Antioxidant effects of vitamin D on lacrimal glands against high dose radioiodine-associated damage in an animal model.

PURPOSE: To evaluate antioxidant effects of active vitamin D (calcitriol) against high-dose radioiodine (RAI) therapy-associated damage of lacrimal gland. MATERIALS AND METHODS: Wistar albino rats were used and divided into three groups randomly (n = 12/group). The first group was appointed as the negative control group and received no RAI or medication. The second group was appointed as the positive control group that only received 3 mCi/kg (111 MBq/kg) RAI via gastric gavage and the last group was the treatment group that received 3 mCi/kg RAI via same method and calcitriol (200 ng/kg/day) via intraperitoneal administration. Seven days after RAI administration, bilateral intraorbital (IG), extraorbital (EG) and Harderian (HG) glands were removed for the evaluations of histopathologic, tissue cytokine, total oxidant status (TOS) and total antioxidant status (TAS). RESULTS: RAI led to significant increase in tissue TOS, TNF-α, IL-6 levels and significant decrease in IL-10 and TAS levels (p < 0.05 for each). Addition of adjunctive calcitriol reversed all these parameters significantly (p < 0.05 for each).The following histopathologic parameters were seen more frequently in positive control group than the other groups: Abnormal lobular pattern, perivascular infiltration, periductal infiltration, lipofuscin-like accumulation, acinar atrophy, periductal and periacinar fibrosis in all lacrimal gland types (p < 0.05), acinar fibrosis in EG (p = 0.049), periductal fibrosis in EG and HG (p = 0.049 and 0.038, respectively), abnormal cell outlines in EG and HG (p = 0.020 and 0.011, respectively) and variation in cell size in the IG and the HG (p = 0.003 and 0.049 respectively). CONCLUSIONS: RAI caused significant oxidative stress and inflammation in lacrimal glands. Vitamin D demonstrated potent anti-inflammatory, antioxidant and radio-protective effects on lacrimal glands in histopathologic, tissue cytokine and oxidant/antioxidant level evaluations.

The Role of Dynamic Retinoscopy in Predicting Infantile Accommodative Esotropia and Influencing Emmetropization.

INTRODUCTION AND PURPOSE: To investigate the role that dynamic retinoscopy can play in reducing the occurrence of infantile accommodative esotropia and facilitating emmetropization in infants with high hyperopia. PATIENTS AND METHODS: 211 orthotropic infants under 1 year of age (3.5 to 12 months) identified as having ≥5 diopters of hyperopia in their more hyperopic eye on a routine eye exam. On enrollment, infants underwent an assessment of accommodation using dynamic retinoscopy as well as a cycloplegic refraction. Infants who showed normal accommodation were followed without spectacles. If dynamic retinoscopy showed subnormal accommodation, partial hyperopic correction that allowed for full binocular accommodative responses at near were prescribed. Main outcome measures were the occurrence of esotropia, changes in refractive error, and visual acuity. RESULTS: Of the 211 infants enrolled, 146 showed normal accommodation and were followed without glasses (Group 1). None of these patients developed strabismus. Sixty-five patients showed subnormal accommodation and received partial hyperopic correction (Group 2). Thirty-four of the 65 (52%) in Group 2 did not develop strabismus (Group 2A) and 31 of the 65 (48%) developed strabismus (Group 2B). All 3 groups showed a reduction of hyperopia of 0.37D ± 0.25/year, 0.50D ± 0.28/year, and 0.60D ± 0.20/year in groups 1, 2A, and 2B, respectively. None of the differences between groups were statistically significant. CONCLUSIONS: Normal accommodation on dynamic retinoscopy in orthotropic hyperopic infants is a predictor of continued good alignment and such infants can be followed without spectacles. Partial spectacle correction based on dynamic retinoscopy may have a beneficial effect on reducing the development of strabismus without impeding emmetropization. Early binocular accommodative behavior seems to be predictive of infants at risk of developing strabismus.

