Gonioscopy-assisted transluminal trabeculotomy as a primary surgical option for glaucoma in Fuchs uveitis syndrome: A case series

BACKGROUND

Fuchs uveitis syndrome (FUS) is a chronic intraocular inflammatory disease. It can lead to glaucoma which can be intractable to both medical and surgical treatment. In the present report, we describe our experience with GATT as a primary surgical option in the treatment of glaucoma secondary to FUS.

RESULTS

Four consecutive patients with FUS-associated glaucoma underwent GATT in a single institution. Case 1 was a 28-year-old pseudophakic male with a preoperative intraocular pressure (IOP) of 43 mmHg had unsuccessful circumferential cannulation; his IOP remained high after GATT and received trabeculectomy followed by Ahmed glaucoma valve (AGV) implantation to control IOP. Although IOP was stable following AGV, he required descemet membrane endothelial keratoplasty due to persistent corneal decompansation. He had a stable IOP of 12 mmHg over 21 months. Case 2 was a 42-year-old male with preoperative IOP of 35 mmHg and posterior subcapsular cataract had 360-degree GATT combined with phacoemulsification; his IOP reduced to 14 mmHg over 18 months. Case 3 was an 52-year-old pseudophakic male with a preoperative IOP of 28 mmHg had 360-degree GATT; his IOP remained stable at 10 mmHg over 18 months. Case 4 was an 47-year-old pseudophakic female with a preoperative IOP of 39 mmHg had 360-degree GATT; her IOP remained stable at 14 mmHg over 12 months.

CONCLUSION

GATT may be used as an initial approach in secondary glaucoma due to FUS. But, further evidence is still warranted to better ascertain the usefulness of GATT in this specific patient population.

Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol

PURPOSE

The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment.

METHODS

The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively).

RESULTS

The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3-18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001).

CONCLUSION

This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.

Phylogeography and phenotypic wing shape variation in a damselfly across populations in Europe

BACKGROUND

Describing geographical variation in morphology of organisms in combination with data on genetic differentiation and biogeography can provide important information on how natural selection shapes such variation. Here we study genetic structure using ddRAD seq and wing shape variation using geometric morphometrics in 14 populations of the damselfly Lestes sponsa along its latitudinal range in Europe.

RESULTS

The genetic analysis showed a significant, yet relatively weak population structure with high genetic heterozygosity and low inbreeding coefficients, indicating that neutral processes contributed very little to the observed wing shape differences. The genetic analysis also showed that some regions of the genome (about 10%) are putatively shaped by selection. The phylogenetic analysis showed that the Spanish and French populations were the ancestral ones with northern Swedish and Finnish populations being the most derived ones. We found that wing shape differed significantly among populations and showed a significant quadratic (but weak) relationship with latitude. This latitudinal relationship was largely attributed to allometric effects of wing size, but non-allometric variation also explained a portion of this relationship. However, wing shape showed no phylogenetic signal suggesting that lineage-specific variation did not contribute to the variation along the latitudinal gradient. In contrast, wing size, which is correlated with body size in L. sponsa, had a strong negative correlation with latitude.

CONCLUSION

Our results suggest a relatively weak population structure among the sampled populations across Europe, but a clear differentiation between south and north populations. The observed geographic phenotypic variation in wing shape may have been affected by different local selection pressures or environmental effects.

Impact of perioperative characteristics on the recurrence risk and survival of patients with uterine leiomyosarcoma

OBJECTIVES

To analyze the impact of perioperative characteristics on the risk of recurrence in patients with uterine leiomyosarcomas.

METHODS

A sub-analysis of the SARComa of the UTerus (SARCUT) study, which is a multicentric cross-sectional pan-European study that included 390 patients diagnosed with leiomyosarcoma, between 2001 and 2007. Perioperative factors related to risk of recurrence and survival were analyzed.

RESULTS

The 5-year and 10-year disease-free survivals (DFS) were 46% and 55%, respectively. Overall survival at 5 and 10 years was 34% and 47%, respectively. The most important factors related to global recurrence were the incomplete cytoreduction (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.91-4.31); performing bilateral adnexectomy (HR 2.71; 95% CI 1.23-5.93); tumor persistence after any treatment (HR 2.38; 95% CI 1.39-4.06); and adjuvant chemotherapy administration (HR 2.55; 95% CI 1.82-3.58) or adjuvant radiotherapy (HR 2.26; 95% CI 1.53-3.32). The major factors significantly associated with pelvic relapse were tumor persistence after any treatment (HR 3.63; 95% CI 1.83-7.20) and adjuvant radiotherapy (HR 2.74; 95% CI 1.44-5.20). Incomplete cytoreduction was the most important factor associated with distant relapse (HR 1.91; 95% CI 1.22-2.97). The most important factors related to overall survival were tumor persistence after any treatment (HR 4.59; 95% CI 2.51-8.40), incomplete cytoreduction (HR 3.68; 95% CI 2.44-5.56), tumor margin involvement (HR 2.41; 95% CI 1.64-3.55) and adjuvant chemotherapy (HR 1.91; 95% CI 1.31-2.78).

CONCLUSIONS

Complete cytoreduction is the main prognosis factor impacting the DFS and overall survival of patients with uterine leiomyosarcoma. Adjuvant chemotherapy administration was associated with decreased rates of DFS and overall survival. The adjuvant radiotherapy was associated with a higher risk of global recurrence.

Impact of Hospital Case Volume on Uterine Sarcoma Prognosis: SARCUT Study Subanalysis

BACKGROUND

High-complexity and low-prevalence procedures benefit from treatment by referral centers. The volume of cases necessary to maintain high training in the treatment of gynecologic sarcoma is currently unknown. This study aimed to determine differences in survival and recurrence as a function of the volume of patients treated per center.

METHODS

The multicentric cross-sectional SARComa of the Uterus (SARCUT) study retrospectively collected cases of uterine sarcomas from 44 centers in Europe from January 2001 to December 2007. The survival of patients treated in high case-volume (HighCV) centers was compared with the survival of patients treated in low case-volume (LowCV) centers.

