sensory for cornea, eyelid and conjunctiva. These nerve fibres play a role in sensing temperature, chemical and mechanical stimuli, and pain, whereas, branches of the facial nerve (cranial nerve VII) contain motor nerves that control blinking and autonomic (sympathetic and a paucity of parasympathetic) fibres that stimulate tear production and secretion via feedback loops between the ocular surface, lacrimal glands and brain. Disruption of these nerves with interruption of neural feedback loops between the ocular surface and lacrimal glands can lead to corneal diseases such as dry eye disease (DED) and neurotrophic keratopathy (NK). Inversely, hypersensitivity of the nerve fibres and/or dysregulation of pain-controlling nervous centres may lead to neuropathic pain. Recently, medications that specifically target regeneration of corneal nerves have started to become available - and considering the high prevalence of diseases associated with corneal nerve dysfunction, these agents promise to fulfil a hitherto important unmet need. In this review, we explore the physiology of corneal nerves, the pathology of corneal nerve diseases and how these relate to neuropathic pain, NK and DED. We also discuss what novel treatments may be useful against diseases involving corneal nerves.

Controlled Adverse Environment Chambers in Dry Eye Research.

Dry eye disease (DED) is a common condition with signs and symptoms that vary depending on a wide range of environmental factors to which people are exposed in their daily lives. Factors such as variable temperature, airflow velocity, relative humidity, seasonality, and pollutants can alter the rate of tear film evaporation, improving or exacerbating symptoms of DED. Results from currently available clinical tests do not always correlate well with patient-reported symptoms, and the continually changing environment and variability in DED symptoms present challenges for the design and conduct of clinical trials. Controlled adverse environment chambers allow standardization of temperature, humidity, and airflow and may minimize potential confounding factors in clinical investigations. Their use can promote accurate study of the pathophysiology of DED, discovery of disease biomarkers, and assessment of the effect of various therapeutic approaches on patients' symptoms. Controlled adverse environment chambers have been used to simulate indoor surroundings such as airplane cabins and to test their effects on contact lens wearers. This review summarizes how these chambers may be useful for the development, approval, and differentiation of potential new treatments for DED.

Vascularization is more delayed in amniotic membrane graft than conjunctival autograft after pterygium excision.

PURPOSE: To monitor the development of graft vascularization by indocyanine green angiography (ICGA) after pterygium excision with limbal-conjunctival autograft transplantation (LCAT) and amniotic membrane transplantation (AMT). DESIGN: Randomized prospective interventional case series. METHODS: Anterior segment ICGA findings at one, seven, and 30 days after surgery were evaluated in eyes with primary pterygium treated by excision and LCAT (14 eyes of 14 patients) or AMT (13 eyes of 13 patients), and the results for graft vascularization were compared. RESULTS: All conjunctival autografts showed early vascularization from underlying episcleral vascular bed as multiple hyperfluorescent foci at the graft margin on postoperative day 7; graft vascularization was complete on postoperative day 30. In contrast, all grafts in AMT group showed no graft vascularization at any stage after pterygium surgery. This delay of vascularization with AMT persisted until one month after surgery. CONCLUSIONS: Anterior segment ICGA is useful to monitor graft vascularization after pterygium surgery. Graft health after LCAT may be demonstrated by early graft vascularization and perfusion; however, there is a delay in graft vascularization after AMT that may be related to the antiangiogenic effects of the membrane. Further study is needed to demonstrate the relationship between this delay of graft perfusion and early postoperative pterygium recurrence.

The effects of two systemic alpha1-adrenergic blockers on pupil diameter: a prospective randomized single-blind study.