Age-related change in corneal biomechanical parameters in a healthy Caucasian population.

PURPOSE: To determine the effect of aging on corneal biomechanical parameters measured via ocular response analyzer in a homogenous healthy Caucasian population. METHODS: A total of 2039 Caucasian adults were consecutively recruited and divided into seven groups according to decades of age. The difference in mean corneal hysteresis (CH), mean corneal resistance factor (CRF), mean Goldmann-correlated intraocular pressure (IOPg), and mean corneal-compensated IOP (IOPcc) between decades of age were investigated. The strength of the correlations between corneal biomechanical parameters, and between each biomechanical parameter and age were evaluated. The effect of age on each corneal biomechanical parameter was analyzed. RESULTS: Mean age of the participants (1173 female and 866 male) was 43.30 ± 14.64 years. Mean CH, CRF, IOPcc, and IOPg were 11.49 ± 1.89 mmHg, 11.40 ± 2.30 mmHg, 15.01 ± 3.11 mmHg, and 15.72 ± 3.80 mmHg, respectively. There were significant differences in mean CH, CRF, IOPcc, and IOPg between groups (p < 0.001 for all parameters). There was a significant negative correlation between age and CH (r = -0.067 and p = 0.003), and a significant negative correlation between age and CRF (r = -0.053 and p = 0.017). There was a significant positive correlation between age and IOPg (r = 0.25 and p < 0.001), and between age and IOPcc (r = 0.20 and p < 0.001). Linear regression analysis showed that for every 1-year increase CH decreased 0.011 mmHg, CRF decreased 0.004 mmHg, IOPcc increased 0.053 mmHg, and IOPg increased 0.047 mmHg. CONCLUSIONS: Aging can cause significant changes in corneal biomechanical parameters. Corneal biomechanical parameters were correlated with each other, and each was correlated with aging.

The Effect of Smoking on Corneal Biomechanics.

PURPOSE: To determine the effect of smoking on corneal biomechanical behavior. MATERIALS AND METHODS: The medical records of consecutive patients that presented to the ophthalmology department were reviewed. History of smoking and ophthalmological examination findings were recorded. The smoking group met the following criteria: a clear history of and present smoking habit, negative history of corneal disease and surgery, ocular response analyzer measurement at the time of examination, and a waveform score ≥3.7. Nonsmokers (never smoked or quit smoking ≥6 months earlier) that met the same criteria constituted the control group. Corneal biomechanical parameters were measured using ocular response analyzer. Data were analyzed using Pearson's χ2 test, Mann-Whitney U test, and Spearman's correlation coefficient. RESULTS: The smoking group included 166 eyes of 166 patients with a mean age of 38.7 ± 11.95 years, and the control group consisted of 170 eyes of 170 patients with a mean age of 38.40 ± 12.2 years. Mean cumulative smoking dose in the smoking group was 9.59 ± 11.87 pack-years (0.04- 75.00). There was no significant correlation between cumulative smoking dose and corneal hysteresis and corneal resistance factor (P = 0.382 and 0.074, respectively). There were no significant differences in corneal hysteresis or the corneal resistance factor between the two groups (P > 0.05). There was no significant difference in corneal hysteresis between those in the smoking group aged 18-44 years and those aged 45-64 years (P = 0.258), whereas in the control group mean corneal hysteresis was significantly lower in the 45-64 year olds than in the 18-44 year olds (P = 0.034). CONCLUSIONS: Although there was no significant difference in corneal biomechanics between smoking and control groups, the decrease in corneal hysteresis with aging was less apparent in the smoking group, which may be due to the potential changes in the cornea's microstructure induced by smoking during aging and the effect of smoking in aged corneal tissue viscosity.

The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body.

