The influence of corneal geometrical and biomechanical properties on tonometry readings in keratoconic eyes.

PURPOSE: To identify the effect of corneal geometrical and biomechanical parameters on the intraocular pressure (IOP) measurements obtained by Goldmann Applanation Tonometer (GAT), non-contact tonometer, iCare Pro Rebound Tonometer (IRT), Tonopen and Ocular Response Analyzer (ORA, Goldmann-correlated IOP: IOPg, corneal compensated IOP: IOPcc). METHODS: We prospectively recruited patients with a tomographically confirmed diagnosis of keratoconus. IOP measurements were performed in the following order: non-contact tonometry, ORA, IRT, GAT and Tonopen. The means of the three IOP measurements were used for the analysis. Correlation analyses were performed to assess the association between tonometer readings and the corneal geometrical and biomechanical parameters including ORA waveform parameters. Tonometer variability was assessed using a stepwise linear regression analysis. RESULTS: Fifty-one patients with keratoconus (27 females, mean age 30.8 ± 8.7 years) were evaluated. The highest mean IOP was measured by IOPcc (14.6 ± 2.3 mmHg) followed by IRT IOP (13.0 ± 3.2 mmHg), Tonopen IOP 12.0 ± 2.6 mmHg), GAT IOP (11.7 ± 3.1 mmHg), NCT IOP (10.2 ± 3.2 mmHg) and IOPg (10.2 ± 3.6 mmHg). NCT and IOPg were affected from all corneal parameters including thickness, curvature and biomechanical parameters. While GAT and IRT had significant correlations with corneal resistance factor (CRF) and corneal hysteresis, IOPcc only had a significant correlation with CRF. None of the corneal factors had any statistically significant correlation with Tonopen. CRF predicted tonometer measurement variability in 7 of the 15 inter-device variability assessments. CONCLUSION: Tonopen was the least affected from the corneal parameters followed by IOPcc and GAT. CRF was a strong determinant of tonometer variability.

Ahmed glaucoma valve implantation versus suprachoroidal silicone tube implantation following the injection of bevacizumab into the anterior chamber in patients with neovascular glaucoma.

PURPOSE: This study compared the efficacy and safety of Ahmed glaucoma valve (AGV) implantation versus suprachoroidal silicone tube (SST) implantation after the injection of bevacizumab into the anterior chamber in patients with neovascular glaucoma. METHODS: Patients were randomly assigned to undergo AGV or SST implantation. Bevacizumab was injected into the anterior chamber at a dosage of 1.25 mg/0.1 mL, 1 week before surgery. Intraocular pressure (IOP) control, complication, and success rates were compared between the groups. Success was defined as a final IOP > 5 mmHg, < 22 mmHg with or without any antiglaucoma drug. RESULTS: A total of 23 patients were enrolled in the study, including 13 (56.5%) in the AGV group (group 1) and 10 (43.5%) in the SST group (group 2). The mean baseline IOP was 42.0 ± 9.1 mmHg in group 1 and 39.5 ± 10 mmHg in group 2 (p > 0.05). The mean IOP was 16.9 ± 7.0 mmHg in group 1 and 12.5 ± 6.7 mmHg in group 2 on the first day after surgery. After a mean follow-up period of 19.4 ± 5.2 months, success was achieved in 12 (92.3%) patients in group 1 and in 1 (10%) patient in group 2. There was a statistically significant difference in terms of the success rate between groups (p < 0.05). Complications included hyphema in three (23%) patients, obstruction of the AGV tube by iris tissue in one (7.7%) patient, and tube exposure in one patient (7.7%) in group 1. Suprachoroidal silicone tube dislocation to the anterior chamber was observed in one (10%) patient in group 2. CONCLUSION: AGV implantation after the injection of bevacizumab into the anterior chamber had a higher success rate than SST implantation. Complications were seen more frequently in the AGV group.

The analysis of posterior segment findings in term and premature infants using RetCam images.

