The relationship of tear osmolarity with tear meniscus curvature and contact angles in healthy subjects: anterior segment optical coherence tomography study.

PURPOSE: To evaluate the relationship of tear osmolarity (TO) with tear meniscus curvature and contact angles by anterior segment optical coherence tomography (AS-OCT) in healthy subjects. METHODS: The right eyes of 64 consecutive healthy subjects were included in the study. The eyes were scanned by AS-OCT for the measurements of upper and lower tear menisci. The geometrical components of the upper and lower menisci, including height, depth, area, and radius of the menisci, cornea-meniscus angle (α-angle), meniscus-eyelid angle (ß-angle), and curvature angle (θ-angle) were measured. TO was obtained by TearLab. All participants were administered Ocular Surface Disease Index questionnaires (OSDI), and tear film break-up time (TBUT), Schirmer I and II test measurements were also performed. RESULTS: There was no association of TO with height, depth, and area of both menisci while TO was negatively correlated to θ-angle and radius of the lower eyelid meniscus (r = - 0.41, P < 0.001 and r = - 0.40, P < 0.01, respectively). The θ-angle and the radius of the lower meniscus were also significantly associated with OSDI score, TBUT, Schirmer I and II (P < 0.01 for all). There was a statistically strong correlation between the θ-angle and the radius of the lower meniscus (r = 0.91, P < 0.001). CONCLUSION: The curvature angle and radius of the lower meniscus are significantly associated with TO. The curvature angle of the lower meniscus is a useful non-contact measure that may provide information indirectly about the osmolarity and the quality of the tear.

Histopathological and mechanical effects of Ankaferd Blood Stopper® on wound healing in rats: an experimental model

Background/aim: To evaluate the histopathological and mechanical effects of Ankaferd Blood Stopper (ABS) application on wound healing. Materials and methods: A total of 24 Wistar albino rats were randomly divided into three equal groups. In each group, a 3 cm-long midline vertical skin incision was performed in the back of the rats. In Group 1, the incision was sutured primarily. In Group 2, incision was left to secondary healing. In Group 3, ABS was applied to the incision. On the 10th day, burst pressure width was measured, and rats were sacrificed. The tissue samples were examined histopathologically. Statistical analysis was conducted with IBM SPSS program. P < 0.05 was considered significant. Results: The mean burst pressure widths of wound separation were 13.66 ± 0.457, 7.18 ± 2.599, and 13.66 ± 1.11 mm for Groups 1­3, respectively. The difference in burst pressure width between Groups 1 and 3 was not significant (P > 0.05) but was significant between Groups 2 and 3 (P = 0.000). The vascular proliferation median values were 1, 2, and 2, for Groups 1­3, respectively. Although the difference was significant between Groups 1 and 2 in terms of vascular proliferation score (P = 0.047), no significant difference was observed between Group 3 and others. No statistically significant difference was observed among the groups in terms of collagen score, mononuclear cell infiltration, and polymorphonuclear cell proliferation (P > 0.05). The median values of fibroblast proliferation score were 1, 2, and 3, in Groups 1­3, respectively. Fibroblast proliferation score significantly differed between Groups 1 and 3 (P = 0.003). Conclusions: ABS application results in a clean wound healing that is as strong as primary repair. However, additional studies are required to evaluate the late results of increased fibroblastic activity in the early period of ABS application alone.

Comparison of central corneal thickness measurements using different imaging devices and ultrasound pachymetry.