RESULTS

The study enrolled 966 patients: 753 in the LowCV group and 213 in the HighCV. Overall survival (OS) was 117 months, and cancer-specific survival (CSS) was 126 months. The difference was significant (respectively p = 0.0003 and 0.0004, log rank). After adjustment for other confounding factors, the remaining significant factors were age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03-1.05), histology (HR, 1.19; 95% CI, 1.06-1.34), extrauterine involvement (HR, 1.61; 95% CI, 1.24-2.10) and persistent disease after treatment (HR, 3.22; 95% CI, 2.49-4.18). The cytoreduction performed was significantly associated with the CSS and OS in both groups. The log rank for surgical cytoreduction was a p value lower than 0.0001 for OS, lower than 0.0001 for the LowCV centers, and 0.0032 for the HighCV centers.

CONCLUSIONS

The prognosis for patients with uterine sarcoma is directly related to complete tumor cytoreduction, histologic type, and FIGO stage, with significant differences between low and high case-volume centers. Patients with uterine sarcomas should be centralized in HighCV centers to improve their oncologic outcomes.

Prognostic factors in undifferentiated uterine sarcoma: a subanalysis of the SARCUT study

PURPOSE

The aim of this study was to analyze the prognostic factors related to the recurrence rate and overall survival of patients with undifferentiated uterine sarcoma.

METHODS

An international multicenter study involving 43 international centers, the SARCUT study, collected 966 uterine sarcoma cases; among them 39 cases corresponded to undifferentiated uterine sarcoma and where included in the present subanalysis. The risk factors related to the oncological outcomes where analyzed.

RESULTS

The median age of the patients was 63 (range 14-85) years. Seventeen (43.5%) patients presented FIGO stage I. The 5-year overall survival (OS) was 15.3% and 12-months disease-free survival (DFS) 41%. FIGO stage I was significantly associated with a better prognosis. In addition, patients who received adjuvant radiotherapy showed significant longer disease-free survival compared to those without adjuvant radiotherapy (20.5 vs. 4.0 months, respectively; p = 0.04) and longer overall survival (34.7 vs. 18.2 months, respectively; p = 0.05). Chemotherapy administration was associated with shorter DFS (HR 4.41, 95% CI 1.35-14.43, p = 0.014). Persistent disease after primary treatment (HR = 6.86, 95% CI 1.51-31.09, p = 0.012) and FIGO stage IV (HR 4.12, 95%CI 1.37-12.44, p = 0.011) showed significant worse prognosis for OS.

CONCLUSION

FIGO stage seems to be the most important prognostic factor in patients with undifferentiated uterine sarcoma. Adjuvant radiotherapy seems to be significantly associated also to a better disease-free and overall survival. On the contrary, the role of chemotherapy administration remains unclear since was associated to a shorted DFS.

Conjunctival Microbiota and Blepharitis Symptom Scores in Patients With Ocular Rosacea

PURPOSE

Investigation of the relationship between blepharitis-related symptom scores, tear film functions, and conjunctival microbiota in patients with ocular rosacea (OR) compared with healthy controls was aimed.

METHODS

Consecutive 33 eyes of 33 patients with OR who were admitted from the dermatology clinic and age-matched and gender-matched 30 healthy controls were included in the study. Tear breakup time (TBUT), Schirmer score, and blepharitis symptom score (BLISS) were recorded for each patient. For the bacteriological examination, bacterial culture was obtained by inoculating the samples on chocolate agar, blood agar, and fluid thioglycollate medium. The growth of different colonies of bacteria was identified using matrix-assisted laser desorption or ionization time-of-flight mass spectrometry.

RESULTS

Bacterial culture positivity was observed in 13 eyes (39.4%) in the patients with OR and 10 eyes (33.3%) in the controls ( P =0.618). Patients with OR showed worse TBUT and Schirmer scores, and higher BLISSs ( P =0.005, P =0.007, and P =0.001, respectively). Patients with OR with conjunctival culture-positive results showed higher BLISSs (8.0±4.7) compared with those with negative results (4.7±2.3; P <0.001). The most frequent bacteria was Micrococcus luteus (18.2%) in patients with OR and Staphylococcus epidermidis (20.0%) in the controls.

CONCLUSION

This pilot study showed that patients with OR had similar conjunctival culture positivity compared with healthy controls. However, the observation of different dominant bacterial species in conjunctival microbiota and the observation of worse BLISSs in patients with OR with positive culture might suggest a potential role of conjunctival microbiota in the pathogenesis of OR.

Phototherapeutic keratectomy: current approaches and changing trends in a tertiary eye clinic

PURPOSE

To examine the efficacy of phototherapeutic keratectomy as a treatment for variable pathologies with anterior corneal opacities and evaluate the distribution of phototherapeutic keratectomy indications over the past 10 years.

METHODS

The records of 334 eyes from 276 patients who underwent phototherapeutic keratectomy between March 2010 and 2020 were retrospectively reviewed. Etiologies of the patients who underwent phototherapeutic keratectomy were noted, and their changes were examined. Refractive and visual acuity results before and after the operation were recorded and analyzed according to etiology.

RESULTS

The mean age of the patients was 40.7 ± 16.2 years (range: 19-84). The mean follow-up was 25.5 ± 19.1 months (range: 3-96). Phototherapeutic keratectomy was most frequently applied for corneal stromal dystrophies (44%, 151 eyes from 111 patients), and granular dystrophy was the most common phototherapeutic keratectomy indication among corneal dystrophies. Unlike other indications, there has been an increase in the application of phototherapeutic keratectomy for persistent subepithelial opacities due to adenoviral conjunctivitis in the past 10 years. There was a significant increase in visual acuity in all groups except for the recurrent epithelial defect group (p<0.05). The greatest improvement in visual acuity was detected for stromal dystrophies in the granular dystrophy subgroup.