INTRODUCTION: Corneal foreign bodies are reported to be the second most common type of ocular injury. Anterior segment optical coherence tomography (AS-OCT) is a valuable tool for the early diagnosis and monitoring the progress of treatment in cases of ocular trauma. Herein we aimed to report on a patient with an intra-corneal foreign body and the role of AS-OCT in management. CASE PRESENTATION: A 34-year-old male presented with foreign body sensation in his left eye. Slit-lamp biomicroscopic examination revealed a peripherally located intrastromally embedded foreign body with a free anterior edge extending outwards from the cornea. It was not possible to visualize the foreign body's entire route through the cornea because of localized corneal edema. AS-OCT showed shadowing of the corneal layers corresponding to the location of the corneal foreign body. A hyper-reflective lesion was observed close to the inside edge of the foreign body in the cornea, indicating that the foreign body had not completely penetrated the cornea. The foreign body was removed via the external route, as it had not completely penetrated the cornea. During the postoperative period the patient was asymptomatic, although the left eye's cornea healed with scar tissue. DISCUSSION AND EVALUATION: AS-OCT facilitates non-invasive rapid imaging of ocular tissue at va rious depths, thereby providing accurate assessment of foreign body characteristics.The location of an intracorneal foreign body and the status of the surrounding ocular structure dictate the optimal surgical technique to be employed. CONCLUSIONS: AS-OCT in the present case facilitated localization and determination of the size of a corneal foreign body. In addition, AS-OCT findings assisted in selection of the appropriate surgical intervention.

Hyperbaric oxygen for the treatment of the rare combination of central retinal vein occlusion and cilioretinal artery occlusion.

A 43-year-old male presented with sudden onset of painless, blurred vision in his left eye. Dilated fundoscopic examination showed signs consistent with the diagnosis of a combination of central retinal vein occlusion (CRVO) and cilioretinal artery occlusion (CLRAO). He received daily 2-h sessions of hyperbaric oxygen treatment (HBOT), 253 kPa for 14 days. At the end of the HBOT course, the patient's left visual acuity had improved from 20/200 to 20/20. Dilated fundoscopic examination showed that the intra-retinal haemorrhages in the entire retina and the retinal whitening along the course of the CLRA seen at presentation had completely resolved. The combination of CLRAO and CRVO comprises a discrete clinical entity. Even though there are many hypotheses concerning this condition, it is most likely the result of elevated intraluminal pressure in the retinal capillaries due to CRVO that exceeds the pressure in the CLRA. HBOT may be an effective treatment for CRVO-associated CLRAO.

Corneal Biomechanical Properties in Aspirin Users.

PURPOSE: To analyze corneal biomechanical properties in aspirin users using an ocular response analyzer. METHODS: This study included 80 eyes of 40 aspirin users and 80 eyes of 40 individuals who did not use aspirin. Corneal hysteresis (CH), the corneal resistance factor (CRF), Goldman-correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) were measured in all participants. The independent samples t test was used to compare measurements in the aspirin users and nonusers in the total study population, and in the diabetic patient subgroup. Pearson's correlation analysis was used to examine the relationship between the measured variables in the aspirin users and nonusers. RESULTS: Aspirin users (59.08 ± 11.83 years) were older than nonusers (39.82 ± 12.97 years; p < 0.001). The mean CH was significantly lower in the aspirin user group than in the nonuser group (p = 0.013). Mean IOPg and mean IOPcc were also significantly higher in the aspirin user group (p = 0.027 and p = 0.002, respectively). The mean CRF was lower in the aspirin user group, but not significantly (p = 0.70). There was a positive correlation between CH and CRF (r = 0.767, p < 0.001), and between CRF and IOPg (r = 0.680, p < 0.001), and a negative correlation between CH and IOPcc (r = -0.415, p < 0.001). CONCLUSIONS: Aspirin should be taken into account when interpreting the results of corneal biomechanical measurements.

Retinal tear: an unusual complication of ocular toxoplasmosis.