PURPOSE: To compare central corneal thickness (CCT) measurements obtained by the AL-Scan, Lenstar LS900, Galilei, and ultrasound pachymetry (UP) in normal and cataractous eyes. METHODS: Eighty eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measurements using the AL-Scan, Lenstar LS900, Galilei, and UP by a single examiner. To assess the intraobserver repeatability, three consecutive measurements were taken for the AL-Scan. RESULTS: The mean CCT [± standard deviation (SD)] for the AL-Scan, Lenstar LS900, Galilei, and UP were 554.6 ± 30.9 µm, 542.9 ± 31.3 µm, 570.7 ± 30 µm, and 552.7 ± 32.8 µm, respectively. The differences between pairs of mean CCT for the methods are statistically significant for the pairs of Galilei-UP, AL-Scan-Galilei, and Lenstar LS900-Galilei. Bland-Altman plots showed that AL-Scan-UP have the closest agreement, followed by Lenstar-UP and AL-Scan-Lenstar. Galilei was found to have the poorest agreement with the other three methods. The intraobserver repeatability of the AL-Scan was very good with an intraclass correlation coefficient (ICC) of 0.980. CONCLUSION: We found that CCT measurements between the AL-Scan-UP, Lenstar LS900-UP, and AL-Scan-Lenstar LS900 showed very strong correlation and comparable agreement. AL-Scan-UP showed the closest agreement and these devices can be used interchangeably in clinical practice. Galilei significantly showed higher value of CCT compared to other methods. It was also observed that the Al-Scan had excellent intraobserver repeatability.

Chromosomal microarray analysis of patients with Duane retraction syndrome.

PURPOSE: Duane retraction syndrome (DS) is a rare congenital strabismus with genetic heterogeneity. The genetic causes of DS are not always of monogenic origin; various chromosomal copy number variations (CNVs) have also been reported. The objective of our study was to characterize the CNVs, including gains and losses detected by high-resolution chromosomal microarray in patients with DS. METHODS: Twenty patients with DS were investigated using high-resolution chromosomal microarray analysis (CMA) (Affymetrix CytoScan Array 750 K). Conventional cytogenetic analysis was also performed. RESULTS: All samples revealed normal karyotype by cytogenetic analysis. However, in all our patients, multiple CNVs, including gains and losses, were detected using the high-resolution CMA method. Chromosomal loci 1q21.2, 2p11.2-q11.1, 2q21.1-q21.2, 4p16.1, 7p11.2-q11.21, 14q32.33, 17p11.2-q11.1 and 20p11.1-q11.21 were the most frequently affected regions. CONCLUSIONS: This study emphasized that CNVs in several chromosomal regions are known to be involved in DS. We also underscore the genetic heterogeneity of DS. Our suggestion is that genes located in the most frequently affected regions should be focused on in the following candidate gene studies.

Choroidal Thickness in Strabismus and Amblyopia Cases.

PURPOSE: The aim of our study was to examine the effect of hypermetropia and anisometropic, exotropic, and esotropic amblyopia on choroidal thickness. METHODS: A prospective, cross-sectional, comparative study of 120 children under the age of 16 years was conducted. Choroidal thickness was measured in patients with hypermetropia, anisometropia, esotropia, exotropia, and controls. RESULTS: The mean subfoveal choroidal thickness in the control and hypermetropia groups was 323.9±69.0 µm and 348.9±64.5 µm, respectively. Mean choroidal thickness in amblyopic and fellow eyes was 387.4 and 351.9 µm in anisometropic, 353.8 and 338.7 µm in exotropic, 347.5 and 336.5 µm in esotropic, and 389.3 and 359.3 µm in esotropic+anisometropic groups, respectively. Choroid was significantly thicker in amblyopic eyes of anisometropic group compared to fellow (P=0.004) and control (P=0.03) eyes. The difference of choroidal thickness was not significant between both eyes and when compared to control eyes in the other groups. CONCLUSIONS: Anisometropic amblyopic eyes had thicker choroids compared to controls and fellow eyes. However the choroidal thickness was not significantly different between amblyopic and fellow eyes of esotropic or exotropic patients.

Comparison of Anterior Segment Measurements with Optical Low-coherence Reflectometry and Partial-coherence Interferometry Optical Biometers.