CONCLUSION

Despite changing indication trends, phototherapeutic keratectomy remains an effective and reliable treatment for anterior corneal lesions.

Lymph node dissection in uterine leiomyosarcomas: A matched-pair study

OBJECTIVE

To assess the impact of the lymph node dissection (LND) in the disease-free (DFS) and overall survival (OS) of the women treated surgically of uterine leiomyosarcoma (ULMS).

MATERIAL AND METHODS

A multicentric retrospective study was conducted among European countries collecting patients diagnosed of uterine sarcoma (SARcoma of the UTerus - SARCUT study). A total of 390 ULMS were selected for the present study to compare patients who underwent LND and those who did not. A further matched-pair subanalysis identified 116 women, 58 pairs (58 with LND and 58 without it) comparable in age, tumor size, surgical procedures, extrauterine disease and adjuvant treatment. Demographic data, pathology results and follow-up were abstracted from medical records and analyzed. Disease-free (DFS) and overall survival (OS) were studied using Kaplan-Meier curves and Cox regression analysis.

RESULTS

Among the 390 patients, the 5-year DFS was significantly higher in no-LDN group comparing to the LDN group (57.7% vs. 33.0%; HR 1.75, 95% CI 1.19-2.56; p = 0.007), but not the 5-year OS (64.6% vs. 64.3%; HR 1,10 95% CI 0,77-1,79; p = 0.704). In the matched-pair subanalysis, there were no statistical differences between the study groups. The 5- year DFS was 50.5% in the no-LND and 33.0% in the LND group (HR 1.38; 95% CI 0,83-2.31; p = 0,218) and the 5-year OS was 59.7% and 64.3% respectively (HR 0.81; 95% CI 0,45-1,49; p = 0,509).

CONCLUSIONS

LND performed in women diagnosed of ULMS have no impact neither in the disease-free nor in the overall survival compared to patients without LDN in a complete homogeneous group.

Prognostic factors in patients with uterine sarcoma: the SARCUT study

OBJECTIVE

Uterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma.

METHODS

This international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007.

RESULTS

The 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93).

CONCLUSION

Incomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.

Sutureless Amniotic Membrane Transplantation Using Pediatric Nasogastric Tube for Patients With Acute Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

PURPOSE

Evaluation of the results of sutureless amniotic membrane transplantation (AMT) using a pediatric nasogastric tube (NGT) for patients with acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) was aimed.

METHODS

Twenty-six eyes of 13 patients with SJS/TEN with ocular involvement at a single tertiary care hospital between May 2020 and January 2022 were included in the study. An amniotic membrane was implanted to the ocular surface and conjunctival fornix using a modified symblepharon ring (MR) created by inserting NGT end-to-end. Patients were followed for at least 6 months. The mean duration of the surgery was recorded. The presence of corneal epithelial defect and vascularization, meibomian gland dysfunction (MGD) grade, conjunctival scarring, eyelid margin keratinization, symblepharon, and trichiasis were recorded.

RESULTS

The mean age of the patients was 38.4±17.6 years. Amniotic membrane transplantation was performed only once for eight patients and twice for five patients. The mean duration of the surgery was 3.2±0.4 min. The modified symblepharon ring was removed 28 days after its application. At the first examination, 20 eyes (76.9%) had a corneal epithelial defect and 6 (23.1%) had early symblepharon. At the postoperative 6 months, although seven eyes (26.9%) had conjunctival scarring and 5 (19.2%) had eyelid margin keratinization, all patients were without any corneal defect, corneal vascularization, or symblepharon. Only 11 eyes (42.3%) showed MGD, and 1 eye (3.8%) showed trichiasis.

CONCLUSIONS

This study showed that sutureless AMT using pediatric NGT could be a potentially fast and inexpensive treatment option for the treatment of SJS/TEN with ocular involvement at the bedside without the need for general anesthesia.

Long-term results of a new posterior chamber phakic intraocular lens in patients with high myopia: 5-year results

PURPOSE

To evaluate the long-term refractive outcomes of Eyecryl posterior chamber spherical phakic intraocular lens (pIOL) implantation in high myopia and endothelial cell density (ECD) change.

SETTING

Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.

DESIGN

Retrospective.

METHODS

Eyes that were not suitable for corneal refractive surgery, had high myopia between -6.00 diopters (D) and -20.00 D, had Eyecryl posterior chamber spherical pIOL implantation, and had at least 5 years of follow-up were included. Preoperative ECD was ≥2300 cells/mm 2 and cylindrical value was ≤2.0 D in all cases. Preoperative and postoperative first, third, and fifth years of refraction, uncorrected and corrected distance visual acuity (UDVA/CDVA), and ECD were recorded.

RESULTS

36 eyes of 18 patients were examined. The mean UDVA and CDVA in postoperative fifth years were 0.24 ± 0.19 logMAR and 0.12 ± 0.18 logMAR, respectively. The safety and efficacy indices were 1.52 ± 0.54 and 1.14 ± 0.38, respectively. At 5 years, the spherical equivalent was ±0.50 D in 75% of eyes and ±1.00 D in 92% of eyes. After 5 years, the mean cumulative ECD loss was 6.91% ( P = .07). The annual ECD loss was 1.57% in the first year, 0.26% between 1 year and 3 years, and 2.38% between 3 years and 5 years. Asymptomatic anterior capsule opacity developed in 1 eye 4 years after surgery. Rhegmatogenous retinal detachment developed in 1, and myopic choroidal neovascular membrane occurred in 1 eye.

CONCLUSIONS

Eyecryl posterior chamber spherical pIOL implantation is one of the effective and safe refractive surgical methods in correcting high myopia with predictable and stable refractive results over a 5-year period. Longer-term studies are needed for complications such as decreased ECD, retinal complications, and lens opacity.