Our aim was to investigate the effects of two alpha(1)-adrenergic blockers-tamsulosin and alfuzosin-on pupil diameter (PD). In this prospective randomized single-blind clinical trial, 64 patients with benign prostatic hyperplasia received treatment with either tamsulosin or alfuzosin. The same ophthalmologist, masked to the given medication, evaluated patients prior to, 4 weeks after and 6 months after the start of the medication (day 0, day 28 and month 6). Best corrected visual acuity and PD under mesopic, scotopic, and dilated conditions were measured. t-test, ANOVA, and Dunnett's multiple comparison post-test were used for statistical analysis. With tamsulosin treatment, both mesopic and scotopic PD decreased, respectively, from 3.9 +/- 0.7 and 5.7 +/- 0.6 mm at day 0 to 3.6 +/- 0.9 and 5.5 +/- 0.8 mm at day 28, and 3.6 +/- 0.7 and 5.4 +/- 0.7 mm at month 6 (ANOVA; P = 0.021 and = 0.040, respectively). However, the difference in dilated PD was not significant (day 0 7.8 +/- 0.6 mm, day 28 7.7 +/- 0.7 mm, and month 6 7.6 +/- 0.6 mm, P = 0.379). In the alfuzosin group, PD did not differ significantly from the baseline except for the scotopic measurements, which decreased from 5.6 +/- 0.6 mm at day 0 to 5.5 +/- 0.6 mm at day 28 and 5.2 +/- 0.8 mm at month 6 (P = 0.004). Compared to baseline values, small but statistically significant decreases were detected in mesopic and scotopic illumination in patients treated with tamsulosin and in scotopic PD in patients treated with alfuzosin. The clinical significance of these differences needs further evaluation.

Effect on astigmatism of the location of clear corneal incision in phacoemulsification of cataract.

PURPOSE: To investigate the refractive results of clear corneal incision performed at the steepest meridian of pre-existing corneal astigmatism. METHODS: One hundred eighty-two patients with astigmatism > 0.75 diopters (D) were evaluated. Superior, temporal, nasal, superotemporal, or superonasal clear corneal incisions were performed at the steep meridian. Refraction, visual acuity, and topography values were evaluated, and changes in surgically induced astigmatism were calculated by vector analysis using the Fourier formula. Paired t test was used to compare mean values. RESULTS: Postoperative cylinder values showed minor changes in all groups, except the nasal group. Nasal incision increased preoperative cylinder from 1.13 D to 1.83 D 6 months after surgery. Temporal and superotemporal incisions resulted only in small astigmatic changes. Conversely, superior, superonasal, and nasal incisions induced more pronounced astigmatism. CONCLUSIONS: Performing clear corneal incision for phacoemulsification of cataract at the steep meridian resulted in small changes with temporal incisions, whereas nasal incisions resulted in higher surgically induced astigmatism.

Efficiency of Rarebit perimetry in the evaluation of homonymous hemianopia in stroke patients.

AIMS: To compare the efficiency of Rarebit perimetry and the Humphrey field analyser (HFA) in detecting the homonymous hemianopia in stroke patients with occipital lobe infarcts. METHODS: 40 patients who suffered from visual complaints caused by acute occipital lobe infarcts underwent visual field analysis on the same day, in random order-first with either Humphrey perimetry 30-2, SITA standard program (Zeiss Humphrey Systems) or Rarebit perimetry. A visual field was classified into four quadrants for right and left eyes: superior temporal, superior nasal, inferior temporal, and inferior nasal. The entire mean hit rate numbers (MHR) and mean deviation and pattern standard deviation (PSD) values were compared for each quadrant of each eye. RESULTS: The results of Rarebit MHR and HFA mean deviation values for each quadrant of the right and left eyes were highly correlated in all patients with homonymous hemianopia (Pearson's r correlation coefficients for superior temporal, superior nasal, inferior temporal and inferior nasal quadrants of right and left eyes were 0.827, 0.833, 0.843, 0851 and 0.746, 0821, 0882, 0.824, respectively (p<0.001 for all quadrants)). There was a strong correlation between Rarebit MHR and HFA PSD for each quadrant of both eyes. CONCLUSIONS: Rarebit perimetry is rapid, reliable, and easily performed in patients with homonymous hemianopia. It can be done using a simple software program and simple hardware and it readily detects severe visual loss in patients with occipital lobe lesions.

Regression of neovascular posterior capsule vessels by intravitreal bevacizumab.

We present a 76-year-old woman who developed neovascularization of the posterior capsule 1 year after extracapsular cataract extraction. She had type 2 diabetes for 15 years, with proliferative diabetic retinopathy that had been treated with panretinal photocoagulation. The neovascular vessels on the posterior capsule originated from existing rubeosis iridis and regressed after a single injection of intravitreal bevacizumab (Avastin). The patient's visual acuity increased to 20/40 after an uneventful neodymium:YAG capsulotomy.