AIMS: To evaluate a new noncontact optical biometer using partial-coherence interferometry and to compare the clinical measurements with those obtained from the device using optical low-coherence reflectometry (OLCR). SETTING AND DESIGN: Ondokuz Mayis University, Samsun, Turkey. Nonrandomized, prospective clinical trial. SUBJECTS AND METHODS: The study was performed on the healthy phakic eyes of volunteers in the year 2014. Measurements of axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT), mean keratometry (K), and white-to-white (WTW) measurements obtained with the low-time coherence interferometry (LTCI) were compared with those obtained with the OLCR. STATISTICAL ANALYSIS USED: The results were evaluated using Bland-Altman analyses. The differences between both methods were assessed using the paired t-test, and its correlation was evaluated by Pearson's coefficient. RESULTS: We examined seventy participants with a mean age of 33.06 (±9.7) (range: 19-53) years. AL measurements with LTCI and OLCR were 23.7 (±1.08) mm and 23.7 (±1.1) mm, respectively. ACD was 3.6 (±0.4) mm and 3.5 (±0.4) mm for LTCI and OLCR, respectively. The mean CCT measurements for both devices were 533 (±28) mm and 522 (±28) mm, respectively. The mean K readings measurements for LTCI and OLCR were 43.3 (±1.5) D and 43.3 (±1.5) D, respectively. The mean WTW distance measurements for both devices were 12.0 (±0.5) mm and 12.1 (±0.5) mm, respectively. CONCLUSIONS: Measurements with LTCI correlated well with those with the OLCR. These two devices showed good agreement for the measurement of all parameters.

Prediction of severe retinopathy of prematurity using the screening algorithm WINROP in preterm infants.

PURPOSE: To assess the sensitivity and specificity of weight gain, insulin-like growth factor 1 (IGF-1), and neonatal retinopathy of prematurity (WINROP) algorithm to predict proliferative retinopathy of prematurity (ROP), in a Turkish population of preterm infants. METHODS: The medical records of infants screened and monitored for ROP from 2007 to 2014 were analyzed retrospectively. Birth weights of infants born before 32 weeks' gestation were recorded on the WINROP online database system weekly until postmenstrual week 36. The sensitivity, specificity, and positive and negative predictive values of the WINROP algorithm were analyzed. RESULTS: A total of 223 infants were included. WINROP yielded a low-risk result in 106 infants (48%) and a high-risk result (red alarm) in the remaining 117 infants (53%). The sensitivity of the WINROP online system was found to be 84.3% (27/32), whereas its specificity was found to be 52.8% (101/191). The time between the first alarm and treatment was 8.59 ± 3.92 (2-15) weeks. Using this algorithm, 106 infants would not have needed eye examinations, possibly resulting in a 40% decrease in the total number of examinations. CONCLUSIONS: The WINROP online system is a valuable and easy-to-use monitoring system that could decrease the number of infant ROP examinations.

Optic Disc, Macula, and Retinal Nerve Fiber Layer Measurements Obtained by OCT in Thyroid-Associated Ophthalmopathy.

Aim. To compare the measurements of retinal nerve fiber layer (RNFL), macula and optic disc parameters obtained by optical coherence tomography (OCT), and intraocular pressure (IOP) between the patients with thyroid-associated ophthalmopathy (TAO) and healthy controls. Methods. One hundred and thirty-two eyes of 66 patients with TAO and 72 eyes of 36 healthy controls were included in the study. Proptosis level was determined by Hertel exophthalmometer. Optic disc, peripapillary retinal nerve fiber layer, and macula parameters were measured by OCT. All measurements of the patients were compared with those of age- and sex-matched healthy controls. Results. No statistically significant difference was found between the patients with TAO and control group in terms of demographic characteristics (P > 0.05). Exophthalmometer measurements and IOP were higher in TAO group (P < 0.05). Mean macula thicknesses in TAO and control groups were 239.3 ± 29.8 µm and 246.6 ± 31.8 µm, respectively, and the difference between the groups was statistically significant (P = 0.000). TAO group had thinner inferior RNFL thickness and macular thicknesses (superior, inferior, temporal, and nasal) and higher disc area and C/D ratio when compared with the control group (P < 0.05). Conclusion. IOP, disc area, and C/D area ratio were higher in the patients with TAO and the thicknesses of macula and inferior RNFL were thinner when compared with healthy controls. This trial is registered with registration number at clinicaltrials.gov NCT02766660.

