Improvement in levator function after anterior levator resection for the treatment of congenital ptosis.

PURPOSE: To evaluate the surgical outcome of levator resection in congenital ptosis, and to assess the change in levator function (LF) after surgery, as well as its effect on surgical outcomes. METHODS: The charts of patients who underwent an anterior levator resection for congenital ptosis between January 2010 and February 2013 were retrospectively reviewed. Preoperative and postoperative grades of blepharoptosis, margin-reflex distance, LF, and reoperation status were noted, and postoperative outcomes were evaluated. RESULTS: A total of 42 eyelids of 37 patients were included of which 32 eyelids (76.2%) had severe ptosis while 10 eyelids (23.8%) had moderate ptosis. The mean follow up was 11.0 ± 7.2 months. The overall success rate after initial surgery was 78.6%, and undercorrection was the leading course of surgical failure, with a rate of 14.3% (6 eyelids) at the final visit. Lagophthalmus and/or overcorrection occurred in 7.1% (3 eyelids) at the final visit, respectively. The mean preoperative LF was 6.8 mm ± 3.1 mm, which increased postoperatively to 8.7 mm ± 3.4 mm (p < 0.05) at month 1 and 9.6 mm ± 3.8 mm (p < 0.05) at the final visit. The mean LF improvement following surgery was 2.9 mm ± 2.2 mm. CONCLUSIONS: The levator resection surgery was observed to be an effective treatment for congenital ptosis, including severe ptosis with poor LF. Levator resection resulted in substantial improvement of postoperative levator muscle functioning, which might have an additive effect on the surgical success, especially for those with poor LF.

Does moxifloxacin alter oxidant status in the cornea? An experimental study.

OBJECTIVE: In this experimental study, we investigated the possible effects of intracameral moxifloxacin on oxidative stress parameters and endothelial cell morphology in corneal tissue. METHODS: In total, 30 rats were randomly assigned to three groups of 10 rats: the sham group (Group 1, n = 10); the control group (Group 2), where balanced salt solution (BSS) was administered at a dose of 0.01 cc (n = 10); and the treatment group (Group 3), where moxifloxacin was administered at a dose of 0.05 mg/0.01 cc (n = 10). Total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood samples were measured and the oxidative stress index (OSI) was calculated. Also, corneal tissue histopathology was evaluated with caspase-3 and caspase-8 staining. Apoptotic activity was also evaluated. RESULTS: In blood samples, TAS, TOS, and OSI levels were not statistically significantly different (all p > 0.05). Compared with the sham and control groups, TOS and OSI levels in cornea tissue were significantly different in the moxifloxacin group (all p < 0.05). However, compared with the control group, no statistically significant difference was found in the sham group (all p > 0.05). Compared with the sham and control groups, apoptotic activity was higher in the moxifloxacin group, in both immunohistochemical staining for caspase-3 and caspase-8. CONCLUSIONS: Intracameral moxifloxacin injection seems to be safe systemically, but it may have toxic effects on corneal tissues, as suggested by oxidative stress parameters and a histopathological evaluation.

Lacrimal gland prolapse in two cases of blepharochalasis syndrome and its treatment.

Blepharochalasis is a rare disorder characterized by recurrent non-painful eyelid edema, which leads to atrophy and stretching of the supporting connective tissue around the eye. As a consequence, prolapse of the lacrimal gland can occur which results in fullness in the temporal third of the upper eyelids and may cause visual field restriction or cosmetic blemish for patients. Thus, correct diagnosis is important to plan appropriate surgery and obtain a successful postoperative result. We present two young patients with lacrimal gland prolapse associated with blepharochalasis and report on their treatment.

Pupil occlusion due to a large dislocated Soemmering ring in an aphakic eye.

We report an 84-year-old female patient who presented to our clinic with a complaint of low vision in her right eye. She described an occasional foreign body-like object around the pupil area. She had a history of extracapsular cataract surgery without an intraocular lens implantation 20 years ago. The patient underwent surgery to remove the foreign body-like object after conducting necessary investigations before surgery. The histopathological features of the specimen were consistent with a Soemmering ring. However, a Soemmering ring does not usually reduce vision unless it is dislocated, as in this case. We report this unusual case to show that ophthalmologists can encounter unexpected cases that present with complications as a result of previous cataract surgery after a lengthy period of time.