Biofilm formation, antibiotic resistance and genotyping of Shiga toxin-producing Escherichia coli isolated from retail chicken meats

1. The Shiga toxin-producing Escherichia coli (STEC) is a hazardous zoonotic agent for chicken meat consumers. This study determined the serogroups and evaluated the virulence genes, antibiotic resistance, biofilm-forming profiles and genetic relationships of STEC isolates in chicken meat.2. A total of 100 samples belonging to dressed-whole chicken and different parts of the chicken (wing, breast, thigh, drumstick) were collected between September and November 2019 from different retail markets in Kayseri, Türkiye.3. Phenotypic (identification, disc diffusion test, Congo red agar and microtitre plate tests) and molecular tests (identification, serogrouping, virulence factors, biofilm, antibiotic susceptibility, 16S rRNA sequencing and enterobacterial repetitive intergenic consensus-PCR for typing of the isolates) were carried out.4. E. coli was isolated from 35% of the samples and 35% of the samples harboured at least one STEC. Among 35 STEC isolates, 3 (8.5%), 6 (17.1%), 2 (5.7%) and 3 (8.5%) were found to be positive for fliCH2, fliCH8, fliCH11, fliCH19 genes, respectively. Out of 35 STEC positive isolates, 4 (11.4%) were identified as E. coli O157, from which 2 (5.7%) were E. coli O157:H7. E. coli O157 was detected in two (10%), one (5%), one (5%) of the thigh, drumstick and whole chicken samples, respectively.5. Biofilm-forming ability was reported in 33 (94.2%) of 35 E. coli isolates, whilst the biofilm-associated genes detected among 35 STEC isolates included csgA (88.5%), fimH (88.5%), bcsA (85.7%), agn43 (14.2%) and papC (8.5%). The STEC strains showed resistance against ampicillin (88.5%) and erythromycin (88.5%), followed by tetracycline (74.2%) and gentamicin (25.7%). However, the distribution of isolates harbouring bla_CMY, ere(A), tet(A) and aac(3)-IV antibiotic resistance genes was found to be 17.1%, 11.4%, 85.7% and 5.7%, respectively.6. ERIC-PCR showed that E. coli strains obtained from different parts and whole of chicken samples had genetic diversities. ERIC-PCR patterns grouped strains of 35 STEC into eight clusters designated A-H, with 73% similarity. Proper hygiene measures and staff training are essential for public health during poultry processing and in retail stores to control STEC.

The effect of anterior segment parameters on surgical success of Descemet membrane endothelial keratoplasty: a prospective study

PURPOSE

To investigate how anterior segment parameters affect the success of Descemet membrane endothelial keratoplasty (DMEK) in patients with endothelial insufficiency without stromal opacities and to identify factors predisposing them to repeat keratoplasty.

METHODS

Our prospective observational study included patients who underwent primary DMEK for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy between March 2019 and March 2020. After a detailed ophthalmologic examination, corneal topographic analysis, anterior segment optical coherence tomography (AS-OCT) scans, endothelial cell density (ECD) and axial length (AL) measurements were performed. Surgical success was defined as no endothelial dysfunction during follow-up. Changes in the parameters and how preoperative parameters affect surgical success were investigated.

RESULTS

In 43 eyes of 43 patients (mean age: 68.58 ± 8.51 years), mean visual acuity was 1.73 ± 0.74 LogMAR before DMEK and 0.31 ± 0.29 LogMAR in the final visit. Central corneal thickness (CCT, p = 0.026) and mean anterior chamber depth (ACD, p = 0.001) affected surgical success. Preoperative CCT values greater than 770 µm increased the risk of repeat keratoplasty by 8.75-fold, whereas preoperative ACD values less than 2.5 mm increased the risk by 2.92-fold.

CONCLUSION

Preoperative higher CCT and lower ACD values were associated with surgical failure after DMEK. Early surgery may be considered for more successful results.

TRIAL REGISTRATION

This prospective study has been registered on the ClinicalTrials.gov system with the registration number NCT04420429 on 06/06/2020.

Changes in anterior chamber dimensions following small incision lenticule extraction (SMILE)

PURPOSE

To evaluate the changes in anterior chamber dimensions including horizontal anterior chamber diameter (HACD), anterior chamber depth (ACD), and iridocorneal angle (ICA) following small incision lenticule extraction (SMILE) using Scheimpflug-Placido disk tomographer (Sirius).

METHODS

The records of the 73 eyes of 47 patients who received SMILE for myopia and myopic astigmatism were retrospectively reviewed. Preoperative and 6-month postoperative measurements of central corneal thickness (CCT), HACD, ACD, ICA, nasal anterior chamber angle (nACA), and temporal anterior chamber angle (tACA) were obtained by tomography, and compared with paired t-tests. Pearson's correlation and linear regression tests were used to evaluate the relationship between these parameters.

RESULTS

The CCT, HACD, and ACD values decreased significantly at 6-month postoperatively (p < 0.05 for all). ICA, nACA, and tACA showed no statistically significant difference postoperatively (p = 0.54, p = 0.118, and p = 0.255, respectively). Pearson's correlation analysis confirms negative relationship between Δ-HACD and Δ-tACA (r = -0.475, p < 0.01), and a loose negative relationship between change in ACD and change in ICA (r = -0.282, p = 0.016). Age and Δ-tACA were found as predictive parameters for Δ-HACD and, Δ-ICA was a predictor for Δ-ACD.

CONCLUSION

While HACD and ACD decreased significantly, there was no significant change in ICA, nACA and tACA. Changes in HACD and ACD should be considered in terms of subsequent surgeries after SMILE.

Comparison of Intraocular Pressure Measurements With Goldmann Applanation Tonometry, Tonopen XL, and Pascal Dynamic Contour Tonometry in Patients With Descemet Membrane Endothelial Keratoplasty

PRCIS

IOP measured with Tonopen and DCT was higher than GAT in eyes that underwent DMEK.