OBJECTIVE: To analyze posterior segment findings in term and premature infants using the RetCam image database. METHODS: RetCam images taken of infants born between January 2012 and December 2015 were reviewed. Group 1 included infants with posterior segment findings other than retinopathy of prematurity (ROP). Group 2 included infants with mild-to-severe ROP. The baseline characteristics, anterior segment findings, and percentage of infants who received treatment were compared among the 2 groups. RESULTS: In total, 331 out of 3440 infants (9.6%) were included. The major diagnoses in group 1 (n = 75) were retinal hemorrhages in 26, optic nerve pathologies in 14, findings associated with a metabolic disease in 6, ocular tumors in 5, persistent hyperplastic primary vitreous in 4, and familial exudative vitreoretinopathy in 4 cases. The mean birth weight (g) (2481.9 ± 700.5 in group 1 vs 1090.5 ± 330.9 in group 2), gestational age (weeks) (35.9 ± 3.4 in group 1 vs 28.2 ± 2.4 in group 2), and postmenstrual age at initial examination (35.9 ± 3.4 in group 1 vs 28.2 ± 2.4 in group 2) were significantly different among the 2 groups (p < 0.001). Thirteen out of 75 cases in group 1 and 124 out of 256 ROP cases received therapy (p < 0.001). Anterior segment pathologies were found in 13.3% of group 1 versus 7.8% of group 2 infants (p = 0.216). CONCLUSIONS: A considerable number of infants suffered from posterior segment disorders other than ROP. The majority of these infants were term babies. Routine fundus screening may be recommended in all newborns to diagnose all posterior segment pathologies other than ROP.

The macular findings on spectral-domain optical coherence tomography in premature infants with or without retinopathy of prematurity.

The purpose of the study was to present spectral-domain optical coherence tomography (OCT) findings in premature infants with or without mild-to-severe retinopathy of prematurity (ROP). Seventy-two infants born <37 weeks of gestation were analyzed, prospectively. Group 1 (n = 18) included infants without ROP. Infants with stage 1, 2, or 3 ROP without indication for treatment formed the second group (n = 15). Group 3 (n = 21) included threshold cases, who would receive laser photocoagulation (LPC) after OCT examinations. Group 4 (n = 18) had already received LPC. The mean central foveal thickness (CFT) (µm) in right eyes was 194.27 ± 19.93, 207.67 ± 25.44, 224.29 ± 21.42, and 222.00 ± 37.80, for groups 1, 2, 3, and 4, respectively (p = 0.01). The presence of a well-formed foveal pit was documented in 60 % of right and 67 % of left eyes in group 1, while a well-formed foveal pit was observed in 14 % of right and 16 % of left eyes in group 3 (p < 0.05). Cystoid macular edema (CME) was shown in 29 % of right and 21 % of left eyes in group 3 (p < 0.05 for right eyes). CME was observed in two of right and left eyes in group 4. Epiretinal membrane (ERM) was shown in one right eye in group 3, two right and four left eyes in group 4 (p < 0.05 for left eyes). Thicker CFT, CME, and failure of a well-formed foveal pit could be related to the severity of ROP. The development of ERM could be the consequence of LPC.

Richner-Hanhart syndrome (tyrosinemia type II): a case report of delayed diagnosis with pseudodendritic corneal lesion.

Richner-Hanhart syndrome (tyrosinemia type II) is a rare autosomal recessive disease associated with high serum tyrosine levels caused by the deficiency of tyrosine aminotransferase enzyme. We report a 15-year-old female patient with complaints of bilateral photophobia and tearing, which started during the infancy period. Biomicroscopic examination revealed bilateral circular corneal opacities on the inferior quadrant and small dendritic lesions at the center of the circular opacities. Blood tests showed a tyrosine level of 508 micromol/L (normal range: 30-150). On her dermatologic examination, plantar hyperkeratosis and seborrheic dermatitis were noted, and mild mental retardation was detected. One and a half months after the tyrosine- and phenylalanine-restricted diet, her tyrosine level dropped to 395 micromol/L level, her corneal lesions subsided, and a symptomatic relief was achieved. Tyrosinemia type II should be suspected in patients demonstrating dermatologic signs, especially palmoplantar keratosis, associated with bilateral pseudodendritic corneal lesions unresponsive to antiviral therapy.

Evaluation of the Vestibulocochlear System in Patients with Pseudoexfoliation Syndrome

