Expression of placental growth factor, neuropilin-1, and neuropilin-2 in primary pterygium tissue

PURPOSE

The aim of this study was to evaluate the expression of placental growth factor (PLGF), neuropilin-1 (NP-1), and neuropilin-2 (NP-2) molecules in primary pterygium tissue compared with normal conjunctival tissue.

METHODS

The records of 42 patients who underwent excision surgery with autografts for primary pterygium (pterygium group) and 20 patients who underwent conjunctival nevus excision surgery (control group) in the same period were reviewed retrospectively. The samples obtained from the pterygium tissues in the pterygium group and the clean conjunctival tissues adjacent to the nevus in the control group were collected from the archive. Immunohistochemical stains of the primary antibodies-1/100 diluted PLGF, NP-1, and NP-2 (Abcam Cambridge Science Park, UK)-were applied to all groups. Staining intensities and the percentage of positive cells in epithelial, endothelial, stromal, and inflammatory cells were analyzed by an experienced pathologist.

RESULTS

The positivity rates of PLGF and NP-2 expression in epithelial, endothelial, stromal, and inflammatory cells were found to be higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively; NP-2: p < 0.001 for all). Staining intensities for PLGF and NP-2 were higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively; NP-2: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). However, no significant differences were found in any cell type in terms of NP-1 expression positivity rates (p = 0.730, p = 0.121, p = 0.524, and p = 0.624, respectively) or staining intensity (p = 0.716, p = 0.147, p = 0.147, and p = 0.780, respectively).

CONCLUSION

PLGF and NP-2 levels were found to be higher in pterygium tissue, while there was no difference in NP-1. These results indicate the possible roles of NP-2 and PLGF in primary pterygium.

A Rare Pediatric Case of Neurobrucellosis With Cerebral Salt Wasting

The central nervous system involvement is a serious complication of brucellosis, which is known as neurobrucellosis, although rare. Here we report a 14-year-old case who developed neurobrucellosis and presented with cerebral salt wasting. As far as we know, our case is the first pediatric case of cerebral salt wasting caused by neurobrucellosis. Clinical manifestations of our patient have completely improved with treatment for Brucella.

Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology

PURPOSE

To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity.

METHODS

One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups.

RESULTS

The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001).

CONCLUSION

In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.

Dry eye disease and ocular surface characteristics in patients with keratoconus

PURPOSE

The purpose of this study is to investigate the ocular surface alterations in patients with mild or severe keratoconus (KC).

METHODS

A total of 80 participants were included in the study. The corneal topography was performed on each participant using Pentacam and the grouping was done accordingly. The patients with Kmax ≥52.0 D (severe KC) were considered Group 1 (n = 28), the patients with Kmax ≥47.2 and <52.0 D (mild KC) were considered Group 2 (n = 30). Healthy control participants with Kmax <47.2 D were considered Group 3 (n = 22). Tear breakup time (TBUT), Schirmer-I test, ocular surface disease index (OSDI) questionnaire, and conjunctival impression cytology (CIC) were evaluated among the groups.

RESULTS

The mean values of TBUT and Schirmer-I test were significantly lower (P = 0.012, P = 0.012) and the mean scores of OSDI and CIC were significantly higher (P = 0.006, P < 0.001) in Group 1 and Group 2 than in Group 3. The mean values of TBUT and Schirmer-I test were lower and the mean scores of OSDI and CIC were higher in Group 1 than in Group 2 but the differences were insignificant (P > 0.05 for all).

CONCLUSION

These results indicated that the tests associated with dry eye disease are correlated with KC. Tear film alterations and goblet cell loss are higher in severe KC.

Tear Function Alterations and Conjunctival Impression Cytology Findings in Patients With Gout

OBJECTIVES

The aim of this study was to evaluate the tear functions and conjunctival impression cytology (CIC) findings of patients with gout and compare them with healthy controls.