PURPOSE/AIM OF THE STUDY

To compare intraocular pressure (IOP) measurements measured based on Goldmann applanation tonometry (GAT), Tonopen XL, and Pascal Dynamic Contour Tonometry (DCT) in patients who had undergone descemet membrane endothelial keratoplasty (DMEK) and to appraise the influence of central corneal thickness (CCT) on IOP measurements.

MATERIALS AND METHODS

Thirty-four eyes (from 34 patients) who underwent DMEK at least 1 month before the study were included. We performed Tonopen XL, GAT, and DCT IOP measurements at 10 min intervals. Bland-Altman plots were used to assess agreement between GAT, Tonopen XL, and DCT. Spearman rank correlation was used to calculate the deviation from GAT readings by each device and correlate the readings with the CCT variable.

RESULTS

The mean IOP values with GAT, Tonopen XL, and DCT were 14.9±5.8, 16.2±5.5, and 19.2±5.0, respectively. Statistically significant differences between GAT and Tonopen XL and between GAT and DCT were noted ( r =0.942 [0.885-0.971]; P =0.0001 and r =0.942 [0.885-0.971]; P =0.0001, respectively). DCT tended to return a higher IOP relative to GAT and Tonopen XL. CCT and IOP readings obtained by GAT, Tonopen XL, and DCT did not show a statistically significant correlation with each other.

CONCLUSION

IOP as measured with both Tonopen and DCT was found to be higher than GAT in eyes that underwent DMEK surgery although the techniques showed a good correlation. After DMEK surgery, all 3 measurement techniques can be practical in routine postoperative examinations, however it is recommended to measure IOP with the same device during patient follow-up.

Early intraocular pressure changes following different keratoplasty techniques and association with cornea parameters and anterior chamber depth

Background:

Corneal transplantation surgery is associated with an increased risk of intraocular pressure (IOP) elevation. Increased IOP may cause irreversible vision loss and graft failure.

Objective:

We aimed to evaluate early IOP changes following different keratoplasty techniques and to investigate the relationship between corneal thickness (CT), keratometry values, anterior chamber depth (ACD), and IOP changes.

Methods:

We included patients who underwent penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and Descemet membrane endothelial keratoplasty (DMEK) in this observational study. ACD, CT, and keratometry measurements were repeated postoperatively at hour 24, week 1, and month 1. IOP measurements were repeated at postoperative hours 6 and 24, week 1, and month 1 by Tono-Pen XL.

Results:

In total, 22 patients underwent PK, 12 patients underwent DALK, and 19 patients underwent DMEK. The difference between the IOP preoperatively and postoperatively hour 6, and between the IOP preoperatively and postoperatively hour 24 was statistically significant in the three types of surgery ( p < 0.05 for each). The difference between preoperative and postoperative week 1 IOP was statistically significant only in the PK group ( p = 0.023). When the IOP was compared between the three types of surgeries, the IOP at postoperative week 1 in the PK group was significantly higher than the DALK and DMEK groups ( p = 0.021). There was no correlation between ACD, CT, K values, and IOP in any group.

Conclusion:

IOP may increase in all types of keratoplasty during the first hours after surgery, but PK has a risk of high IOP longer in the early postoperative period. PK patients should be followed more carefully during postoperative week 1 to check for an increase in IOP.

Efficacy and safety of iris-supported phakic lenses (Verisyse) for the treatment of high myopia: 5-year results

PURPOSE

Evaluating efficacy and safety of iris-supported phakic lenses (Verisyse) for high myopia treatment.

METHODS

Patients treated with Verisyse (Abbott Medical Optics, Santa Ana, CA, USA) intraocular lens (IOL) implants were evaluated retrospectively. Patients with follow-up periods of more than 5 years were included in the study. Pre- and postoperative fifth-year spheric equivalent (SE) of manifest refraction values, uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively), and endothelial cell density (ECD) values were recorded. Complications were evaluated.

RESULTS

Forty-seven eyes of 31 patients were included in the study. Pre- and postoperative fifth year mean SE was - 12.50 ± 3.51D and - 0.72 ± 0.40D, respectively. Pre- and postoperative fifth-year UDVA was 1.56 ± 0.22 and 0.33 ± 0.18 logMAR (p < 0.001), respectively. The safety index (pre- and postoperative CDVA) was 1.39 ± 0.63 at the 5-year follow-up (p > 0,05). The efficacy index (ratio of mean postoperative UDVA to mean preoperative CDVA) of the patients was 1.14 ± 0.60. The mean postoperative endothelial cell loss at 5 years was -7.42%. None of the patients had lost 25% of their preoperative endothelial cells at 5-year follow-up. The mean postoperative endothelial cell loss was -3.05% at 1 year, -1.23% between years one and three, -1.02% between the third and fifth years.

CONCLUSION

Verisyse IOL implantation is an effective and safe for high myopia surgical treatment. However, the 5-year follow-up period is not sufficient to evaluate the safety profiles in terms of endothelial cells.

Comparison of topical omega-3 fatty acids with topical sodium hyaluronate after corneal crosslinking : Short term results

Purpose: To evaluate the effect of topical omega 3 on ocular surface following corneal crosslinking (CXL) in keratoconus and compare with topical sodium hyaluronate.Material methods: 50 patients who underwent CXL were divided into two groups. In addition to topical steroids and antibiotics, Group A was prescribed topical omega 3; Group B was prescribed 0.3% sodium hyaluronate. Postoperatively, epithelial defect was measured everyday and at the first month corneal staining, Schirmer test was performed, tear break up time (TBUT), tear meniscus height (TMH) were measured.Results: Preoperative keratometric values were similar between groups; there was no difference in terms of corneal staining, tear film stability; epithelial closure time (p: 0.052), and postoperative pain scores between groups. At 1st month, TBUT and TMH were significantly better in Group A than Group B(p: 0.001, p: 0.047).Conclusion: Topical omega 3 increases tear film stability more prominent than sodium hyaluronate following crosslinking.