PURPOSE: It is aimed to report on a 16-year-old patient with acquired ocular toxoplasmosis complicated by a retinal tear. METHODS: Retrospective medical chart review. RESULTS: A 16-year-old Caucasian female presented with vision loss in her right eye. In addition to a white active lesion between the fovea and the optic nerve head, marked vitreous opacification was noted. She was diagnosed with ocular toxoplasmosis. The patient was treated with oral azithromycin, clindamycin, and trimethoprimsulfamethoxazole. One month later, retinochoroiditis resolved and vitreous cleared. Three months after onset, patient presented with floaters in the right eye and a retinal tear was located at the temporal region of the retina. Prophylactic argon laser treatment that encircled the retinal tear was performed. No other abnormalities were noted during 6 months of follow-up. CONCLUSIONS: Retinal tear associated with ocular toxoplasmosis is rare; however, a retinal tear can occur due to vitreoretinal traction following post-inflammatory structural alteration of the vitreous. Retinal tears may be seen during the healing phase, when the inflammation turns into tightening of vitreous substance. Careful retinal examination in cases of ocular toxoplasmosis is warranted, especially in patients with severe vitreous inflammation.

Comparison of Two Techniques for the Treatment of Recurrent Pterygium: Amniotic Membrane vs Conjunctival Autograft Combined with Mitomycin C.

PURPOSE: To compare the results of amniotic membrane transplantation (AMT) combined with mitomycin C (MMC) to the results of free conjunctival autograft (CA) combined with MMC for the treatment of patients with recurrent pterygium. METHODS: In this prospective study, 60 eyes of 55 patients with recurrent pterygium were included and randomly assigned into group I (n = 30) who underwent AMT combined with MMC (AMT-MMC) and group II (n = 30) who underwent CA combined with MMC (CA-MMC). During a mean follow-up of 27.2 ± 20.8 months, recurrence of pterygium, change in uncorrected visual acuity and complications (including pain, corneal, conjunctival or scleral changes) were analyzed and were compared between groups. RESULTS: Five eyes of 5 patients were lost to follow-up and were removed from analysis. The mean age (p = 0.274), the mean follow-up (p = 0.063), the number of prior pterygium excision surgeries (p = 0.641) and the mean preoperative visual acuity (p = 0.959) were similar in both groups. Recurrence was seen in 2 eyes (8%) in AMT-MMC group and 4 patients (13.3%) in CA-MMC group (p = 0.531). Postoperative visual acuity (p = 0.237), change in visual acuity (p = 0.525), severe pain (p = 0.531) and epithelial defect lasting more than 5 days (p = 0.510) were similar in both groups. CONCLUSIONS: Amniotic membrane combined with MMC has similar recurrence rate to CA combined with MMC, in patients with recurrent pterygium. Similar outcomes and complication rates make AMT-MMC a promising method for the treatment of recurrent pterygium cases.

Role of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor treatment in age-related macular degeneration.

PURPOSE: The aim of this study was to determine the effect of posterior vitreous detachment on outcome of anti-vascular endothelial growth factor injection. METHODS: Sixty-one eyes with age-related macular degeneration that had received intravitreal bevacizumab or ranibizumab injections were retrospectively reviewed. The vitreomacular interface was evaluated, and eyes were grouped according to the presence of posterior vitreous detachment (Group 1, n = 25) or vitreomacular adhesion (Group 2, n = 36). All patients received three loading doses of intravitreal anti-vascular endothelial growth factor injections at monthly intervals, and subsequently, pro re nata regimen was performed. Best-corrected visual acuity and central foveal thickness measurement at follow-up were evaluated. The development of posterior vitreous detachment during the follow-up was also reported. RESULTS: The best-corrected visual acuity changes at each visit compared with baseline were significantly better in Group 1 (P = 0.01, 0.02, 0.02, 0.009, 0.009, respectively at third, sixth, ninth, 12th month, and last visit). When best-corrected visual acuity was classified according to the change in visual acuity of 10 letters or more, the rate of improved or stable best-corrected visual acuity was greater in Group 1 (P = 0.02). During the follow-up, 5 eyes (14.3%) developed posterior vitreous detachment. CONCLUSION: Vitreomacular adhesion seems to have an adverse effect on the visual prognosis of anti-vascular endothelial growth factor treatment for age-related macular degeneration.

