Endothelial loss following postoperative intracameral triamcinolone acetonide and subconjunctival dexamethasone injections

OBJECTIVES

To compare endothelial toxicity and efficacy of two local steroid injections (intracameral triamcinolone acetonide and subconjunctival dexamethasone) in controlling postoperative inflammation following pars plana vitrectomy (PPV) combined with phacoemulsification cataract surgery.

METHODS

This cohort included 54 patients that underwent combined surgery and received either intracameral triamcinolone acetonide injections (n = 27, IC-TA group) or subconjunctival dexamethasone (n = 27, Sc-Dex group) injections at the end of the surgery. All participants had at least 4 months or longer follow-up. A detailed ophthalmologic examination including intraocular pressure (IOP) measurement and specular microscopy was performed at every visit.

RESULTS

Endothelial cell density (ECD) reduced significantly in IC-TA group postoperatively (2418 vs. 2249, p = 0.019), while it did not change significantly in Sc-Dex group (2541 vs. 2492, p = 0.247). Postoperative ECD was also significantly lower in IC-TA group compared to Sc-Dex group (p = 0.011). Preoperative and postoperative IOP values remained unchanged both in IC-TA and Sc-Dex groups (p = 0.424 and p = 0.523, respectively). However, 4 patients in IC-TA group and 5 patients in the Sc-Dex group needed glaucoma medications. The postoperative need for glaucoma medications was similar between the groups (p = 0.347). Postoperative inflammation was well controlled in both groups and none of the patients developed fibrin membrane or synechiae postoperatively.

CONCLUSION

Both treatments were effective in controlling postoperative inflammation, but patients in IC-TA group experienced significantly higher endothelial loss. Sc-Dex injections are safer in terms of endothelial loss and preferable to control postoperative inflammation following complex intraocular surgeries.

Corneal Sensation and Nerve Fiber Changes in Patients With Interstitial Cystitis

PURPOSE

Central sensitization syndromes are associated with ocular surface discomfort and certain changes in corneal sensation. The aim of this study was to evaluate corneal changes in patients with interstitial cystitis (IC).

METHODS

Thirty patients with IC and 32 healthy control subjects were included in this study. All patients had a detailed ophthalmological examination including measurement of corneal sensation with Cochet-Bonnet esthesiometer, tear breakup time, Schirmer I test, and Ocular Surface Disease Index questionnaire. After these examinations, corneal subbasal nerve plexus of the patients was evaluated with in vivo corneal confocal microscopy (IVCM) and the images were analyzed using fully automated software (ACC Metrics Corneal Nerve Fiber Analyzer V.2).

RESULTS

There was no significant difference between the groups regarding age and gender distribution. Corneal sensation was significantly higher in patients with IC (P = 0.03), whereas tear breakup time, Schirmer I test, and Ocular Surface Disease Index scores were similar between the patients and controls. IVCM demonstrated nerve fiber loss in patients with IC. Corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length were significantly reduced in patients with IC compared with healthy controls (P < 0.001, P = 0.04, and P < 0.001, respectively).

CONCLUSIONS

Patients with IC had increased corneal sensation and decreased nerve fiber density in IVCM analysis. Corneal nerve fiber loss might decrease the induction threshold of the remaining fibers to induce peripheral sensitization, which may also trigger central sensitization in long term.

Low levels of soluble low-density lipoprotein receptor-related protein 1 in patients with type 2 diabetes mellitus and diabetic retinopathy