METHODS

Thirty-four patients with gout (group 1) and 32 age-matched and gender-matched healthy individuals (group 2) were included in this cross-sectional study. Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and CIC grade were evaluated and compared between the groups.

RESULTS

There was no significant difference between the groups in gender and age (P=0.923 and P=0.078, respectively). The mean of Schirmer 1 test result was significantly lower in group 1 (9.74±6.03 mm) than that in group 2 (17.16±9.33 mm) (P<0.001). The TBUT was also significantly lower in group 1 (7.00±2.09 seconds) than that in group 2 (12.75±5.25 seconds) (P<0.001). The OSDI score (20.04±12.92) was significantly higher in group 1 than that in group 2 (6.19±10.07) (P<0.001). Although 10 patients (29.4%) in group 1 had the CIC grade of 2 to 3, none of the controls had CIC grade 2 to 3. The mean CIC grade in group 1 (1.15±0.89) was significantly higher than that in group 2 (0.47±0.51) (P<0.001).

CONCLUSIONS

The results of this study suggest that ocular surface alterations assessed by CIC and tear function abnormalities are more common in patients with gout.

Conjunctival impression cytology and tear film parameters in patients with multiple sclerosis

PURPOSE

To evaluate conjunctival impression cytology (CIC) findings and tear film parameters in patients with multiple sclerosis (MS) compared with controls.

METHODS

Thirty-three patients with MS (MS group) and 33 age- and sex-matched healthy subjects (control group) were included in this cross-sectional comparative study. CIC grades, tear break-up time (TBUT), Schirmer 1 test results, and Ocular Surface Disease Index (OSDI) scores were compared between the two groups, and correlations between CIC grade, TBUT, Schirmer 1 test result, OSDI score, Expanded Disability Status Scale score, and disease duration were analyzed.

RESULTS

Mean CIC grade was higher in the MS group than in the control group (1.48 ± 0.71 and 0.39 ± 0.56, respectively; p < 0.001). In the MS group, CIC of the 14 participants (42.4%) was grade 2-3. In the control group, CIC of the only one participant (3.3%) was grade 2, and none of them was grade 3. TBUT (8.12 ± 3.16, 13.06 ± 4.23 s in MS and control groups, respectively; p < 0.001) and Schirmer 1 test results (8.45 ± 5.75, 17.36 ± 10.89 mm in MS and control groups, respectively; p < 0.001) were lower, and OSDI score (36.36 ± 19.19, 13.70 ± 15.36 in MS and control groups, respectively; p < 0.001) was higher in the MS group compared to the control group.

CONCLUSION

In patients with MS, objective findings of dry eye, subjective symptoms related to dry eye, and CIC abnormalities, including high grades of conjunctival squamous metaplasia and goblet cell loss, are more common. Patients with MS should be monitored for ocular surface alterations and dry eye disease.

Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series

PURPOSE

To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS).

METHODS

Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively.

RESULTS

There were 8 men and 5 women, with an average age of 56 ± 19 years. The mean follow-up was 8.7 ± 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.±6.6 months (range, 1.5-26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 ± 69 μm) to postoperative last visit (523 ± 71 μm) was statistically significant (P < 0.001).

CONCLUSIONS

DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.

Evaluation of inflammatory biomarkers in patients with keratoconus

OBJECTIVE

To investigate the monocyte-to-HDL-cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocytes ratio (ELR), platelet distribution width (PDW), red blood cell distribution width (RDW), mean platelet volume (MPV), MPV to platelet count ratio (MPV/PC), and RDW to platelet ratio (RPR) that are accepted as inflammatory markers in patients with keratoconus.

METHODS

In this study, 43 patients with keratoconus and 43 healthy individuals as the control group were retrospectively evaluated. High density lipoprotein cholesterol (HDL-c), lymphocyte, neutrophil, eosinophil, monocyte, platelet, MPV, PDW, and RDW values were obtained with complete blood count performed on the peripheral blood samples.