Effect of keratorefractive surgery on choroidal thickness in anisometropic amblyopia

PURPOSE

To evaluate postoperative change in choroidal thickness (CT) in patients with anisometropic amblyopia undergoing keratorefractive surgery.

METHODS

Anisometropic amblyopic patients and nonamblyopic patients who underwent keratorefractive surgery were included in the study. The eyes were divided into three groups. Group 1 consisted of eyes with anisometropic amblyopia, group 2 were the nonamblyopic fellow eyes, and group 3 (control group) were nonamblyopic eyes which had undergone keratorefractive surgery. At the third postoperative month, the CT of these eyes were measured by Enhanced Depth Imaging OCT (EDI-OCT). The choroidal thickness (CT) was measured in the subfoveal area and at 500 micron intervals nasally and temporally.

RESULTS

Twenty-three anisometropic amblyopia patients with amblyopic and fellow eyes and 23 control eyes were enrolled. The mean subfoveal choroidal thickness (CT) was 387.3±168.8μm in group 1, 412.2±88.8μm in group 2 and 337.3±99μm in group 3 (P: 0.019). Group 1 and group 2 showed higher choroidal thickness (CT) in the nasal and temporal quadrants than group 3 (P: 0.03, P: 0.04). At the third postoperative month, central foveal choroidal thickness was 356.6±115.5μm in group 1, 375.1±112.5μm in group 2 and 284.4±98.9μm in group 3 (P: 0.071). Choroidal thickness (CT) in the nasal and temporal quadrants at the third postoperative month was also similar (P: 0.210, P: 0.103).

CONCLUSIONS

The macular choroid is thicker in amblyopic eyes and non-amblyopic fellow eyes than in the nonamblyopic controls. Improved fixation after refractive surgery may normalize CT.

Validity of ocular trauma score in open globe injury patients from Turkey

OBJECTIVE

To determine the efficacy of ocular trauma score (OTS) in determining the prognosis in patients with open globe injury who admitted to our clinic.

MATERIALS AND METHODS

Data of patients with open globe injury who were admitted to our clinic between 2014 and 2016 were retrospectively analyzed. The OTS raw score of each patient was determined and translated into OTS categories according to OTS study. Prognostic results of OTS study and current study was compared with chi square analysis.

RESULTS

In our study, 101 eyes of 101 patients were examined. The mean age of the patients was 27.08±15.36 years. The mean follow-up period was 12.84±9.04 months. In total, 86 of the cases were male (85.1%). In our study, the mean initial visual acuity of the patients was 0.10±0.23. In 64.3% of the cases, IVA was at hand movement level or lower. IVA was found to be≥20/40 in 10.9%. The mean FVA was 0.38±0.37. In total, 41.6% of the cases had a FVA≥20/40. In 28.7% of these cases, FVA was at hand movement level or lower. While no significant difference was found in patients with OTS3, OTS 4 and OTS 5 (P>0.05), prognosis of patients with OTS 1 and OTS 2 was better than OTS study (P<0.001) CONCLUSION: Although OTS can be effective and safe data in terms of prognosis, it can be improved with more comprehensive studies.

Prognostic factors in patients with vulvar cancer: the VULCAN study

OBJECTIVE

This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.

METHODS

This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.

RESULTS

After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).

CONCLUSIONS

Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Laser in situ keratomileusis (LASİK) in patients with superior steepening on corneal topography: Is it safe and predictable?

BACKGROUND

Attention is usually given to inferior steepening on corneal topography in the evaluation of a patient's suitability for LASIK surgery. The aim of this study is to investigate long-term refractive results with superior steepening.

METHODS

Patients who underwent LASIK surgery between 2015 and 2019 in our refractive surgery department were retrospectively reviewed. The patients with a ≥ 1.0 D superior-inferior (S-I) quadrant difference in the tangential map, using a Scheimpflug camera with a Placido disc topographer (Sirius), were included in the study. Preoperative and postoperative best-corrected and uncorrected visual acuity (Snellen), cylindrical refraction values, and spherical equivalent (SE) values were compared. Adverse events were recorded.

RESULTS

Fifty eyes of 28 patients participated in the study. The mean age of the patients was 27.5 ± 8.0 (19-59). Sixteen patients were female (57.1%), and 12 (42.8%) patients were male. The average follow-up time was 29.8 ± 11.1 months (12-61). Average central corneal thickness was 549.4 ± 26.0 (498-602) μm. Average minimal corneal thickness was 549.1 ± 26.9 (497-598) μm. Preoperative S-I quadrant difference (D) was 1.87 ± 0.7 (1.0-3.99). Posterior elevation (Kvb) was 11.2 ± 1.9 (9-17) μm. The preoperative SE value was - 1.7 ± 2.1 (- 6.25-3.25) and improved to - 0.3 ± 0.44 D (- 1.25-0.75) (p < 0.001). Preoperative cylindrical refraction values were - 2.04 ± 1.7 (- 6.25-0), and postoperative values were - 0.47 ± 0.4 (- 2-0) D (p < 0.001). Uncorrected visual acuity was median 1.0 (0.4-1.0) with 38 eyes (76%) having 20/20 postoperative uncorrected visual acuity. No sight threatening complications or ectasia findings were observed during the 2 years postoperative follow-up time.

CONCLUSIONS

Abnormal corneal topographies with (S-I) asymmetry result in predictable results after LASIK.

Phototherapeutic Keratectomy in Macular and Granular Dystrophy: Two-year Results

PURPOSE

To evaluate two-year outcomes of phototherapeutic keratectomy in granular and macular dystrophy and to investigate the effects of dystrophy type on results.

