Cutaneous leishmaniasis of the eyelids: Retrospective evaluation of 18 patients.

OBJECTIVE: Although eyelid involvement is rare in cutaneous leishmaniasis (CL), it can cause severe ocular complications if the diagnosis is delayed and not treated. Our purpose in this study is to examine the clinical characteristics, diagnosis, and treatment methods as well as accompanying ocular complications in patients with CL diagnosis and eyelid involvement. METHODS: In this retrospective study, the clinical characteristics, diagnosis, and treatment methods of the disease as well as accompanying ocular complications were examined for 18 patients with CL diagnosis and eyelid involvement between May 2018 and October 2022 in our Dermatology and venereal diseases clinic. RESULTS: 10 (55%) of the patients were male and 8 (45%) were female. Unilateral lower eyelid involvement was most common (9 patients [50%]). Chalazion-like lesions (8 patients [45%]) were observed most commonly. All patients were diagnosed with CL by direct microscopic examination and were given systemic meglumine antimonate treatment. No ocular complications were observed in any of the patients. CONCLUSION: It should be kept in mind that eyelid involvement may occur in CL, and ophthalmological examinations of these cases should be performed and treatment should be initiated in the early period to prevent possible ocular complications.

Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic.

PURPOSE: To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. METHODS: The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. RESULTS: ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. CONCLUSION: ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

Evaluation of choroidal thickness and ocular manifestations in lipoid proteinosis.

PURPOSE: To assess choroidal thickness in patients with lipoid proteinosis versus healthy subjects using enhanced depth imaging optical coherence tomography. METHODS: Twenty eyes of 20 patients and the same number of age and sex-matched healthy individuals were enrolled. Comprehensive ocular examinations including measurement of best-corrected visual acuity, spherical equivalent values of refractive errors, and axial length were performed. Choroidal thickness at three points (subfoveal, 500 µm nasal and temporal regions) were measured automatically using MATLAB software. RESULTS: The mean age was 15.68 ± 5.98 years in the patient group and 16.48 ± 5.69 years in the control group. Mean choroidal thickness was statistically significantly thicker at each point in patients with lipoid proteinosis compared to the healthy controls: subfoveal, temporal and nasal choroidal thickness measurements were 425.65 ± 51.42, 380.20 ± 69.66, 334.05 ± 49.98 µm in the study group; 346.15 ± 47.76, 330.15 ± 44.35, 298.95 ± 44.21 µm in the control group, respectively (P < 0.05). CONCLUSION: Patients with lipoid proteinosis have thicker choroid compared to control eyes. Hyalin deposition and ensuing potential inflammation in the disease process may explain this finding.

Comparison of the effects of operating microscopes with light emitting diode and halogen light source on the eye: a rabbit study.

PURPOSE: To evaluate the potential toxicity of operation microscopes with halogen and light emitting diode (LED) light source on the rabbit eyes. MATERIALS AND METHODS: Thirty-two eyes of 16 male New Zealand pigmented rabbits were involved in the study. The rabbits were divided into two groups according to the type of light source applied. Only one eye of each rabbit was exposed to illumination light, unexposed fellow eyes served as the control group. Experimental groups included group 1 exposed to halogen light for 2 h and evaluated 1 day and 1 week after the illumination, group 2 exposed to LED light for two hours and evaluated 1 day and 1 week after the illumination. On the first and seventh days after exposing the light, we evaluated the rabbit corneas using in vivo confocal microscopy (IVCM). At the end of the seventh day, the Hematoxylin-eosin staining and TUNEL staining were performed to investigate the presence of apoptosis in the retina and retina pigment epithelium. RESULTS: Early IVCM findings revealed corneal epithelial cell ovalization and indistinct intercellular borders in the halogen light group. We also observed more increase in the keratocyte density index (23.7% vs 14.1%, p = 0.001, respectively) and the Bowman reflectivity index (12.4% vs 4.1%, p = 0.001, respectively) at first day of the light exposure in halogen light group compared to LED light group. However, late IVCM indicated that these findings disappeared one week later. No apoptosis was observed in the corneal and retinal layers in early and late examination groups. CONCLUSION: The present experimental study demonstrated that both halogen and LED lights, which were commonly used for microscopic eye surgery, had no sustained adverse effect on the cornea and retina of the rabbits; however, halogen light had a temporary adverse effect on corneal epithelium and stroma, which resolved within 1 week.

