Effects of systemic anti-androgen drugs on the ocular surface

PURPOSE

To investigate the effect of systemic anti-androgen drugs on tear function tests and the ocular surface.

METHODS

Sixty-four male subjects were included in this study. Subjects who were on anti-androgen treatment for prostate cancer (Group A, n: 31) and those who had received only surgical treatment for prostate cancer (Group B, n: 17) were recruited from the department of urology. Age-matched subjects who had never received anti-androgen treatment (Group C, n: 16) constituted the control group. Group A was divided into two subgroups according to the number of anti-androgen drugs used (Group A1: one drug, Group A2: two drugs). All cases underwent a complete ocular examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and ocular surface disease index (OSDI) questionnaire.

RESULTS

The mean Schirmer's values were 6.87mm, 11.41mm, and 13.03mm in Groups A, B, and C, respectively (P=0.001). TBUT was 5.45±2.01, 9.85±2.52 and 9.81±1.96seconds in Groups A, B, and C, respectively (P=0.001). Schirmer and TBUT were significantly lower, and corneal staining and OSDI questionnaire scores were higher in Group A compared to groups B and C (P<0.01). Conjunctival impression cytology results according to the Nelson grading system revealed no statistically significant difference between the groups (P=0.422).

CONCLUSION

Anti-androgen drugs alter tear function tests, cause increased corneal and conjunctival staining scores and worsen complaints of dry eye in patients with prostate cancer.

Role of the vitreous in age-related macular degeneration

PURPOSE

To investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD).

METHODS

The condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls.

RESULTS

There was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD.

CONCLUSIONS

PVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.

Chemodenervation in treatment of upper eyelid retraction

Upper-eyelid retraction is a common sign of thyroid-associated eye disease (TAED), and these patients are highly bothered by the appearance of their eyes. In this study, botulinum toxin A (BTA) was injected into the levator palpebrae superioris muscle in 8 eyes of 4 patients in an attempt to control the abnormal elevation of the upper eyelid. BTA provided control of the upper-eyelid retraction, and the cosmetically acceptable effect lasted for 3-4 months. It was concluded that BTA is an effective method of treatment in this condition. Since it has a temporary effect, it can safely be used to provide relief of symptoms related to upper-eyelid retraction during unstabilized periods of TAED, which may last as long as several years in some patients.

Evaluation of conjunctival morphology in thyroid associated eye disease by use of impression cytology

Thirty-one patients with the diagnosis of thyroid associated eye disease were included in the study. Samples were obtained from upper and temporal bulbar conjunctiva of both eyes by cellulose acetate filter paper. Control group included 20 healthy individuals. In patients with thyroid associated eye disease, grade 2 or 3 squamous metaplasia was observed in 32.26% of the samples obtained from upper bulbar conjunctiva, whereas this ratio increased to 82.26% in temporal bulbar area. None of the control cases showed changes of grade 2 or more. The evaluation of cytological changes with respect to clinical findings revealed that the main factor responsible for the cytological findings was inflammatory changes of the conjunctiva, whereas interpalpebral distance and proptosis had only a partial effect.

The results of surgical treatment in Duane's retraction syndrome

In an attempt to evaluate the response to surgical treatment, the surgical outcome of 16 patients with Duane's retraction syndrome (DRS) was investigated. Single horizontal rectus muscle recession, transposition of vertical recti and recession of both horizontal recti were carried out. In one of the four patients with significant globe retraction, Y splitting of the lateral rectus muscle was added to the procedure to overcome the cosmetically unacceptable upshoot. Single horizontal muscle recession surgery was effective in reducing the abnormal head posture and the deviation in primary position. The results of both horizontal recti recession were not so predictable in reducing globe retraction. Recession of both horizontal recti was ineffective in vertical DRS. It is suggested that the variability of surgical outcome in DRS may be related to the different innervational patterns and mechanical factors.

Acute endophthalmitis outbreak after cataract surgery

PURPOSE

To evaluate the source of organisms causing an epidemic of postoperative endophthalmitis and to emphasize the importance of prompt intervention with an early diagnosis.

SETTING

S.B. Ankara Hospital Eye Department, Ankara, Turkey.

METHODS

Thirteen patients who had surgery on the same day and developed acute postoperative endophthalmitis were evaluated. Clinical patterns were observed and intraocular cultures and stains performed in 10 eyes. Broad-spectrum intravitreal antibiotics were injected on an empirical basis.

RESULTS

Intravitreal cultures showed Pseudomonas aeruginosa in four cases and coagulase-negative staphylococci in three cases; three cases were culture negative. P. aeruginosa were also isolated from irrigation solutions used on the same day. Two patients with P. aeruginosa had a visual acuity of 20/200 and 20/300, respectively.

CONCLUSION

The different culture results were probably related to the amount of inoculation, individual risk factors, and the subconjunctival antibiotic injection given at the end of surgery. That one patient with P. aeruginosa endophthalmitis retained a visual acuity of 20/200 shows the importance of rapid intravitreal antibiotic treatment.

Corynebacterium minutissimum endophthalmitis: management with antibiotic irrigation of the capsular bag

Chronic endophthalmitis, due to Corynebacterium minutissimum, developed in a patient following uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens (PC-IOL) implantation. In this case, which to our knowledge is the first reported case of Corynebacterium minutissimum endophthalmitis, chronic inflammation persisted for 8 months with fluctuations in the inflammation. The specimens from the capsular bag yielded positive culture, but the vitreous culture was negative. The case was successfully treated by a capsular bag irrigation with vancomycin.