Low-density lipoprotein receptor-related protein-1 (LRP-1) is a large transmembrane receptor. LRP-1 plays a role in diverse cellular processes, including lipid metabolism, cell growth, migration, and regeneration. Soluble form of LRP-1 (sLRP-1) can be detected in serum. sLRP-1 can serve as a biomarker of atherosclerosis and cardiometabolic diseases. This study investigated the concentrations of the circulating serum sLRP-1 in patients with retinopathy and type 2 diabetes mellitus. Fifty-two patients with diabetic retinopathy and 71 controls were enrolled based on well-defined eligibility criteria. Venous blood samples were collected after 12 h of fasting. sLRP-1 concentrations were measured using the commercially available ELISA in an accredited laboratory. The mean age of patients and control groups were 63.6 and 48.5 years, respectively. The median disease duration was 8.1 years. The median serum sLRP-1 levels were lower in patients with diabetic retinopathy compared to the controls (2.11 μg/mL versus 2.44 μg/mL, p = 0.034). No significant correlation was observed between the sLRP-1 and serum lipid levels. The sLRP-1 levels are low in patients with diabetic retinopathy compared to healthy controls, and future studies are needed to assess sLRP-1 as a potential biomarker in diabetic retinopathy.

A Novel Use of Retinoscopy for the Evaluation of Binocular Balance of Spherical Refractive Errors

PURPOSE

Binocular balancing is an important component of refractive correction to avoid asthenopic complaints. Polaroid filters are commonly used for binocular balancing; they rely on subjective examination and cannot represent daily visual activities. We describe a new examination approach to evaluate binocular balance with retinoscopy, which is an objective examination method and does not require strict patient cooperation.

METHODS

Healthy young individuals with refractive errors (under the age of 40) were included in this study. Each patient was examined by three different ophthalmologists in the same room at 20-min intervals. The first ophthalmologist performed refractive examination separately for each eye, the second physician used binocular balance tests with polaroid glasses, and the third physician practiced binocular balance test with retinoscopy. After completion of clinical examinations, autorefractometry was repeated with cycloplegia. The difference between the spherical equivalents (SE) of the eyes was calculated for each method and compared with the SE difference obtained by cycloplegic autorefractometry. The SPSS 21.0 software was used for the statistical tests.

RESULTS

The study included 30 patients (16 males, 14 females) and the mean age of the patients was 21 ± 8.5 years (range 10-37 years). There was no significant difference between the four groups for the interocular difference of SE (Greenhouse-Geisser F = 1.390, p = 0.257). The highest correlation was found between the retinoscopic binocular balance technique and cycloplegic autorefractometry (r = 0.878, p < 0.001). In addition, the intraclass correlation coefficient and the 95% limits of agreement supported strong agreement.

CONCLUSION

Currently used binocular examination tests are subjective and some patients give inconsistent answers impairing the reliability of the outcome. These tests cannot be performed on patients with limited ability to cooperate. This study demonstrates that the use of retinoscopy in the evaluation of binocular balance delivers reliable results and is a low-cost, practical approach to address the above-mentioned problems.

Refractive outcome of trocar-assisted sutureless scleral fixation with 3-piece intraocular lenses

PURPOSE

Intraocular lens (IOL) implantation with a trocar-assisted sutureless scleral fixation technique is a relatively new IOL implantation approach for aphakic eyes. During this surgery, the intrascleral position of the haptics can change the location of the IOL optic and may alter the refractive outcome. This study aimed to evaluate the refractive outcome of this surgery.

METHODS

The files of 22 patients who had undergone IOL implantation with the trocar-assisted sutureless scleral fixation technique were retrospectively reviewed, and the patients were invited for final examination. IOL power was calculated with optical biometry (Lenstar LS900). IOL power calculations were performed according to formulas designed for in-the-bag IOL implantation. The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1).

RESULTS

This study included 14 patients (8 male, 6 female, mean age: 62.7 ± 18.7). There were no significant differences between the preoperative and postoperative corneal astigmatism values (p = 0.16). There were also no significant differences between the postoperative corneal and total astigmatism values (p = 0.44), confirming the absence of significant IOL tilt. The difference between the implanted IOLs and the calculated IOL power for emmetropia was 0.09 D ± 0.49 D (p = 0.52). Although emmetropia was targeted, the refractive outcome shifted to hyperopia (+ 0.85 D ± 1.15 D) and was significantly different from the refractive status calculated with optical biometry (p = 0.034).

CONCLUSIONS

The intrascleral fixation of IOLs results in increased posterior positioning of the IOL optic and can induce approximately 0.85 D of hyperopia if proper adjustments are not performed during IOL power calculations.