Objectives: Patients with pseudoexfoliation syndrome (PES) can also have sensorineural hearing loss as well as balance problems. Our aim was to evaluate vestibulocochlear system involvement in PES patients. Materials and Methods: The study included 16 subjects with PES (study group) with a mean age of 66.12±5.64 years and 17 healthy subjects (control group) with a mean age of 61.70±8.46 years. Both groups underwent ophthalmological, neuro-otological, audiological, and vestibular evaluation. Pure-tone audiometry and tympanometry were performed as audiological tests and bithermal caloric test and vestibular-evoked myogenic potential (VEMP) testing were used as vestibular tests. The Romberg, tandem Romberg, and Unterberger tests were also performed. Results: In the PES group, bithermal caloric tests revealed right canal paresis in 6 patients, left canal paresis in 3 patients, and bilateral stimulation loss in 2 patients, despite no clinical evidence of balance loss. Paresis was not detected in any of the control subjects. Unilateral VEMP responses could not be obtained in 3 patients in the PES group. The ocular PES patients whose VEMP waves were obtained differed significantly from the control group (p<0.05). In office tests for vestibular evaluation, pathologic findings were found in 7 of 16 patients in the study group and only 4 subjects in the control group. Audiological evaluation with pure-tone thresholds revealed sensorineural decline at 4000 and 8000 Hertz in the PES patients. A statistically significant difference was found between the study group and the control group (p<0.05). Conclusion: Patients with PES showed elevation in pure-tone thresholds and a decrease in superior and inferior vestibular nerve function, demonstrating that the vestibular system as well as the auditory system are affected in PES.

The relationship of retinopathy of prematurity with brain-derivated neurotrophic factor, vascular endotelial growth factor-A, endothelial PAD domain protein 1 and nitric oxide synthase 3 gene polymorphisms.

BACKGROUND: In addition to risk factors such as low birth weight and uncontrolled oxygen therapy, genetic predisposition is also thought to play a role in the development of retinopathy of prematurity (ROP). In our study, we aimed to analyze single-nucleotide polymorphisms (SNPs) in VEGFA, EPAS1, BDNF and NOS3 genes in infants who develop ROP. MATERIALS AND METHODS: Seventy-five mild-moderate and 73 severe ROP cases were included in this study. Eleven different SNPs regions that located in VEGFA, EPAS1, BDNF and NOS3 genes were analysed by SnapShot technique and compared between two groups by the multiple logistic regression analysis. RESULTS: Statistically significant results were obtained in 8 of the 11 SNPs. It was observed that the excess of mutant alleles in four (VEGFA rs2010963 and rs3025039, EPAS1 rs13419896, NOS3 rs2070744) of these regions increased ROP severity and treatment requirement (p < .001, p < .001, p = .022, p = .004, respectively) while the excess of mutant alleles in the other four regions (VEGFA rs833061, BDNF rs7929344, EPAS1 rs1867785 and rs1868085) showed that ROP severtiy was milder and eliminated the need for treatment (p < .001, p = .019, p = .017, p = .017, respectively). CONCLUSIONS: Considering the results of our study, it was seen that besides the known environmental and demographic factors in ROP pathogenesis, genetic predisposition also had an effect on the clinic and course of ROP. Polymorphisms of VEGFA rs2010963 and rs3025039, EPAS1 rs13419896, NOS3 rs2070744 were found to be associated with severe ROP. More studies involving different populations cases are needed to confirm these findings and enlighten the etiology of ROP.

Coexistence of Peripheral Retinal Diseases with Macular Hole

Objectives: To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole. Materials and Methods: The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskisehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated. Results: Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient. Conclusion: This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.

The Relationship Between Vasoproliferative Tumor and Uveitis in a Multiple Sclerosis Patient: A Case Report and Review of the Literature

Vasoproliferative retinal tumor (VPRT) is a rare, benign lesion with a variable clinical course depending on the individual. Favorable outcomes are obtained with early diagnosis and treatment of patients with VPRT. In this case report, we present a case of concomitant VPRT and multiple sclerosis along with our management of uveitis and secondary glaucoma that presumably developed following cryotherapy for VPRT.

A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries.

Background. To analyze the effects of factors other than the ocular trauma score parameters on visual outcomes in open globe injuries. Methods. Open globe injuries primarily repaired in our hospital were reviewed. The number of surgeries, performance of pars plana vitrectomy (PPV), lens status, affected tissues (corneal, scleral, or corneoscleral), intravitreal hemorrhage, intraocular foreign body, glaucoma, anterior segment inflammation, loss of iris tissue, cutting of any prolapsed vitreous in the primary surgery, penetrating injury, and the time interval between the trauma and repair were the thirteen variables evaluated using linear regression analysis. Results. In total, 131 eyes with a mean follow-up of 16.1 ± 4.7 (12-36) months and a mean age of 33.8 ± 22.2 (4-88) years were included. The regression coefficients were 0.502, 0.960, 0.831, -0.385, and -0.506 for the performance of PPV, aphakia after the initial trauma, loss of iris tissue, penetrating injury, and cutting of any prolapsed vitreous in the primary surgery, respectively (P < 0.05 for these variables). Conclusions. The performance of PPV, aphakia after the initial trauma, and loss of iris tissue were associated with poor visual outcomes, whereas cutting any prolapsed vitreous in the primary repair and penetrating-type injury were associated with better visual outcomes.