RESULTS

Absolute monocyte (593 ± 182 vs 492 ± 177; p < 0.05) and neutrophil (4860 ± 1553 vs 3954 ± 1297; p < 0.01) counts were statistically significantly higher in the keratoconus groups compared to the control group. MHR (13.18 ± 5.02 vs 9.88 ± 4.45; p < 0.01) and NLR (2.30 ± 0.87 vs 1.77 ± 0.61; p < 0.01) were statistically significantly higher and LMR (4.07 ± 1.67 vs 5.18 ± 2.06; p < 0.01) was significantly lower in the keratoconus group. As a result of univariate logistic regression analysis, it was observed that MHR and NLR were statistically significant relationship with keratoconus (p = 0.02 and p = 0.021) (Odds ratio = 5.41 (95% CI: 1.169-6.669) and Odds ratio:5.28 (95% CI: 1.024-6.321); respectively). No statistically significant difference was found between the groups in terms of PLR, ELR, RDW, MPV, PDW, MPV/PC, and RPR. Adjusting for age and gender, multivariate regression analysis revealed that MHR was the most significant parameter to demonstrate relationship with keratoconus (p = 0.025) (Odds ratio = 4.99 (95% CI: 1.019-6.332)).

CONCLUSION

MHR and NLR values considered as inflammatory markers were statistically significantly higher and LMR value was significantly lower in the keratoconus group. Among these values, MHR was the most reliable parameter.

Evaluation of the systemic inflammation in patients with pterygium: Monocyte-to- high-density lipoprotein cholesterol ratio and hematologic indexes of inflammation

PURPOSE:

The purpose of this study is to evaluate systemic inflammation in patients with pterygium using the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and hematologic indexes of inflammation.

METHODS:

Thirty-one patients with primary pterygium and 31 age-and sex-matched healthy participants were enrolled in this retrospective study. The MHR, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, eosinophil-to-lymphocyte ratio, monocyte-to-eosinophil ratio, mean platelet volume-to-platelet count ratio, platelet distribution width, and red cell distribution width were compared between the two groups.

RESULTS:

There was not a statistically significant difference in terms of the MHR between the pterygium group and the control group (P = 0.693). The NLR was higher in the pterygium group than in the control group (P = 0.028). In the other hematologic indexes, there were no statistically significant differences between the two groups (P > 0.05 for all).

CONCLUSION:

The MHR is not associated with the presence of pterygium. An increased NLR in patients with pterygium may be an indicator of systemic inflammation.

Subclinical inner retinal layer thickness changes in the fellow eyes of patients with unilateral central retinal artery occlusion: a pilot study

PURPOSE

To investigate microstructural changes in the macular inner retinal layers over time in the fellow eyes of patients with unilateral central retinal artery occlusion (CRAO).

METHODS

Spectral-domain optical coherence tomography scans of 16 patients with CRAO were performed at initial examination (1st day), at 1st month, at 3rd month, at 6th month, and the central macular thickness (CMT) and inner retinal layer thicknesses in the fellow eyes of the patients were compared between each visit. The thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL) were calculated in 9 quadrants according to the definition by the Early Treatment Diabetic Retinopathy Study.

RESULTS

CMT decreased over a 6-month period, but the difference was insignificant among visits (p = 0.072). Also, there were no significant differences in the thicknesses of RNFL and GCL among visits (p > 0.05 for all quadrants). But there was thinning in the parafoveal superior and perifoveal superior quadrants of the IPL (p = 0.007, p = 0.01) and in the parafoveal temporal quadrant of the INL (p = 0.033) within 6 months of follow-up in the fellow eyes of the patients with CRAO.

CONCLUSION

This study demonstrated subclinical alterations of the macular inner retinal layers over time in the fellow eyes of CRAO patients.