Descemet's membrane area and posterior corneal power may predict the Descemet membrane folds after deep anterior lamellar keratoplasty in patients with advanced keratoconus.

AIMS: To investigate possible predictive topographic characteristics for the development of Descemet's membrane (DM) folds after the uneventful deep anterior lamellar keratoplasty (DALK). METHODS: A retrospective study included 56 eyes of 56 consecutive patients who underwent uneventful DALK using the big-bubble technique to treat advanced keratoconus. At baseline and each visit, best-corrected logMAR visual acuity (BCVA), slit-lamp findings, endothelial cell density, topographic parameters were recorded. DM area is calculated using morphogeometric modelling. RESULTS: Twelve (21.4%) of them exhibited DM folds, whereas the remaining 44 (78.6%) did not exhibit any DM folds after the surgery. The mean follow-up time was 36.3 ± 16.7 (range, 12-71) months. The mean posterior corneal power was - 13.8 ± 0.6 D in patients with DM folds, whereas - 13.0 ± 0.8 D in those without DM folds (p = 0.016). The mean DM area was 53.6 ± 2.3 (50.9-57.9) mm2 in patients with DM folds, whereas 51.6 ± 1.7 (47.1-53.9) mm2 in those without DM folds (p = 0.001). The ROC curve showed that two best cut-off value for the posterior corneal power and DM area were 13.75 D and 53.8 mm2, respectively, to predict the occurrence of DM folds. CONCLUSION: DALK surgery seems to cause DM folds in patients with large DM area and high posterior corneal power.

Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome.

PURPOSE: To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). METHOD: This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. RESULTS: Schirmer's test 1 scores were 2.7 ± 0.5 mm at baseline and 3.5 ± 0.7 mm at 12th month in DE-SS, 2.9 ± 0.7 mm at baseline and 9.5 ± 0.7 mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). CONCLUSION: Topical CsA seems to be more effective in the treatment of the DE-NSS.

Sustained Elevation of Intraocular Pressure After Administration of Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Patients With and Without Pseudoexfoliation Syndrome.

PRéCIS:: Intravitreal anti-vascular endothelial growth factor therapy resulted in sustained elevation of intraocular pressure (IOP) in 18.6% of patients with coexisting age-related macular degeneration and pseudoexfoliation (PXF) syndrome. The development of sustained elevation of IOP after ~19 injections reflected the cumulative effect of anti-vascular endothelial growth factor injections on IOP. PURPOSE: The purpose of this study was to compare the long-term effect of intravitreal ranibizumab (IVR) and intravitreal bevacizumab (IVB) therapies on IOP in patients with and without PXF syndrome. DESIGN: This was a retrospective comparative study. PATIENTS AND METHODS: Data from 412 eyes of 206 patients diagnosed with unilateral neovascular age-related macular degeneration, treated with IVR or IVB, and followed-up for at least 6 months, were retrospectively reviewed. Seventy treated and 70 untreated fellow eyes of 70 patients with bilateral PXF syndrome, and 136 treated and 136 untreated fellow eyes of 136 patients without PXF syndrome were included in this study. Demographic information, clinical findings, total number of IVR and IVB injections, and IOP values at each visit were recorded. Sustained elevation of IOP (SE-IOP) was defined as either an IOP >21 mm Hg or a ≥5 mm Hg increase in IOP from baseline for at least 2 consecutive visits. Baseline and final IOP values in each group were compared using the paired sample t test, and IOP changes in the groups were compared using split-plot analysis of variance. Multivariate logistic regression analysis was used to evaluate the influence of variables on the development of SE-IOP. RESULTS: The mean (±SD) age of the patients was 77.53±3.78 years (range, 70 to 83 y), and the mean follow-up was 28.50±16.51 months (range, 6 to 58 mo). The mean number of injections was 15.56±8.01 (range, 5 to 36). The mean baseline and final IOP in treated eyes were 14.82±3.08 and 16.50±3.11 mm Hg, respectively (P<0.001). A higher incidence of SE-IOP and higher final IOP values were observed in PXF-positive eyes receiving IVB compared with the other groups. Seven of the patients required antiglaucomatous treatment. Multivariate logistic regression analysis revealed an increased odds ratio (4.90; P=0.016) of SE-IOP in PXF-positive eyes compared with PXF-negative eyes. CONCLUSION: IVB therapy may cause greater increases in IOP in patients with PXF syndrome. The co-accumulation of PXF material and bevacizumab particles on the trabecular meshwork should be further investigated.