Comparison of conjunctival autograft with amniotic membrane transplantation for pterygium surgery: surgical and cosmetic outcome.

PURPOSE: To compare the clinical results of conjunctival autograft and amniotic membrane transplantation (AMT) for primary and recurrent pterygium excision. In an effort to determine whether AMT yields acceptable cosmetic results as conjunctival autografting in pterygium surgery, we compared the final cosmetic outcomes of these 2 techniques. METHODS: We performed a prospective, randomized clinical study of 78 eyes (78 patients) divided into 2 groups. Forty eyes (28 with primary and 12 with recurrent pterygia) received conjunctival limbal autograft (group 1), and 38 eyes (27 with primary and 11 with recurrent pterygia) received AMT (group 2) after extensive removal of pterygium. Mean follow-up time was 16.6 +/- 3.52 months in group 1 and 13.4 +/- 2.08 months in group 2. The results were evaluated by clinical examination and photographing and final appearances were graded from 1 to 4. Grade 4 represented true recurrence, whereas grade 3 indicated unacceptable cosmetic appearance. RESULTS: Recurrence rates of primary, recurrent, and all pterygia in group 1 and group 2 were 3.6%, 16.7%, and 7.5% and 3.7%, 18.2%, and 7.9%, respectively. There was no significant difference in recurrence rates between the 2 groups (P = 1.00 for all). The rates of final appearance as grade 3 were 10.0% in group 1 and 21.1% in group 2, and the difference was statistically significant (P = 0.048). No major complications occurred during the follow-up period. CONCLUSIONS: Although better results in the final appearance were achieved using conjunctival autografting than with AMT, AMT can be a useful alternative in pterygium surgery, especially in those patients who may have a limited amount of conjunctiva for future surgeries.

The effects of systemic alpha-1 adrenergic antagonists on pupil diameter in rats.

PURPOSE: To investigate the effects of alpha-1 adrenergic blockers on pupil diameter (PD) in rats. METHODS: Four groups, with 10 rats each, were designed to receive terazosin, tamsulosin, doxazosin, and no medication. Dilated pupil diameter (PD) measurements were performed 24 hr before, 24 hr after, and 30 days after the initiation of medication, and after 30 days of washout. The intergroup and intragroup differences in PD were evaluated using one-way ANOVA and Wilcoxon signed rank test, respectively. RESULTS: In day 1, PD decreased in both eyes significantly only in tamsulosin and doxazosin groups, but these effects became insignificant at 30 days of treatment (p > 0.05). The control group showed no significant difference in PD (p > 0.05). PD values returned to baseline after the washout period in all groups. CONCLUSIONS: A significant reduction in PD occurred in two of the three groups with alpha-1 adrenergic blockers (tamsulosin and doxazosin), but this effect was not sustained at 30 days. Further functional and structural studies of the iris are needed to determine the clinical significance of these findings.

Evaluation of ocular surface changes in a rabbit dry eye model using a modified impression cytology technique.

PURPOSE: To evaluate the ocular surface changes in a rabbit dry eye model by using a modified impression cytology technique. METHODS: Nitrocellulose filter paper with a pore diameter of 0.45 microm was used to collect the specimens from 12 rabbits that were injected with atropine every day for 3 days. Filter papers were kept in distilled water overnight and then dried to increase cell pickup. Samples were stained with periodic acid-Schiff. The mean temporal and superior bulbar conjunctival goblet cell densities were counted. The data were compared with transmission (ocular surface) and scanning electron microscopic (filter paper) examination of the ocular surface. RESULTS: In the acute stage of atropine injection, there was not a major change in the goblet cell count. Although the goblet cell distribution was variable over the ocular surface, the average cell density was 55.4+/-22 in the superior quadrant and 69.2+/-9 in the temporal quadrant. In the 3-day atropine-injection group, there was a marked decrease in goblet cells, and there was mucin accumulation rather than accumulation of the goblet cells. No morphologic differences could be observed with scanning electron microscopy between the regular nitrocellulose filter paper and the paper kept in distilled water. CONCLUSIONS: The findings indicate that keeping the filter paper in distilled water and then drying it improves cell pickup and ocular surface evaluation in rabbits.