Descemet's membrane endothelial keratoplasty in aphakic and vitrectomized eye

Objective: To report a new technique for Descemet’s membrane endothelial keratoplasty (DMEK) in aphakic and vitrectomized eyes.

Case description: A 56-year-old man presented with corneal decompensation in the left eye after combined pars plana vitrectomy and lensectomy for the management of a traumatic eye injury. DMEK graft and recipient bed were prepared as regular. The posterior half of the donor stroma was dissected with a crescent knife to form a temporary stromal barrier tissue. The prepared donor stromal tissue was implanted into the anterior chamber (AC) to form a barrier over the iris and pupilla. Then, the endothelial graft was safely injected into the anterior chamber and deployed by gently tapping on the corneal surface. Air tamponade was applied into the AC for 10 minutes to allow the graft to attach. Afterwards, the stromal barrier tissue was removed through the main incision and the AC was refilled with air tamponade. There were no intraoperative or postoperative complications during 1-month follow-up.

Conclusion: Insertion of a temporary posterior stromal tissue as a barrier over the iris and pupilla successfully provided AC stability and prevented posterior dislocation of the graft or air tamponade. This new technique was a safe and effective approach for DMEK in aphakic and vitrectomized eyes.

Central retinal vein occlusion after coronary artery bypass surgery: A case report

OBJECTIVE

The aim of this study is to report a case of central retinal vein occlusion (CRVO) after coronary artery bypass graft (CABG) surgery. In this report, we present the third case in the literature with CRVO after cardiopulmonary bypass (CPB), and the first case after CABG.

CASE REPORT

A 59-year-old male patient complaining of chest pain was admitted to our hospital. The patient underwent an elective coronary angiography and was diagnosed with three-vessel coronary artery disease. An uneventful coronary artery bypass graft operation was performed using CPB. On the second postoperative day, the patient described blurring and decreased vision in his left eye, whereas the right eye was normal. The anterior-posterior segment was examined by an ophthalmologist who diagnosed central retinal vein occlusion, using a visual acuity test, fundoscopy. After 5 months of treatment, there has been no improvement in the patient's visual acuity.

CONCLUSION

As two previous case reports indicated CRVO can be a rare complication after CPB, this study demonstrated that CRVO can also be a complication of CABG. Therefore, CRVO should always be considered as a potential complication after cardiac surgery.

Corneal sensitivity and subjective complaints of ocular pain in patients with fibromyalgia

PurposeFibromyalgia (FM) is a chronic pain disorder associated with pain and hypersensitivity in various parts of the body. The aim of this study was to understand whether changes in corneal sensitivity were associated with the subjective complaints of these patients.Patients and methodsIn this study, we included 36 patients with FM (30 female, 6 male, mean age: 46.7±9.2 years) and 39 healthy control subjects (33 females, 6 males, mean age: 44.3±7.6 years). We performed a detailed ophthalmological examination, measured tear film breakup time (TBUT), and performed Schirmer I test without anesthetic (SIT). Only patients that did not have any eye disease were included in this study. Subjective complaints of the patients were evaluated with ocular surface disease index (OSDI) scores and the corneal sensation was evaluated with Cochet-Bonnet esthesiometer.ResultsThere was no significant difference between the groups for age, sex, and visual acuity. Both SIT (16.1 mm vs 15.3 mm, P=0.36) and TBUT results (17.8 s vs 18.8 s, P=0.40) were similar in FM group and the controls subjects. However, corneal sensations in central (60.0 mm vs 55.0 mm, P=0.03), superior (57.5 mm vs 50.0 mm, P=0.005), and inferior (53.89 mm vs 46.03 mm, P<0.001) regions were significantly increased in FM patients. There was a significant positive correlation between corneal sensation and OSDI scores.ConclusionIn this study, we have demonstrated that the patients with FM have increased corneal sensitivity and have related ocular surface complaints similar to dry eye disease in the absence of it.