METHODS

Sixty-three patients who underwent phototherapeutic keratectomy (PTK) for granular and macular dystrophy in the cornea funit of the University of Health Sciences Beyoglu Eye Research and Training Hospital were evaluated retrospectively. Patients under 18 years of age, patients with a follow-up period of less than 24 months, and patients who had previously undergone corneal surgery or excimer laser treatment were excluded from the study. Treatment values (ablation depth, optical zone, mitomycin-C (MMC) application time) and complications during and after treatment were recorded. Patients who had a decrease of two or more lines in their BCVA and those with recurrent or increased corneal opacities were considered to have severe recurrences. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded preoperatively and postoperatively at the 12th and 24th months. The values obtained before and after the PTK were compared with statistical methods.

RESULTS

A total of 41 eyes (27 with granular dystrophy and 14 with macular dystrophy) were included in this study. There were no statistically significant differences between patients with granular dystrophy and macular dystrophy in terms of preoperative UCVA and BCVA, MMC application time, and follow-up period (p > .05). The mean age of patients with macular dystrophy was statistically smaller than that of patients with granular dystrophy (p = .04). The amount of ablation applied to macular dystrophy was statistically higher than for granular dystrophy (p = .03). The mean UCVA and BCVA showed statistically significant improvements at the 24th postoperative month (p < .5). There was no statistically significant difference between the UCVA and BCVA values of the patients with granular and macular dystrophy at the 12th and 24th months after the procedure. No recurrence was observed in any patient after 24 months. However, when the follow-up continued, severe recurrence was encountered in 2 patients with macular dystrophy at 26th and 40th months. Re-treatment procedures were needed in these two patients who had severe recurrence.

CONCLUSIONS

Phototherapeutic keratectomy is an effective and safe option for treatment in both granular and macular corneal dystrophy. Recurrence is a more common problem in patients with macular dystrophy, and recurrent therapies or keratoplasty methods are needed more frequently.

Deep anterior lamellar keratoplasty techniques; predescemetic versus big bubble: Anterior segment optical coherence tomography study

PURPOSE

To compare the visual and refractive outcomes and anterior segment optical coherence tomography (AS-OCT) findings of 2 different deep anterior lamellar keratoplasty (DALK) techniques in the treatment of advanced keratoconus with and without successful big bubble formation.

METHODS

In this retrospective comparative case series, data from 79 consecutive eyes of 69 patients who underwent either big bubble (group 1, n: 62) or manual DALK (group 2, n: 17) were analyzed. The visual and refractive results, keratometric values and residual stromal thickness were assessed. Patients were seen at 1, 3, 6 and 12 months after the procedure and 1 month after complete suture removal.

RESULTS

A big bubble was successfully obtained in 62 eyes (78.5%; group 1) and manual dissection was performed in the 17 remaining eyes (21.5%; group 2). The final best spectacle-corrected visual acuity (BSCVA) was 0.38 logMAR and 0.55 logMAR in Group 1 and 2, respectively (P<0.05). At the final visit, BSCVA≤0.30 logMAR was achieved in 80% and 60.8% of eyes in Groups 1 and 2, respectively (P<0.001). Groups 1 and 2 were comparable in terms of mean keratometry: 47.80D±2.81D (range, 41.30D to 54.2D) versus 45.90D±3.62D (range, 41.10D to 53.8 D), respectively; (P=0.56) and keratometric astigmatism: 3.81D± 2.1D (range, 1.0D to 6.20D) versus 3.56D±1.92D (range 1.2D to 6.85D), respectively; (P=0.40) at the final follow-up. The mean residual stromal thickness was 36.90±17.80μm in group 2.

CONCLUSION

The presence of residual posterior corneal stroma when big bubble formation is not successfully achieved in DALK is correlated with lower postoperative visual acuity.

The effect of intraocular lens tilt on visual outcomes in scleral-fixated intraocular lens implantation

PURPOSE

To investigate the effect of scleral-fixated intraocular lens (IOL) tilt on visual outcomes.

METHODS

Ninety-four eyes of consecutive 94 patients who underwent scleral-fixated IOL implantation with Z-suture technique were included in this prospective study. The values of pre- and postoperative 12th month uncorrected visual acuity (UCVA), cylindrical refractive error, best-corrected visual acuity (BCVA) and corneal and lenticular astigmatism were recorded. The position of the implanted IOL was evaluated with anterior segment optical coherence tomography (AS-OCT). The relationships between the AS-OCT measurements and the visual acuity or refractive errors were investigated.

RESULTS

The IOL position was evaluated as tilted in 68 (72.3%) patients: 29 (30.8%) in both vertical + horizontal axes, 30 (31.9%) in the horizontal axis and 9 (9.6%) in the vertical axis. There were no significant differences between patients with and without tilt IOL position in terms of the UCVA, BCVA, cylindrical refractive error and lenticular astigmatism (p > 0.05, for each). The mean BCVA was significantly higher in the no-tilt group than in the both horizontal + vertical tilt and the vertical tilt groups (p = 0.03, p = 0.04, respectively). The mean lenticular astigmatism was significantly higher in the vertical tilt group than the other groups (p = 0.04).

CONCLUSION

Tilting in IOL position occurs commonly; however, IOLs with tilting on any of the axes do not have significantly worse outcomes when compared with IOLs with no tilt, in terms of visual results and refractive errors. On the other hand, tilting on the vertical axis is observed less commonly, yet is more effective on visual results and refractive errors, when compared with tilting on the horizontal axis.

Descemet's Membrane Endothelial Keratoplasty with Split Corneal Grafts: The Influence of Tamponade Material and Endothelial Storage Time

Purpose: The aim of this study was to describe the clinical outcome of Descemet's membrane endothelial keratoplasty (DMEK) performed with split corneal grafts and to evaluate the influence of tamponade material and endothelial storage time on DMEK success. Material and Method: The records of 43 patients who underwent DMEK surgery with a split corneal graft were reviewed. Diagnosis of the patients, preoperative and postoperative best-corrected visual acuity (BCVA), corneal and endothelial storage time, tamponade material, complications, and success rates were specifically tabulated. Results: The most common indication for DMEK was pseudophakic bullous keratopathy (n = 25, 58.2%). Re-bubbling was needed in 10 cases (23.2%), and a re-DMEK was scheduled in 2 cases and penetrating keratoplasty in 4 cases (9.3%). BCVA improved significantly postoperatively (p < .001). There was an insignificant trend towards a lower re-bubbling rate and better long-term anatomic outcome in favor of 20% SF6 group compared to air tamponade (p = .18 and p = .25). There was no significant difference between the early endothelial transplant (<24 h) and delayed endothelial transplant (3 to 14 days) groups for anatomic success, corneal thickness or BCVA (p = .94, p = .13 and p = .35). Conclusion: The success rate of DMEK was satisfactory with split corneal grafts. There was no adverse influence of delayed endothelial transplantation on clinical outcome. The success rate of 20% SF6 tamponade was slightly better than room air.