A Comparison of Central Corneal Thicknesses Measured with Two Different Methods in Cases of Primary Open-Angle Glaucoma.

Accurate and repeatable measurement of the central cornea thickness (CCT) is important in terms of follow-up of glaucoma patients. The aim of this study was to compare CCT measurements made with an ultrasonic pachymeter (USP) and with the Spectralis Anterior Segment Module optical coherence tomography (OCT) device. The study included 52 eyes of 26 primary open-angle glaucoma patients. CCT measurements were taken with the USP device and then with the OCT by imaging cornea slices. The mean CCT was measured as 555.71 ± 47.76 µm with USP and 569.46 ± 49.5 µm with OCT. Despite the differences between the measurements of the two methods, a very strong degree of consistency was seen between the CCT measurement with USP and OCT (ICC = 0.93, p < 0.001).

The effect of anterior transposition of the inferior oblique muscle on eyelid configuration and function.

PURPOSE: To evaluate the alteration of lower lid configuration and function with anterior transposition surgery of the inferior oblique (IO) muscle. PATIENTS AND METHODS: A prospective clinical trial was conducted on a consecutive series of patients underwent anterior transposition of the IO as a sole operation. All patients received a thorough ophthalmic examination 1 day before and 3 months after surgery. Output parameters were consisted of palpebral fissure, margin reflex distance 1-2, lower lid function, hertel value, and lower lid crease. The differences of the collected data were calculated for statistical significance by using the Wilcoxon test. RESULTS: A total of 19 eyes of 16 consecutive patients were included. The median preoperative grade of IO overaction was 3.5 (ranging from 3 to 4), which decreased to 0 (ranging from 0 to 2) postoperatively (P < 0.05). No significant change was observed in all parameters 3 months postoperatively (P > 0.05). CONCLUSION: In this study, no significant effect on lower lid configuration and function was observed following IO anterior transposition in which the disinserted muscle was placed posterior to inferior rectus insertion.

Spontaneous Regression of Over-elevation in Adduction Following Esotropia Surgery.

PURPOSE: To evaluate the course of over-elevation in adduction in patients who had esotropia following correction of horizontal deviation. METHODS: The review of the medical files identified 28 patients who had esotropia with over-elevation in adduction. Data collected from the patients' full ophthalmological examinations included visual acuity, ocular alignment, duction, versions and sensory tests for binocularity and stereopsis, cycloplegic retinoscopy, and fundus evaluation. Oblique muscle function was graded on a scale of -4 to +4. The primary outcome measure was the amount of improvement in over-elevation in adduction following esotropia surgery. RESULTS: Of the 28 patients (mean age: 53.5 ± 53.7 months), 13 were males and 15 were females. Of these, 22 (78.6%) had infantile esotropia and 6 (21.4%) had partial accommodative esotropia. The mean follow-up was 16.3 ± 7.9 months. All patients underwent bilateral medial rectus recession for correction of esotropia. The mean preoperative inferior oblique overaction was +2.1 ± 0.7 and the final postoperative value was +0.8 ± 0.9 (P < .001). There was a statistically significant decrease in postoperative over-elevation in adduction at all postoperative visits compared to the preoperative value (P < .001 at 3- and 6-month and final visits). Over-elevation in adduction regressed in 42 eyes (80.8%). Of these, 18 eyes (34.6%) completely resolved without any additional surgery to the inferior oblique muscle. CONCLUSIONS: Spontaneous regression in over-elevation in adduction was observed after esotropia surgery without additional inferior oblique weakening surgery. This may affect presurgical evaluation of and surgical planning for patients.

Fonsecaea pedrosoi as a rare cause of acute conjunctival ulceration.

Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.

Anti-inflammatory effect of lycopene on endotoxin-induced uveitis in rats.