The Frequency and Causes of Blindness in a Rural Region of Central Anatolia of Turkey

Objective

This study aimed to evaluate the frequency and primary causes of blindness in adults aged 18 years and more in Sarıkaya rural region of Yozgat, Turkey, to contribute to the epidemiologic information about blindness in our country.

Materials and Methods

Patients who were examined between October 2016 and March 2017 in Sarıkaya State Hospital, Clinic of Ophthalmology, were prospectively investigated. Demographic and ophthalmic examination data, presented visual acuities (VA), primary causes of blindness, and monocular blindness were recorded. Blindness was defined as presented visual acuities (VA) definition of World Health Organization criteria.

Results

A total of 3423 participants, aged 18-96 years, were examined. Among them, 1887 participants (55%) were female and 1536 (45%) were male. The frequency of blindness was 1.5% (95% CI: 1.1%-2.0%); and cataract was the primary cause of blindness (42%). Age-related macular degeneration (21%) and uncorrected refractive error (13%) were the next main causes of blindness. The frequency of monocular blindness was 4% (95% CI: 3.8%-5.2%), and cataract (27%) followed by phthisis bulbi/evisceration (13%) and glaucoma (12%) were the leading causes of monocular blindness.

Conclusion

In this rural region of Central Anatolia, the primary cause of blindness and monocular blindness was an unoperated cataract. The patterns of age-specific causes of blindness are variable, but most of them are avoidable or treatable. Thus, awareness should be increased in societies, and people should be prevented from blindness with health-care programs in rural regions of developing countries.

May Monocyte/HDL Cholesterol Ratio (MHR) and Neutrophil/Lymphocyte Ratio (NLR) Be an Indicator of Inflammation and Oxidative Stress in Patients with Keratoconus?

OBJECTIVE

To evaluate monocyte/high-density lipoprotein cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) in patients with keratoconus (KC).

METHODS

Thirty-one patients with KC (group 1) and 31 healthy control subjects (group 2) were included in the study. All participants' ocular examination findings, clinical and laboratory parameters were obtained from file records and laboratory archives.

RESULTS

When group 1 was compared with group 2, MHR (13.7 ± 5.0 vs. 9.1 ± 3.7; p < .001) and NLR (2.3 ± 0.8 vs. 1.7 ± 0.6; p < .001) were statistically significantly higher in group 1. Optimal MHR cutoff value for KC was calculated as 10.2 with 77.4% sensitivity and 64.5% specificity, and optimal NLR cut-off value for KC was found as 1.9 with 71.4% sensitivity and 55% specificity.

CONCLUSION

MHR and NLR values recognized as indicators of oxidative stress and systemic inflammation were significantly higher in patients with KC compared to the control group.

Efficacy of pulsed-light accelerated crosslinking in the treatment of progressive keratoconus: Two-year results

PURPOSE

The aim of this study was to evaluate the 2-year results of epithelium-off pulsed-light accelerated corneal collagen crosslinking treatment in progressive keratoconus using 30 mW/cm² ultraviolet A light for 6 min with a total dose of 5.4 J/cm².

METHODS

A total of 30 eyes of 22 patients with documented progressive keratoconus and treated with epithelium-off pulsed-light accelerated corneal collagen crosslinking using the KXL® crosslinking device (Avedro Inc, Waltham, MA, USA) were included in this retrospective study. Corneal tomographic measurements and best spectacle-corrected visual acuity were compared using analysis of variance with repeated measurements between the baseline visit (before the corneal collagen crosslinking treatment), and the sixth month, first, and second year visits.