Scleral suture fixation technique for dislocated plate haptic toric IOL

Purpose We describe a scleral suture fixation technique for dislocated plate haptic toric intraocular lens (IOL) implantation. Materials and methods A double-armed 10-0 straight polypropylene suture was passed into the eye from the sclera (2 mm away from the limbus). A suture needle was passed through the hole on the corner of the IOL and pulled out from the paracentesis with a 27-gauge needle. Afterward, the suture needle was reinserted from the same paracentesis and then removed from the eye with the help of a 27-gauge needle entering the eye from a nearby point to the first scleral entrance. The needle was passed through the end of the loop and pulled slightly to initiate the formation of a cow-hitch knot. The same procedure was applied to the other hole on the plate haptic. Both sutures were adjusted and fixed to the sclera with a Z suture. Results No complications were observed and at the follow-up visits, uncorrected visual acuity was 0.8 with decimal. Conclusion Axial, sagittal, and rotational stability rules are taken into consideration, scleral fixation surgery for a dislocated plate haptic foldable toric IOL is an alternative method to eliminate astigmatic refractive error.

Evaluation of the relationship between corneal biomechanic and HbA1C levels in type 2 diabetes patients

Purpose

To evaluate the corneal biomechanical properties due to the glycosylated hemoglobin (HbA1C) levels using the ocular response analyzer (ORA) in the patients with type 2 diabetes mellitus (DM).

Methods

ORA values were obtained from 156 eyes of subjects with type 2 DM and 74 eyes of healthy control subjects with similar age and sex. Subjects were divided into three groups: Group 1, healthy control subjects; Group 2, diabetes patients with HbA1C <7%; and Group 3, diabetes patients with HbA1C ≥7%. Corneal biomechanical parameters: corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc) measurements were obtained using ORA. Ultrasound pachymetry was used for measurement of central corneal thickness (CCT).

Results

CH and CRF were significantly different in each of the three groups (P-values for CH respectively; Groups 1 and 2=0.008, Groups 1 and 3, and Groups 2 and 3, <0.001, and for CRF respectively; =0.002, <0.001, <0.001). CCT was significantly different between Groups 1 and 3 and Groups 2 and 3 (P<0.001) but was insignificant between Groups 1 and 2 (P=0.965). IOPcc was not different between Groups 1 and 2 (P=0.524), and Groups 2 and 3 (P=0.115), but was significantly different between Groups 1 and 3 (P=0.003). IOPg was statistically different between each of the three groups (respectively; Groups 1 and 2, P=0.015, Groups 1 and 3, and Groups 2 and 3, P<0.001).

Conclusion

Both diabetes groups were affected in terms of corneal biomechanical properties when compared to healthy subjects, there was also a positive correlation between HbA1C level and intraocular pressure.

Effect of Oral Isotretinoin Treatment on Retinal Nerve Fiber Layer Thickness

Background:

Oral isotretinoin treatment can cause ocular side effects.

Objective:

This study was performed to detect possible toxic effects of oral isotretinoin treatment on the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL).

Methods:

The study population consisted of 54 eyes of 27 patients with nodulocystic acne who used oral isotretinoin (Roaccutane) treatment. Macular GCL and peripapillary RNFL thickness measurements were performed using spectral domain optical coherence tomography (OCT) before and after therapy.

Results:

Before and after treatment, a complete ophthalmologic examination was normal in all eyes. However, posttreatment lower temporal (TL) values were significantly lower (76.80 ± 16.31) than pretreatment TL values (84.96 ± 24.83) ( p = .02). There was no statistically significant difference in the other OCT values, upper temporal, superotemporal, superonasal, upper nasal, lower nasal, inferonasal, and inferotemporal ( p = .35, p = .40, p = .56, p = .95, p = .94, p = .93, p = .61, respectively). Also, there was no statistically significant difference between the right and left eyes and between genders for all parameters ( p > .05).

Conclusion:

The use of oral isotretinoin treatment has increased in recent years. In addition, oral isotretinoin treatment has a broad adverse effect potential on the ocular system. The measurement of RNFL thickness, especially TL thickness, by OCT may be useful for detecting the possible toxic effect of oral isotretinoin therapy on RNFL.