Toxic optic neuropathies.

PURPOSE OF REVIEW: Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. RECENT FINDINGS: Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. SUMMARY: Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. VIDEO ABSTRACT: See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11).

Posttraumatic intraocular pressure elevation and associated factors in patients with zone I open globe injuries.

BACKGROUND: The object of this study was to determine factors that might be associated with intraocular pressure (IOP) elevation after anterior segment open globe injuries (zone I). METHODS: Data were obtained from the records of 68 patients who experienced zone I open globe injury between January 2008 and October 2010. Group I was composed of patients with chronically elevated IOP of at least 21 mmHg within a 1-year follow-up period. The rate of posttraumatic IOP elevation and associated structural and functional risk factors were evaluated. RESULTS: Of the 68 patients, 17 (25%) developed posttraumatic IOP elevation (Group 1). The mean age in group I was significantly older compared to group II (36.8±24.4 and 15.7±15.3 years, respectively [p=0.003]). Iris damage, postoperative inflammation, and use of long-term corticosteroids were significantly greater in group I (p<0.001, p<0.001, p=0.005 respectively). In group I, 13 of 17 patients (76.5%) had a wound size larger than 6 mm compared to only one patient (1/51, 2%) in group II, and the result was statistically significant (p<0.001). The size of wound larger than 6 mm also retained its statistical significance in multivariate analysis (p<0.001, odds ratio: 162.5). CONCLUSION: This study shows a significant relationship between larger wound size (>6 mm) and elevation of IOP after trauma in zone I open globe injuries.

Intraoperative floppy-iris syndrome: comparison of tamsulosin and drugs other than alpha antagonists.

BACKGROUND: To determine and compare the incidence of intraoperative floppy iris syndrome (IFIS) features in patients using tamsulosin, and other chronic medications. METHODS: We prospectively studied patients who underwent phacoemulsification (PE) between March 2006 and October 2007 on use of tamsulosin or a single medication like antihypertansive (AH), antiaggregant (AAg), antipsycotic (AP) or oral antidiabetic (OAD). Patients were grouped as tamsulosin users (Group 1), previous tamsulosin users (Group 2), chronic medication users (AH, AAg, AP or OAD) (Group 3) and patients with no medication (Group 4). Comparison of pre and postoperative visual acuities, intraocular pressures, intraoperative posterior capsular rupture (PCR) rates and grades of IFIS among groups were evaluated. RESULTS: We studied 1567 eyes of 1530 subjects. Twenty five eyes in the study demonstrated IFIS (1.6%). Five cases were included in Group 1 and IFIS incidence was 80%, while it was 60% in Group 2 (n = 5), 1 % in Group 3 (n = 1099), 1.7% in Group 4 (n = 421). IFIS incidence was significantly higher in Groups 1 and 2 compared to Groups 3 and 4 (p < 0.001). There was no difference between Groups 1 and 2 (p = 1.0) and between 3 and 4 (p = 0.29). Most cases (72%) had all three signs of IFIS. Complete IFIS was seen in one patient in Groups 1 and 2, whereas it was seen in all IFIS patients of Groups 3 and 4 (p < 0.001). Incidence of PCR was significantly higher in Group 1 (p = 0.045). CONCLUSION: Tamsulosin was found to be the drug which was most likely to be associated with IFIS, but IFIS was also observed in patients chronically using losartan, aspirin, chlorpromazine and metformin. Although, IFIS incidences were found to be similar between chronic users of these drugs and those using no medications at the time of surgery, new studies in the future will introduce the predisposing factors and the possible mechanisms of IFIS with these medications.

Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism.