RESULTS

Flat keratometry (K1), steep keratometry (K2), and mean keratometry (Km) decreased significantly at sixth month, first, and second years (p < 0.001, p = 0.001, and p < 0.001, respectively). Maximum keratometry (Kmax) decreased from 55.40 ± 4.90 D at baseline to 54.82 ± 4.68 D, 54.80 ± 5.12 D, and 54.65 ± 5.36 D at sixth month, first year, and second year, respectively (p = 0.007). The best spectacle-corrected visual acuity improved from 0.34 ± 0.24 logMAR at baseline to 0.25 ± 0.16 logMAR, 0.22 ± 0.15 logMAR, and 0.17 ± 0.13 logMAR at sixth month, first year, and second year, respectively (p < 0.001). At the second year visit, best spectacle-corrected visual acuity remained stable (no lines lost) with respect to the baseline in 8 eyes and increased 1 or more lines in 22 eyes.

CONCLUSION

Pulsed-light accelerated corneal collagen crosslinking using 30 mW/cm² ultraviolet A light for 6 min with a total dose of 5.4 J/cm² is an effective treatment modality in cases with progressive keratoconus-it stops progression at 2 years also regresses some of the cases.

The Association of Cataract and Lens Epithelial Cell Apoptosis in Patients with Pseudoexfoliation Syndrome

PURPOSE

The aim of this study was to measure the density of apoptotic lens epithelial cells (LECs) and to determine its association with cataract formation in eyes with pseudoexfoliation syndrome (PEX).

MATERIALS AND METHODS

Twenty-one eyes of 21 patients diagnosed with PEX without glaucoma (Group 1) and 22 eyes of 22 subjects without PEX (Group 2) were enrolled in this study. During cataract surgery, anterior capsule samples were obtained by the 5.5 mm continuous curvilinear capsulorhexis method. Apoptosis was determined with a TUNEL kit (Boster, Wuhan, China) according to the manufacturer's protocol. Four fields in each pathology preparation were chosen randomly under a microscope, and 100 cells were counted in each field to calculate the apoptosis rates.

RESULTS

Forty-three eyes of 43 subjects were enrolled in this study. There were no significant differences in age or sex between the two studied groups (p > 0.05). Under a microscope, the LECs were stained light blue and their nuclei were oval shaped. Positive stained cells were found occasionally in Group 2, while a significant amount of black-brown positively stained LECs with condensed nuclei was found in Group 1. The apoptosis rates were 35.2 ± 2.1% and 14.1 ± 1% in Groups 1 and 2, respectively. The proportion of positively stained LECs was higher in Group 1 (p < 0.001).

CONCLUSION

Our study suggests that apoptosis in LECs is the pathophysiological mechanism for the higher rate of cataracts in PEX patients, in addition to the ocular ischemia hypothesis.

Unilateral Recurrent Anterior Uveitis as the Presenting Sign of Bladder Carcinoma

A 79-year-old male patient was followed for unilateral uveitis with 3 attacks in 10 months, despite initial improvement with steroid therapy. The patient had visual acuity (VA) of counting fingers in right eye, hypopyon and vitritis with no chorioretinal lesions. The left eye was normal. The patient was evaluated for intraocular foreign body, intraocular lymphoma and associated systemic disease and malignancy. Computed tomography of the abdomen showed a mass in the bladder. Biopsy confirmed bladder carcinoma. After resection of the mass, intraocular inflammation improved completely and no attack was noted in the follow-up. In his last examination, two years after the operation, VA was light perception; seclusio pupilla and mature cataracts were seen on biomicroscopy. There was no sign of vitritis on ocular ultrasonography. Evidence is discussed that suggests a link and potential etiology between refractory uveitis with hypopyon and bladder carcinoma. This is the first case of unilateral recurrent uveitis with hypopyon as the initial presenting sign of bladder carcinoma.

Six-month outcomes of corneal crosslinking with dextran-free isotonic riboflavin solution

PURPOSE

To analyze the short-term clinical and topographic outcomes in patients with keratoconus after corneal collagen cross-linking treatment (CXL) with dextran-free isotonic riboflavin solution.

METHODS

In this retrospective case series, 26 eyes from 26 patients with keratoconus were studied. The best corrected visual acuity (BCVA) and refractive and topographic findings were analyzed at a 6-month follow-up.