The effects of complicated cataract surgery on iris structure and anterior chamber angle

PURPOSE

To evaluate iris structure in aphakic eyes scheduled for placement of a secondary intraocular lens.

METHODS

Twenty-eight aphakic eyes of 28 patients who were scheduled for secondary intraocular lens implantation between January 2012 and January 2017 at Beyoglu Eye Training and Research Hospital after a complicated cataract surgery were recruited in this study. The phakic fellow eyes of the patients were defined as a control group. Iris thickness was assessed using anterior segment optical coherence tomography at 750μm (IT750) and 2000μm (IT2000) from the scleral spur. Moreover, maximum iris thickness (ITM) and anterior chamber angle parameters such as trabecular iris surface area at 500 and 750μm (TISA500, TISA750), angle opening distances at 500 and 750μm (AOD500, AOD750) and anterior chamber depth (ACD) were also evaluated.

RESULTS

Mean IT750, IT2000 and ITM readings and were significantly lower in the aphakic eyes compared to the healthy eyes (P=0.04, P=0.01, P=0.01 respectively). Anterior chamber parameters (TISA500, TISA750, AOD500 and AOD750) and ACD were significantly increased in aphakic eyes following complicated cataract surgery compared to healthy fellow eyes (all P<0.001).

CONCLUSIONS

Complicated cataract surgery leading to aphakia results in decreased iris thickness and increased anterior chamber depth. These findings might be helpful in the selection of the type of surgery for placement of a secondary IOL.

Different accelerated corneal collagen cross-linking treatment modalities in progressive keratoconus

Background

To compare the outcomes of two different protocols of accelerated corneal crosslinking (CXL) on visual, corneal high order aberrations (HOA) and topographic parameters in patients with progressive keratoconus.

Methods

In this prospective comparative study, sixty-six eyes of 66 patients with progressive keratoconus were divided into two groups; 37 eyes in Group 1 received 18 mW/cm² for five minutes, and 29 eyes in Group 2 were treated with 9 mW/cm² for 10 min. The uncorrected distant visual acuity (UCVA), best-corrected distant visual acuity (BCVA), corneal HOAs and topography parameters were measured preoperatively and postoperatively at the end of 12 months. The data for the two groups were compared statistically.

Results

The mean UCVA and BCVA were significantly improved at the postoperative 12 months compared with the preoperative values in both groups (P < 0.05 for all). A significant improvement in corneal HOAs was observed in both groups (P < 0.05 for all). The change in corneal coma value was significantly higher in Group 2 (P < 0.05). The change in keratometric values K1, K2, AvgK and maximum keratometry (AKf) were significantly higher in Group 2 (P < 0.05 for all). The regression model showed that the most important factor predicting the change in AKf was the type of CXL (β = − 0.482, P = 0.005).

Conclusions

Accelerated CXL using 10 min of UVA irradiance at 9 mW/cm² showed better topographic improvements and coma values than five minutes of UVA irradiance at 18 mW/cm² independent of keratoconus severity.

An investigation of the effects of the mean platelet volume, platelet distribution width, platelet/lymphocyte ratio, and platelet counts on mortality in patents with sepsis who applied to the emergency department

Aim

The aim of this study is to examine the role of the mean platelet volume (MPV), platelet distribution width (PDW), platelet/lymphocyte ratio (PLR), and platelet values for predicting mortality in patients with sepsis.

Materials and Methods

This is a retrospective study, involving patients 18 years and above who were diagnosed with sepsis. Blood samples were analyzed for platelets characteristics (counts, MPV, PDW, and PLR). The patients were separated into two groups namely the survivors and deceased. The two groups' MPV, PDW, PLR, and platelet counts which were considered to have an effect on mortality, were compared.

Results

Three hundred and thirty patients who were diagnosed with sepsis in our emergency department and complying with the study participation criteria were studied retrospectively. Comparison of the MPV, PDW, PLR, and platelet counts of the deceased and survivors showed that the MPV, PDW, and PLR were higher in the deceased while the platelet counts were higher in the survivors.

Conclusion

The low number of platelets in patients with sepsis at the moment of application and the high PDW and PLR values are valuable for predicting a high mortality.

Associations between red reflex abnormality, consanguinity and intensive care hospitalization of newborns in Turkey

Background

Red reflex screening is the primary but unheeded test for the detection of vision- and life-threatening eye conditions.

Aims

To evaluate the red reflex of newborns, percentage of ocular diseases resulting in red reflex abnormality, and their relation with consanguinity in Southeast Turkey.

Methods

Newborns (n = 1358) were examined with pencil light and direct ophthalmoscopy.

Results

Eight hundred of these newborns were hospitalized in a rooming-in unit. (RIU) and 558 were in the neonatal intensive care service (NICS). In the RIU there were 7 (0.88%) newborns with abnormal red reflex and in the NICS there were 14 (2.51%). Sensitivity of pencil light examination was 71.4%. Studies from the Middle East have shown potential recessive genetic causes of common paediatric ocular conditions. In our study, consanguineous marriage was found to have a significant association with red reflex abnormality (P = 0.017).

Conclusions

Red reflex screening test is important in the early diagnosis of vision- and life-threatening eye disorders in Southeast Turkey where consanguinity is common.