OBJECTIVES: Radioiodine (RAI) is used in the treatment of hyperthyroidism and differentiated thyroid cancer. Radioiodine therapy is associated with dry eyes and some side effects are seen especially due to beta rays. In this study, the functional and cytological status of lacrimal glands after RAI therapy was evaluated. METHODS: Twenty-five patients with a mean age of 55.16 years with planned low-dose RAI therapy were evaluated. Just before and 6 months after the treatment, the lacrimal glands were evaluated with tear break-up time (BUT), Schirmer's test, impression cytology and "Ocular Surface Disease Index (OSDI)" questionnaire. RESULTS: The mean value of Schirmer's test was 16.20 ± 3.61 pre-treatment and 11.28 ± 4.39 post-treatment for the right eye, and 15.76 ± 3.27 and 10.60 ± 4.42 for the left eye, respectively. The mean value of Schirmer's test decreased significantly post-treatment in both eyes (p = 0.0001). The BUT score also decreased significantly post-treatment (p = 0.001). The mean value of OSDI score was 27.5 ± 8.02 pre-treatment and 46.36 ± 10.27 post-treatment. The mean value of OSDI score increased post-treatment (p = 0.0001). The impression scores also increased post-treatment in both eyes (p = 0.0001). CONCLUSION: Even low-dose (≤30 mci) RAI treatment affects lacrimal gland functions. Low-dose RAI causes a decrease in the value of Schirmer's test and the BUT test, and an increase in the value of OSDI score and impression scores.

Comparison of sutures and cyanoacrylate tissue adhesives for wound repair in a rat model of corneal laceration.

AIMS: The aim of the present study was to evaluate the cicatricial repair of a corneal artificial perforation in rats with 10-0 nylon suture, N-butyl-2-cyanoacrylate (NBCA) adhesive, or NBCA + methacryloxysulfolane (NBCA-MS) adhesive through microscopic and histological assays. METHODS: Twenty Wistar rats were randomly divided into 4 groups each containing 5 rats: (1) control group (corneal trauma without suturing and tissue adhesives), (2) suture group, (3) NBCA group and (4) NBCA-MS group. A central full-thickness 2-mm laceration was performed in the left eyes of the studied rats in all 4 groups. The presence of corneal edema, corneal neovascularization and tissue adhesive/suture were evaluated. On the 21st day, the rats were sacrificed and histological examination was performed to determine irregularity of corneal layers, superficial epithelization, polymorphonuclear leucocytes and neovascularization. RESULTS: Tissue adhesives were as effective as suturing in closing full-thickness corneal wounds and no difference in postoperative healing was observed clinically. As for the histological results, suture-treated eyes had persistent corneal irregularity that can limit visual acuity and may also lead to astigmatism. CONCLUSIONS: The use of tissue adhesives constitutes a viable alternative clinical procedure to conventional sutures. Possible influences on astigmatism are hypothetical, as no objective measure of astigmatism was performed in the test animals.

Cup-to-disc ratio in patients with idiopathic intracranial hypertension is smaller than that in normal subjects.

BACKGROUND: A small cup-to-disc (C:D) ratio is an established risk factor for nonarteritic anterior ischemic optic neuropathy. We sought to determine if a small C:D ratio was present in patients with idiopathic intracranial hypertension (IIH) as a potential risk factor for visual loss in that disorder. METHODS: We performed a retrospective review of 52 charts of patients diagnosed with IIH at Michigan State University from 1990 to 2003. Twenty-eight patients (55 eyes) met diagnostic inclusion criteria and had undergone fundus photography of sufficient quality to allow assessment of the C:D ratio after optic disc edema had become minimal or resolved. C:D ratio was measured from the digitized photographs. The data were placed into rank order categories (0.1 unit intervals) and compared to published normative C:D data. RESULTS: The average vertical C:D ratio was 0.143 (SD 0.061) in the right eye and 0.127 (SD 0.056) in the left eye. The average horizontal C:D ratio was 0.145 (SD 0.053) in the right eye and 0.133 (SD 0.053) in the left eye. The IIH group rank distribution data were compared to published normative C:D ratio data (chi-square test). In each case, the IIH population had a statistically significantly smaller C:D ratio (P < 0.0001) compared to normal subjects. CONCLUSIONS: The C:D ratio in our IIH population was smaller than that in published control populations. A small C:D ratio may lower the threshold for developing optic disc edema from ischemia, increased intracranial pressure, or other mechanisms. Additional studies are needed to confirm these findings.