PURPOSE:: We evaluated the efficacy of lycopene, a dietary carotenoid and potent antioxidant, against ocular inflammation and oxidative stress in an experimental uveitis model. METHODS:: Endotoxin-induced uveitis (EIU) was induced in Sprague-Dawley rats by a single subcutaneous injection of 200 µg lipopolysaccharide (LPS). Induction of EIU was preceded by daily intraperitoneal injection of 10 mg/kg lycopene for three consecutive days (Lycopene + LPS group) or equivolume vehicle (Vehicle + LPS group). A positive control group received 1 mg/kg dexamethasone pretreatment (DEX + LPS), and a negative control group received daily vehicle injection but no LPS (Vehicle Control). Twenty-four hours after LPS or final vehicle administration, eyes were enucleated, and aqueous humor was collected for measurement of the number of infiltrating cells, total protein concentration, and levels of nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and oxidative stress markers. Inflammatory response severity was compared among groups clinically and histopathologically. RESULTS:: Infiltrating cell number, total protein concentration, and NO, TNF-α, and IL-6 levels were significantly elevated in the aqueous humor of Vehicle + LPS group rats compared to Vehicle Controls. Compared to the Vehicle + LPS group, lycopene pretreatment significantly reduced aqueous humor concentrations of oxidative stress markers, NO (0.29 ± 0.1 µM vs. 0.19 ± 0.1 µM, p=0.003), TNF-α (71.0 ± 22.3 ng/ml vs. 50.1 ± 2.1 ng/ml, p=0.043), and IL-6 (121.6 ± 3.0 pg/ml vs. 111.1 ± 5.6 pg/ml, p=0.008). Inflammatory score was also reduced (2.0 ± 0.0 vs. 0.4 ± 0.5, p=0.001). Lycopene reduced the infiltrating cell count and protein concentration, but differences did not reach significance. Most lycopene effects were equivalent to dexamethasone. CONCLUSIONS:: Lycopene may aid in the clinical management of uveitis by suppressing inflammation and oxidative stress.

Comparison of refractive error and central corneal thickness in neonates of diabetic and healthy mothers.

PURPOSE: To determine the refractive error and central corneal thickness of neonates born to diabetic mothers and to compare these parameters with those of healthy neonates born to healthy mothers. METHODS: This prospective, cross-sectional study was conducted on 16 consecutive full-term neonates born to diabetic mothers and 17 full-term healthy neonates. The neonates underwent ophthalmic examination within the first week of life. Refractive measurements were assessed by retinoscopy. Central corneal thickness was recorded by using ultrasound pachymeter. RESULTS: The mean spherical equivalent for both eyes in the diabetic group was +2.9 ± 2.6 and significantly greater than that of the nondiabetic group (+1.3 ± 2.1 D) (p = 0.008). The mean sphere value was +2.6 ± 2.4 D in the diabetic group and +1.0 ± 2.0 D in the nondiabetic group, significantly higher in the diabetic group (p = 0.008). In both groups, mean astigmatism was less than 1.00 D, it was lower in the diabetic group, and there was no statistically significant difference between groups (p = 0.95). There were 2 patients in each group with anisometropia. The mean central corneal thickness in the nondiabetic group was 542.9 ± 21.9 µm whereas it was 592.0 ± 40.2 µm in the diabetic group, which was significantly thicker (p = 0.05). CONCLUSIONS: Our study revealed that neonates of diabetic mothers seem to be more hypermetropic compared to full-term healthy neonates; however, we did not observe any significant astigmatism in either group. Neonates of diabetic mothers had thicker corneas.

Tear Film and Serum Prolidase Activity and Oxidative Stress in Patients With Keratoconus.

PURPOSE: To determine and compare the serum and tear film prolidase activity (PA) between patients with keratoconus and healthy subjects. Also, we aimed to evaluate the serum oxidative stress level and the correlation with serum PA in patients with keratoconus. METHODS: This prospective, comparative clinical study included 31 patients with keratoconus and 33 age-matched and sex-matched control subjects. All participants underwent a detailed ophthalmologic examination. Serum and tear samples were obtained from all participants. Tears and serum PA and serum oxidative stress markers were measured. RESULTS: No significant differences in demographic characteristics were detected between groups (P > 0.05). The serum PA was significantly lower in the keratoconus group than in the control group (895.6 ± 198.7 vs. 1145.9 ± 285.4 U/L, P < 0.001). A tear film comparison showed that PA was lower in the keratoconus group than in the control group; however, this difference was not significant (3075.4 ± 672.2 vs. 3225.8 ± 903.2 U·L⁻¹·g⁻¹ protein, P = 0.45). Oxidative stress markers, such as total oxidant status and oxidative stress index, were found to be significantly higher in the keratoconus group (P < 0.001). CONCLUSIONS: The serum PA was found to be lower in patients with keratoconus than in the controls. Additionally, serum oxidative stress markers were found to be higher than those of the controls. Thus, prolidase and systemic oxidative stress may have a role in the pathogenesis of keratoconus.

