An important contributing factor in dry eye disease: somatization.

PURPOSE: Somatization is an important mental process that may causes medically unexplained and treatment-resistant somatic symptoms. The aim of the study is assess the presence of somatization in patients with dry eye disease (DED). METHODS: Eighty-eight patients with no objective DED finding and ongoing DED treatment were included in this prospective and observational study. Patients with subjective symptoms formed the symptom group and patients without subjective symptoms formed the control group. All patients were scored with the Turkish version of the Ocular Surface Disease Index (OSDI), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Symptom Checklist-90-R (SCL-90R) somatization subscale, Toronto Alexithymia Scale (TAS), Pain Catastrophizing Scale (PCS), and Symptom Interpretation Questionnaire (SIQ). RESULTS: Mean OSDI score was significantly higher in the symptom group than in the control group. The mean HAM-D and HAM-A outcomes did not differ between the groups. The mean SCL-90R somatization subscale, TAS, and PCS scores were significantly higher in the symptom group than in the control group. In the SIQ, somatic attributional style score was significantly higher in the symptom group than in the control group. The SCL-90R somatization subscale, PCS, and somatic attributional style scores had positive and mild-moderate correlation with OSDI scores in the symptom group. The TAS score had positive and moderate correlation with OSDI scores in all sample analyses. CONCLUSION: Somatization should be considered in patients with DED with chronic ocular surface symptoms. Presence of subjective symptoms resistant to treatment may be an indicator of somatization.

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

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

Mirror image of familial exudative vitreoretinopathy in identical twins.

PURPOSE: To report the identical twins who had mirror fundus and angiographic images of familial exudative vitreoretinopathy (FEVR). CASE PRESENTATION: A pair of 16 year old female twins presented with mirror-image asymmetry of monocular decreased vision. The twins were born full term with normal weights. Neither twin revealed any medical disorders during childhood and there was no known family history of ocular disorders. On ocular examination, the best corrected visual acuity (BCVA) was 20/20 in OD and 20/63 in OS for twin 1. For the twin 2, the BCVAs were 20/63 and 20/20 for OD and OS, respectively. Intraocular pressures were within normal limits and anterior segment examinations were unremarkable for both twins. Dilated fundus examinations and angiographic images revealed characteristics FEVR appearance with mirror image phenomenon in the twins. CONCLUSION: This is the first report describing identical twins with mirror images of FEVR. This report may confirm a strong underlying genetic inheritance in the pathogenesis of FEVR.

Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study.

BACKGROUND: Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity index (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool. OBJECTIVE: To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis. METHODS: 175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined. RESULTS: The mean CCET value was 58.06±3.1µm in the mild group, 60.10±5.0µm in the moderate group, 65.75±6.3µm in the severe group and 56.16±3.1µm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p=0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<0.001). There was a strong positive correlation between PASI score and CCET (p<0.001, r=0.519). STUDY LIMITATIONS: Cross-sectional design and a relatively small number of participants. CONCLUSIONS: There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.

The Effect of Pterygium and Pterygium Surgery on Corneal Biomechanics.

PURPOSE: To evaluate the effect of pterygium and pterygium surgery on corneal biomechanics by ocular response analyzer (ORA, Reichert, USA). METHODS: This study considered 68 eyes (from 34 patients with a mean age of 21.2±7.1 years) with unilateral nasal, primary pterygium (horizontal length <4 mm), and having undergone pterygium excision and conjunctival autografting. Pterygium length and area were measured from a photograph of the anterior segment using Image J program. ORA measurements were obtained before surgery and after the first month of the surgery. The measurements of the eyes with pterygium and healthy eyes were compared to evaluate the effect of pterygium. Similarly, measurements obtained before and after surgery were compared to evaluate the effect of pterygium surgery on corneal biomechanics. The correlation of the ORA measurements with the pterygium area was evaluated. RESULTS: Mean pterygium horizontal length and area were 3.31±1.43 mm and 6.82±2.17 mm2, respectively. There was no statistically significant difference between the eyes with and without pterygium in corneal hysteresis (CH, p=0.442), corneal resistance factor (CRF, p=0.554), corneal-compensated intraocular pressure (IOPcc, p=0.906), and Goldmann-correlated IOP (IOPg, p=0.836). All preoperative parameters decreased after surgery; however, none of them were statistically significant (CH, p=0.688; CRF, p=0.197; IOPcc, p=0.503; IOPg, p=0.231). There were no correlations between pterygium area and ORA measurements (p>0.05). CONCLUSION: Pterygium <4 mm and its surgical excision did not affect corneal biomechanics. These results may be taken into account when cornea biomechanics, mainly intraocular pressure measurements, are important.

Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study

Abstract Background Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool. Objective To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis. Methods 175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined. Results The mean CCET value was 58.06 ± 3.1 μm in the mild group, 60.10 ± 5.0 μm in the moderate group, 65.75 ± 6.3 μm in the severe group and 56.16 ± 3.1 μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p < 0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p = 0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p < 0.001). There was a strong positive correlation between PASI score and CCET (p < 0.001, r = 0.519). Study limitations Cross-sectional design and a relatively small number of participants. Conclusions There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.

Pterygium size and effect on intraocular lens power calculation.

PURPOSE: To evaluate the effects of pterygium on biometry measurements and the relationship between these effects and pterygium size. SETTING: Ulucanlar Eye Hospital, Ankara, Turkey. DESIGN: Prospective comparative study. METHODS: Patients who had unilateral primary pterygium excision were included in the study group. Anterior segment photographed images were taken of eyes with pterygia to calculate the pterygium length and area using the ImageJ program. Preoperative and 3-month postoperative biometry measurements (Lenstar LS900) were obtained for eyes with pterygium and their healthy fellow eyes (control group). RESULTS: Thirty-two patients with pterygium (mean age 63.31 years ± 7.18 [SD]) were included. The mean pterygium length was 3.07 ± 0.81 mm, and the mean area was 6.26 ± 2.07 mm2. The preoperative intraocular lens (IOL) power calculation with all formulas were higher than postoperative and control values (P < .001). The mean changes were 0.47 diopter (D) for the SRK II, 0.59 D for SRK/T, 0.47 D for Hoffer Q, 0.39 D for Haigis, and 0.38 D for Holladay 2 formulas after pterygium surgery. Positive, significant, and moderate correlations were found between the pterygium size and the change in IOL power. Pterygia longer than 2.40 mm and larger than 5.45 mm2 created at least equal to or more than 0.5 D deviation in the IOL power calculations. CONCLUSION: If the pterygium size is larger than 2.40 mm or 5.45 mm2 and simultaneous surgery is planned, the implanted IOL power should be at least 0.50 D smaller than the calculated power. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.