A Novel AIPL1 Nonsense Mutation: Case Report of Three Siblings Diagnosed with Leber Congenital Amaurosis.

Background: Leber congenital amaurosis (LCA) is a subgroup of early onset retinal dystrophy, manifesting with early or congenital visual loss, wandering nystagmus, amaurotic pupils, oculodigital sign, reduced retinal thickness on optical coherence tomography and abnormal electroretinogram. Today, mutations of about 25 genes account for 80% of individuals with LCA. The AIPL1 mutations causing LCA type 4 account for about 5-10% of this group. Case Report: Three affected siblings with vision loss, nystagmus, cataracts, stage 4 keratoconus, retinal abnormalities (black spots), lack of glaucoma, and dysmorphic features from a consanguineous marriage had LCA type 4 with a novel homozygous missense mutations of AIPL1(c.862 C > T). Conclusion: Cortical cataracts, stage 4 keratoconus, retinal black spots, and lack of glaucoma along with mutations of AIPL1 (c.862 C > T) can be present in LCA type 4.

Engineered Rhodobacter capsulatus as a Phototrophic Platform Organism for the Synthesis of Plant Sesquiterpenoids.

Sesquiterpenoids are a large class of natural compounds offering manifold properties valuable for food, cosmetics, agriculture, and pharma industry. Production in microorganisms is a sustainable approach to provide sesquiterpenoids for research and industrial use independent of their natural sources. This requires the functional transfer of the respective biocatalytic pathways in an adequate host microorganism offering a sufficient supply of precursors that is ideally adjusted to the individual demand of the recombinant biosynthesis route. The phototrophic purple bacterium Rhodobacter capsulatus offers unique physiological properties that are favorable for biosynthesis of hydrophobic terpenes. Under phototrophic conditions, it develops a large intracytoplasmic membrane suitable for hosting membrane-bound enzymes and metabolites of respective biosynthetic pathways. In addition, Rhodobacter harbors an intrinsic carotenoid biosynthesis that can be engineered toward the production of foreign terpenes. Here, we evaluate R. capsulatus as host for the production of plant sesquiterpenoids under phototrophic conditions using patchoulol and valencene as a proof of concept. The heterologous expression of patchoulol synthase PcPS from Pogostemon cablin as well as the valencene synthases CsVS from Citrus sinensis and CnVS from Callitropsis nootkatensis led to the production of the respective sesquiterpenoids in R. capsulatus. To analyze, if gradually adjustable formation of the key precursor farnesylpyrophosphate (FPP) is beneficial for sesquiterpene synthesis under phototrophic conditions, the intrinsic 1-deoxy-D-xylulose 5-phosphate (DXP) pathway genes as well as the heterologous mevalonate pathway genes were modularly expressed in various combinations. To this end, different plasmids and chromosomally integrated expression tools were developed harboring the strong and tightly controlled P nif promoter for heterologous gene expression. Notably, comparative studies identified a distinct combination of precursor biosynthetic genes as best-performing setup for each of the tested sesquiterpene synthases. In summary, we could demonstrate that R. capsulatus is a promising alternative platform organism that is suited for sustainable sesquiterpenoid formation under phototrophic cultivation conditions. A modular engineering of R. capsulatus strains via tailored co-expression of FPP biosynthetic genes further allowed adaptation of sesquiterpene precursor formation to its catalytic conversion by different plant terpene synthases.