Vasoactive intestinal peptide, a promising agent for myopia?

AIM: To investigate the role of vasoactive intestinal peptide (VIP) in form-deprivation myopia (FDM). METHODS: FDM was created in three groups of eight chicks by placing a translucent diffuser on their right eyes. Intravitreal injections of saline and VIP were applied once a day into the occluded eyes of groups 2 and 3, respectively. Retinoscopy and axial length (AL) measurements were performed on the first and 8th days of diffuser wear. The retina mRNA levels of the VIP receptors and the ZENK protein in right eyes of the three groups and left eyes of the first group on day 8 were determined using real time polymerase chain reaction (PCR). RESULTS: The median final refraction (D) in right eyes were -13.75 (-16.00, -12.00), -11.50 (-12.50, -7.50), and -1.50 (-4.75, -0.75) in groups 1, 2, and 3, respectively (P<0.001). The median AL (mm) in right eyes were 10.65 (10.00, 11.10), 9.90 (9.70, 10.00), and 9.20 (9.15, 9.25) in groups 1, 2, and 3, respectively (P<0.001). The median delta-delta cycle threshold (CT) values for the VIP2 receptors were 1.07 (0.82, 1.43), 1.22 (0.98, 1.65), 0.29 (0.22, 0.45) in right eyes of groups 1, 2, and 3, and 1.18 (0.90, 1.37) in left eyes of group 1, respectively (P=0.001). The median delta-delta CT values for the ZENK protein were 1.07 (0.63, 5.03), 3.55 (2.20, 5.55), undetectable in right eyes of groups 1, 2, and 3 and 1.89 (0.21, 4.73) in left eyes of group 1, respectively (P=0.001). CONCLUSION: VIP has potential inhibitory effects in the development of FDM.

Comparison of Different Types of Complications in the Phacoemulsification Surgery Learning Curve According to Number of Operations Performed.

OBJECTIVES: To compare the differences in intraoperative complications rates by the number of resident-performed sequential phacoemulsification surgeries. MATERIALS AND METHODS: Preoperative and postoperative ophthalmological examination records and intraoperative data of 180 eyes of 140 patients who underwent cataract surgery by two residents between November 2009 and February 2012 were analyzed retrospectively. The data of 180 eyes were separated into 3 groups based on the number of operations performed: Group A (first 1-60 eyes), group B (61-120 eyes) and group C (last 121-180 eyes). The number of direct supervisor interventions and the rates of different types of complications were compared between the three groups. RESULTS: The number of direct supervisor interventions was 45, 35 and 19 in group A, B and C, respectively. The number of complications anterior to the iris plane was 3, 4 and 12 in group A, B and C, respectively. The difference in the rate of complications between group B and C was statistically significant (p=0.029). The number of complications posterior to the iris plane was 6, 14 and 3 in group A, B and C, respectively. The difference in the rate of complications between the groups was statistically significant (p=0.042, p=0.004). CONCLUSION: This study provides insight into which types of complications might arise during the phacoemulsification training period. The trends in the rates of different complication types in clinics may be analyzed, and this analysis may be used to improve and modify phacoemulsification training programmes according to the needs of residents.

Bilateral Coats' Disease Combined with Retinopathy of Prematurity.

Purpose. To report a case of bilateral Coats' disease combined with retinopathy of prematurity (ROP). Case. Retinal vascularization was complete in the right eye, whereas zone III, stage 3 ROP and preplus disease were observed in the left eye at 43 weeks of postmenstrual age (PMA) in a 31-week premature, 1200-g neonate. Intraretinal exudates developed and retinal hemorrhages increased in the left eye at 51 weeks of PMA. Diode laser photocoagulation (LP) was applied to the left eye. Exudates involved the macula, and telangiectatic changes developed one month following LP. Additional LP was applied to the left eye combined with intravitreal bevacizumab (IVB) injection at 55 weeks of PMA. Disease regressed one month after the additional therapy. At the 14-month examination of the baby, telangiectatic changes and intraretinal exudates were observed in the right eye. Diode LP was applied to the right eye combined with IVB injection. Exudates did not resolve completely, and cryotherapy was applied one month following LP. Retinal findings regressed three months following the cryotherapy. Conclusion. This is the first report of presumed bilateral Coats' disease combined with ROP. If Coats' disease could be diagnosed at early stages, it would be a disease associated with better prognosis.