Evaluating the safety of intracameral bevacizumab application using oxidative stress and apoptotic parameters in corneal tissue.

AIM: To investigate the possible effects of intracameral bevacizumab on oxidative stress parameters and apoptosis in corneal tissue. METHODS: In total, 30 rats were assigned randomly into the following three groups of 10 rats each: a sham group (Group 1; n=10), a control group [Group 2; balanced salt solution (BSS) was administered at 0.01 mL; n=10], and a treatment group (Group 3; bevacizumab was administered at 0.25 mg/0.01 mL; n=10). The total antioxidant status (TAS) and the total oxidant status (TOS) in the corneal tissue and blood samples were measured, and the oxidative stress index (OSI) was calculated. Additionally, corneal tissue histopathology was evaluated for caspase-3 and -8 staining and apoptotic activity. RESULTS: In the blood samples, the TAS, TOS, and OSI levels were not significantly different (all P>0.05). Compared with the sham and control groups, the TOS and OSI levels in the corneal tissues were significantly different in the bevacizumab group (all P<0.05). No statistically significant differences were observed between the sham and control groups (all P>0.05). However, compared with the sham and control groups, greater immunohistochemical staining for caspases-3 and -8 and an elevated level of apoptotic activity were observed in the bevacizumab group. CONCLUSION: This study revealed that intracameral bevacizumab injections seemed to be systemically safe but may have elicited local toxic effects in the corneal tissue, as indicated by the oxidative stress parameters and histopathological evaluations.

The role of intraoperative bevacizumab for prevention of postoperative vitreous hemorrhage in diabetic vitreous hemorrhage.

PURPOSE: To assess the effect of intravitreal bevacizumab (IVB) on the incidence of postoperative recurrent vitreous hemorrhage (VH) in eyes operated for diabetic VH when injected at the end of the surgery. METHODS: A prospective, comparative clinical trial was conducted on a consecutive series of patients requiring vitrectomy for diabetic nonclearing VH. Intravitreal bevacizumab (2.5 mg/0.1 mL) was injected at the completion of surgery. Patients underwent best-corrected visual acuity (VA), applanation tonometry, and biomicroscopic anterior and posterior segment evaluation for VH grading. Postoperative visits were performed at the first day, first week, first month, third month, and sixth month. The VH was graded at each visit, and the rate of postoperative VH and VA improvement and potential complications were evaluated and compared between the groups. RESULTS: A total of 72 eyes of 66 patients were included. Thirty-four eyes were enrolled in the IVB group and 38 eyes were enrolled in the control group. The rate of postoperative VH did not differ significantly between the groups at any postoperative visit (p>0.05). Three eyes (8.8%) in the IVB group and 5 eyes (13.1%) in the control group had postoperative VH throughout the follow-up period and only one eye from each group underwent a second surgery. Postoperative VA significantly increased in both groups but did not differ significantly between the groups at any postoperative visit (p>0.05). CONCLUSIONS: Intravitreal bevacizumab does not seem to have any beneficial effect on the incidence of postoperative VH in eyes operated for diabetic VH when injected at the end of surgery.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract.

AIM: To assess the early surgical outcomes of quick-chop phacoemulsification technique in patients with high myopia. METHODS: The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens (IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk, 1mo. Early postoperative best corrected visual acuity (BCVA), preoperative and postoperative corneal endothelial cell density (ECD), central corneal thickness (CCT) and postoperative complications were assessed. Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data. RESULTS: There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion. CONCLUSION: Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

Evaluation of resistive index using color Doppler imaging of orbital arteries in geriatric patients with hypertension.