Prevalence of pinguecula and pterygium in patients with thyroid orbitopathy.

PURPOSE: To determine the prevalence of pinguecula and pterygium in patients with thyroid orbitopathy (TO) and to evaluate its correlation with clinical findings. METHODS: All patients underwent a thorough ophthalmic examination, including tear function analysis using tear film breakup time (BUT) measurement. For patients with TO, lid retraction, Hertel exophthalmometry, and clinical activity scores were also measured. All patients were evaluated for the presence of pinguecula and pterygium. RESULTS: The groups were age (P = 0.15) and gender matched (P = 0.2). The prevalence of pinguecula was significantly higher in group 1 (196 patients, 98%) than in group 2 (23 patients, 46%) and group 3 (64 patients, 32%) (P < 0.001). In group 1, lid retraction was significantly correlated with pinguecula prevalence (P < 0.001), whereas there was no correlation between pinguecula prevalence and BUT values (P = 0.624), clinical activity score levels (P = 0.325), or exophthalmometer findings (P = 0.155) In groups 2 and 3, pinguecula was seen more frequently in patients with subnormal BUT measurements (P < 0.001). Pterygium was seen at very low rates in all groups and analysis could not be performed. CONCLUSIONS: Pinguecula was seen more frequently in patients with TO than in both control groups. Lid retraction was the only clinical factor determined with significant impact on the prevalence of pinguecula in patients with TO. Impaired tear function did not influence pinguecula prevalence in patients with TO, in contrast to both control groups. Increased exposure to UV light because of lid retraction may be the major underlying causative factor on pinguecula prevalence in patients with TO, compared with tear dysfunction in both control groups.

Takayasu's disease and secondary ocular ischemic syndrome.

Takayasu's, or "pulseless," disease is a rare, idiopathic, chronic granulomatous vasculitis that affects large arterial blood vessels. Ocular manifestations occur as a consequence of obliteration of the carotid artery, and ocular ischemia may develop. A 14-year-old girl with progressive visual loss and ocular ischemic syndrome secondary to Takayasu's disease is described.

The impact of Nd:YAG capsulotomy on foveal thickness measurement by optical coherence tomography.

BACKGROUND AND OBJECTIVE: To measure the foveal thickness change after Nd:YAG laser capsulotomy by optical coherence tomography (OCT). PATIENTS AND METHODS: Fifty-four eyes of 54 patients who had posterior capsule opacification underwent Nd:YAG laser capsulotomy. OCT of the foveal region was performed preoperatively and postoperatively (on days 1 and 7 and months 1, 3, 6, and 12). The preoperative and postoperative measurements were compared. RESULTS: The foveal thickness did not significantly change in the first year after laser treatment. Cystoid macular edema developed in only 1 patient (2%). Patient age and gender, time between surgery and laser capsulotomy, total laser shots, total laser energy, or mean laser energy per shot did not affect the foveal thickness. CONCLUSION: Foveal thickness does not change in the first year after Nd:YAG laser capsulotomy, as determined by OCT.

Vitrectorhexis versus forceps capsulorhexis for anterior and posterior capsulotomy in congenital cataract surgery.

PURPOSE: To compare the results of anterior and posterior continuous curvilinear capsulorhexis created using forceps with those created using vitrector in eyes suffering from congenital cataract. METHODS: Twenty-eight eyes with congenital cataract were included in the study. The anterior and posterior continuous curvilinear capsulorhexes were created using microforceps in 17 eyes or through a vitrector in 11 eyes. RESULTS: Corneal edema (P = .56) and anterior chamber flare (P = 1.0) were comparable in both groups. In addition, the time for optical axis clarity was also similar between the groups (P = .98). CONCLUSION: The current results suggest that the use of both techniques appears to be equally safe and effective for the achievement of anterior and posterior capsulorhexis.