The destructive effects of antibiotics on the amniotic membrane ultrastructure

The aim of the study was to examine the influence of different antibiotics on amniotic membrane epithelium and to observe the related ultrastructural changes using transmission electron microscope (TEM). Prospective comparative laboratory study. Amniotic membrane samples from a single placenta were obtained using a sterilized method. Tissue samples were placed in either saline or antibiotics-containing (penicillin, streptomycin, neomycin, or amphotericin B) solutions. The viability of the amniotic membrane epithelial cells was then assessed for saline and antibiotics using both light microscope and TEM to investigate morphological changes. The ultrastructural examination of amniotic membrane epithelium held in antibiotics-containing solutions showed damage to the cell membrane, rarefaction, and loss of microvilli. Amniotic membrane from the control group showed intact epithelium, with surface microvilli and junctional complexes between the cells and the basal membrane. The destructive effects of antibiotics on freshly obtained amniotic membrane were examined with both light microscopy and transmission electron microscopy and significant differences in the ultrastructure were observed.

Comparison of pre-incision and single-stepped clear corneal incision in phacoemulsification surgery

AIM

To compare postoperative keratometric corneal refractive changes after phacoemulsification surgery between pre-incision and single stepped clear corneal incision techniques.

PATIENTS AND METHODS

This prospective clinical study included 40 eyes of 40 patients who underwent clear corneal cataract surgery. Twenty eyes were operated using pre-incision technique (Group A), and 20 eyes using single-stepped incision technique (Group B). Corneal refractive power was measured by keratometry before the surgery and one week, one month, and three months postoperatively. NCSS (Number Cruncher Statistical System), 2007&PASS (Power Analysis and Sample Size), and 2008 SS (Statistical Software, Utah, USA) was used for the statistical analysis.

RESULTS

The mean preoperative keratometric corneal power in the pre-incision group was 44.24±1.59 and 44.70±1.26 in the single stepped incision group. After three months postoperatively, it was 44.15±1.57 in the pre-incision group and 44.77±1.39 in the single stepped incision group. There was no significant difference in the keratometric corneal refractive changes between Group A and Group B, three months after surgery (p > 0.05).

CONCLUSIONS

Using pre-incision and single stepped clear corneal incision techniques in phacoemulsification surgery showed no difference on corneal refractive power changes. Pre-incision technique can be used for smoother corneal incision in cataract surgery especially for the beginners.

Influence of axial length on peripapillary retinal nerve fiber layer thickness in children: a study by RTVue spectral-domain optical coherence tomography

PURPOSE

To evaluate the influence of axial length on peripapillary retinal nerve fiber layer (RNFL) thickness in myopic, hyperopic and emmetropic children eyes by RTVue optical coherence tomography (OCT).

METHODS

One hundred twenty eyes of 120 children including 40 myopic, 40 emmetropic and 40 hyperopic eyes were enrolled in the study. Peripapillary RNFL thickness measurements were performed using spectral-domain RTVue OCT (Optovue, Fremont, CA). RNFL thickness parameters were obtained from all octametric sections: upper temporal (TU), superotemporal (ST), superonasal (SN), upper nasal (NU), lower nasal (NL), inferonasal (IN), inferotemporal (IT) and lower temporal (TL). Spherical equivalent refractive error was determined via cycloplegic auto-refraction (Topcon, Tokyo, Japan). The axial length was measured using IOLMaster (Carl Zeiss MEDITEC). Littmann formula was used for correction of axial length-related ocular magnification effect.

RESULTS

Peripapillary RNFL thicknesses were significantly different among the three groups in all sectors except for NU and IT sectors. RNFL thicknesses in all sectors except for TU and TL sectors had significant negative correlations with axial length. However, these differences (excluding TU and TL sectors) and correlations disappeared after correction of magnification effect.

CONCLUSION

In conclusion, axial length influences peripapillary RNFL thickness as measured by RTVue OCT. However, this appears to be due to the ocular magnification effects associated with axial length and can be corrected for with the application of the Littman formula.