RESULTS

The mean BCVA (Snellen lines) values before and 1, 3, and 6 months after CXL were 0.51 ± 0.2, 0.48 ± 0.2, 0.57 ± 0.2, and 0.64 ± 0.2, respectively, and the difference between the preoperative and 6-month values was statistically significant (p=0.006). The mean spherical equivalent refraction decreased from -5.6 ± 2.4 diopters (D) preoperatively to -5.0 ± 2.1 D, and mean simulated keratometry decreased from 48.5 ± 2.5 D to 47.8 ± 2.6 D at 6 months. (p=0.145 and p=0.001, respectively). In addition, the maximum keratometry decreased progressively and significantly from the preoperative value during follow-up (p=0.003). The central and minimal corneal thicknesses, including those of the epithelium, also decreased from 442.8 ± 25.6 µm and 430.5 ± 23.9 µm preoperatively to 420.7 ± 31.8 µm and 409.3 ± 28.7 µm at the most recent follow-up (p<0.001), respectively. No intraoperative or postoperative complications were observed.

CONCLUSIONS

CXL with dextran-free isotonic riboflavin solution appears to be a safe treatment alternative for keratoconus and yields sustained short-term improvements in visual acuity, keratometric readings, and corneal thickness. However, long-term results are needed to confirm these outcomes.

Traumatic luxation of the globe: A 6-year follow-up

A 25-year-old man was involved in a motor vehicle accident. The left globe was luxated out of orbit with total optic nerve avulsion. The globe was intact without any penetration and put back into the orbit. Although the patient has no light perception, he is grateful for satisfactory cosmetic results with 6-year follow-up.

Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes

PURPOSE

To analyze the indications for explantation or exchange of intraocular lenses (IOLs), which were originally implanted for the correction of aphakia during cataract extraction.

METHODS

All cases that involved intraocular lens explantation or exchange in one institution between January 2008 and December 2014 were analyzed retrospectively.

RESULTS

In total, 93 eyes of 93 patients were analyzed. The median time interval between implantation and explantation of the anterior chamber intraocular lenses (AC IOL) and posterior chamber intraocular lenses (PC IOL) was 83.40 ± 83.14 months (range: 1-276 months) and 55.14 ± 39.25 months (range: 1-168 months), respectively. Pseudophakic bullous keratopathy (17 eyes, 38.6%) and persistent iritis (12 eyes, 27.8%) in the AC IOL group and dislocation or decentration (30 eyes, 61.2%) and incorrect IOL power (nine eyes, 18.4%) in the PC IOL group were the most common indications for explantation of IOLs. The mean logMAR best corrected visual acuity (BCVA) improved significantly from 1.30 preoperatively to 0.62 postoperatively in the PC IOL group (p<0.001) but did not improve significantly in the AC IOL group (p=0.186).

CONCLUSIONS

The primary indication for IOL explantation or exchange was pseudophakic bullous keratopathy in the AC IOL group and was dislocation or decentration in the PC IOL group. PC IOL explantation or exchange is safe and improves visual acuity.

Relationship of inferior oblique overaction to macular and subfoveal choroidal thickness

PURPOSE

To evaluate the macular and subfoveal choroidal thickness of eyes with inferior oblique muscle overaction (IOOA) using enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT).

METHODS

The measurements of macular and subfoveal choroidal thickness obtained by EDI SD-OCT of patients with IOOA (24 patients) were compared with those of age- and sex-matched controls (25 subjects).

RESULTS

There were no morphological abnormalities of the macula in patients with IOOA or in control subjects. There were no statistically significant differences in macular and subfoveal choroidal thickness between the eyes with IOOA and the eyes of the control subjects (P > 0.05). When the patients with IOOA were assigned to two distinct groups according to the degree of IOOA, the macular thickness did not differ between groups (P = 0.66), whereas subfoveal choroidal thickness measures were significantly lower in eyes with severe IOOA compared to eyes of the controls (P = 0.01).