BACKGROUND AND AIM: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic disease. The purpose of this study was to evaluate the association between RI values of orbital arteries using the color Doppler imaging (CDI) in geriatric hypertensive patients with or without retinopathy. SETTING AND DESIGN: Designed as a cross-sectional study. MATERIALS AND METHODS: We evaluated 60 geriatric patients with hypertension (Group 1) and 30 healthy subjects (Group 2). Further, the patients with hypertension were grouped into two: Group 1a consisted of patients with retinopathy (n = 30), and group 1b consisted of patients without retinopathy (n = 30). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. RESULTS: Compared to group 2, group 1 had significantly higher mean resistive index of PCA levels (P = 0.017), whereas there were no statistical difference in mean resistive indexes of OA and CRA (both P > 0.05). Besides, there were no statistical difference in mean resistive indexes of OA, CRA, and PCA between the group 1a and group 1b (P > 0.05 for all). Mean resistive indexes of OA, CRA, and PCA were significantly correlated with the duration of hypertension (r = 0.268, P = 0.038; r = 0.315, P = 0.014; r = 0.324, P = 0.012, respectively). CONCLUSIONS: Our study indicates that RI might be a useful marker for the ocular hemodynamic of retinal vessels, provides morphologic and vascular information in hypertension and hypertensive retinopathy.

Evaluation of the safety of intracameral trypan blue injection on corneal tissue using oxidative stress parameters and apoptotic activity: an experimental study.

PURPOSE: The present experimental study aimed to investigate the effects of intracameral trypan blue (TB) on oxidative stress parameters and apoptosis in corneal tissue. METHODS: Thirty rats were randomly assigned to three groups of 10 rats each: the sham group (Group 1); control group (Group 2); and treatment group (Group 3). The control group was administered 0.01 cc of balanced salt solution. The treatment group was administered 0.006 mg/0.01 cc of TB. The total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood were measured and the oxidative stress index (OSI) was calculated. Finally, corneal tissue histopathology was evaluated using staining for caspase-3 and -8, and apoptotic activity was examined. RESULTS: The TAS, TOS and OSI levels in the blood samples were not significantly different (p>0.05 for all). Compared with the sham and control groups, the TOS and OSI levels in corneal tissue were significantly different in the treatment group (p<0.05 for all). No significant difference was observed between the sham group and the control group (p>0.05). Immunohistochemical staining for caspase-3 and caspase-8 demonstrated higher apoptotic activity in the TB group than in the sham and control groups. CONCLUSION: The present study showed that intracameral TB injection is safe systematically but may be toxic to corneal tissue, as demonstrated using oxidative stress parameters and histopathological evaluation.

Anisometropic amblyopia in a case of type 2 Waardenburg syndrome.

This study presents a case of an 8-year-old boy with iris heterochromia and anisometropic amblyopia who was diagnosed with Waardenburg syndrome (WS) type 2. An ophthalmic examination revealed iris heterochromia and anisometropic amblyopia in our patient. In the systemic examination, a white forelock and vitiligo on the arms and body were observed and neurosensory hearing loss was revealed, for which the patient used hearing aids. Identification and typing of patients with WS is crucial to address neurosensory hearing loss, glaucoma and fundus changes. While it might be challenging to communicate with a patient with speech and hearing problems, visual acuity should be examined carefully and probable amblyopia should be identified. Anterior segment changes and signs of glaucoma should also be evaluated in detail.

Comparison of efficacy and safety between transconjunctival 23-gauge and conventional 20-gauge vitrectomy systems in macular surgery.

PURPOSE: To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery. METHODS: Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups. RESULTS: There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001). CONCLUSIONS: Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.

Idiopathic multiple tiny serous retinal pigment epithelial detachments: report of 2 cases and review of the literature.

BACKGROUND: Bilateral multiple serous retinal pigment epithelial detachments (PEDs) are a very rare entity. Such conditions may be idiopathic or a presentation of some ocular and/or systemic pathologies. We report 2 unique cases of bilateral multiple serous PEDs without any known cause. Additionally, similar cases of multiple serous idiopathic PEDs reported in the literature were reviewed. CASE REPORT: The patients were middle-age women with no known related ocular and systemic problems. Fundus examination, fluorescein angiography, and optical coherence tomography found innumerable, small, serous, idiopathic PEDs mainly located in the macular area. One woman also had an associated subretinal pigment epithelial hemorrhage in 1 eye, which regressed spontaneously. There are only a few similar cases reported in the literature. CONCLUSION: Idiopathic bilateral, multiple, tiny, serous PEDs in middle-age healthy people are rare entities that may be a variant of central serous choroidopathy in which retinal pigment epithelium is predominantly involved. The visual prognosis seems to be good without any intervention unless complicated by hemorrhages.