CONCLUSIONS

IOOA has no effect on the morphology and the thickness of the macula. Severe IOOA seems to be related to thinning of subfoveal choroid due to possible external mechanical effect.

Current evidence of pathophysiology of diabetic macular edema: A review

Diabetic macular edema (DME) is an important cause of vision loss in patients with diabetes mellitus. The pathophysiology of DME can be described as a process whereby hyperglycaemia leads to overlapping and inter-related pathways that play a role not only in the initial vascular events, but also in the events that cause the edema to become chronic. On a macrocellular level, DME is believed to be in part caused by alterations in hydrostatic and oncotic pressures and shear stress. Angiogenic factor expression, inflammation and oxidative stress constitute the key components of microvascular pathways. The interactions, signalling events and feedback loops between the various molecules are complicated and are not completely understood. These molecular mediators, acting in conjunction with macrocellular factors, which are all stimulated in part by the hyperglycaemia and hypoxia, can have a direct endothelial effect leading to hyperpermeability, disruption of vascular endothelial cell junctions, and leukostasis. Macular edema is thought to be caused as a result of these consequences.

Influence of cyclopentolate hydrochloride on corneal biomechanical properties in healthy individuals

OBJECTIVE

This observational study aims to investigate the effects of cyclopentolate hydrochloride (1%) on corneal biomechanical properties, with the ocular response analyzer (ORA), in healthy individuals.

METHODS

Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements of 36 (15 female and 21 male) healthy individuals, before and after 45 min of 1% cyclopentolate hydrochloride instillation, were performed by the ORA.

RESULTS

The mean CH and IOPcc measurements of the eyes were 10.63±1.17 mm Hg and 15.15±2.69 mm Hg, precycloplegia, and 11.09±1.32 mm Hg and 14.16±2.77 mm Hg, postcycloplegia, respectively. The differences between the precycloplegia and postcycloplegia in both measurements were statistically significant (P=0.031, P=0.016, respectively; paired t test). The mean CRF and mean IOPg measurements of the eyes were 10.40±1.16 mm Hg and 14.83±2.56 mm Hg, precycloplegia, and 10.61±1.33 mm Hg and 14.25±2.65 mm Hg, postcycloplegia, respectively. The differences between the precycloplegia and postcycloplegia measurements of the eyes were insignificant (P=0.264 and P=0.100, respectively; paired t test).

CONCLUSIONS

A 1% cyclopentolate hydrochloride instillation leads to significant changes in the CH values and IOPcc measurements. This should be taken into account during the evaluation of refractive surgery candidates and in clinical conditions where ORA measurements are considered in the diagnosis and follow-up.

Nanophthalmos and situs inversus totalis

Nanophthalmos is characterized by short axial length, high hypermetropia, thick sclera and a normal-sized crystalline lens. Situs inversus totalis is the mirror image of the normal morphology of the thoracic and abdominal viscera. To the best of our knowledge this is the first report of a nanophthalmic patient with situs inversus totalis. Therefore, we would like to invite the attention of our colleagues to our case and underline the importance of the systemic examination of the nanophthalmic patients to detect systemic malformations and visceral transpositions.

Behcet's disease presenting with cerebral vasculitis: a case report

Introduction

Behcet's disease encompasses a group of multisystemic complications secondary to occlusive vasculitis. It presents usually with oral or genital ulcers however, other system involvements may be the first sign as well.

Case presentation

A 26-years-old man admitted to our clinic for his decreased visual acuity. Ophthalmologic examination revealed bilateral vitritis and optic disc swelling. However, the meticulously taken history included other complains like headache and oral ulcers. Further investigation with cranial MRI demonstrated cerebral vasculitis secondary to Behcet's disease.

Conclusion

Behcet's disease may be easy to diagnose when it presents with oral and genital ulcers or panuveitis, however presentation with optic disc swelling may warrant a thorough investigation.