A Possible Cause of Nasolacrimal Duct Obstruction: Narrow Angle Between Inferior Turbinate and Upper Part of the Medial Wall of the Maxillary Sinus.

BACKGROUND: To search the relationships between the primary nasolacrimal duct obstruction and the angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus. DESIGN: Retrospective study. PARTICIPANTS AND METHODS: Computed tomography findings of 35 patients with primary nasolacrimal duct obstruction and 100 sides of 50 individuals were reviewed. While the study group was composed of patients who had external dacryocystorhinostomy surgery, the control group was composed of patients who had CT scans due to headache, sinusitis and smell dysfunction. Epiphora complaint was evaluated with the lacrimal syringing. The exclusion criteria were: age less than 20 years, previous nose, sinus, turbinate or lacrimal surgery, prior history of maxillofacial fracture, nasopharyngeal malignancy, reflex hypersecretion, and associated pathology of the lacrimal canaliculi. MAIN OUTCOME MEASURES: The angle of inferior turbinate. RESULTS: The mean angles were 53.2° (range, 37.9-82.9°) for affected side of the study group, 58.6° (range, 32-85.3°) for the unaffected side of the study group and 56.8° (range, 41.2-76.9°) in the control group. The difference between the angles was statistically significant between the study and the control groups (p < 0.05). The difference between the operated and non-operated sides of the study group was also statistically significant (p < 0.05). CONCLUSION: Although this study was performed in a small group, we thought that the narrow angle between the bony inferior turbinate and upper part of the medial wall of the maxillary sinus might be a possible causative factor in primary acquired nasolacrimal duct obstructions.

The effect of pupil dilation on AL-Scan biometric parameters.

The purpose of this study was to investigate the effects of pupil dilation on the parameters of the AL-Scan (Nidek Co., Ltd, Gamagori, Japan). We compared the measurements of axial length (AL), anterior chamber depth (ACD), central corneal keratometry reading, pupil diameter, and intraocular lens (IOL) power of 72 eyes of 72 healthy volunteers and patients scheduled for cataract surgery before and 45 min after instillation of cyclopentolate hydrochloride 1 % using the AL-Scan. Intraobserver repeatability was assessed by taking three consecutive recordings of ACD and AL. Only ACD readings were significantly different between predilation and postdilation (P < 0.001). The difference of the other measurements between two sessions was not statistically significant (P > 0.001). Only two cases in the study demonstrated changes in IOL power higher than 0.5 D. The intraobserver repeatability of both devices was good (CV values for ACD and AL were 0.16 and 0.20 %, respectively). Dilated pupil size did not affect the measurement of IOL power using the A-Scan optical biometer, but increase in ACD after dilation should be taken into account when performing refractive surgeries in which ACD is very important such as phakic anterior chamber IOL implantation.

Papillophlebitis associated with the use of oral contraceptive: a case report.

We present a 20-year-old female patient with papillophlebitis in the right eye. Minimal expansion of the blind spot and nasal peripheral defects in the right eye visual field were detected. The patient was using ethinyl estradiol-cyproterone acetate for ovarian cyst and menstrual irregularity. An improvement in the patient's visual field began within a week after cessation of ethinyl estradiol-cyproterone acetate. Ophthalmoscopic findings resolved completely in the sixth week. This situation suggests that female sex hormones or thromboembolic process caused by them may be responsible for the pathogenesis of papillophlebitis. But the exact mechanism in the pathogenesis of papillophlebitis is still controversial.

Effects of Birth Weight on Anterior Segment Measurements in Full-Term Children Without Low Birth Weight by Dual-Scheimpflug Analyzer.

PURPOSE: To evaluate the effects of birth weight on ocular anterior segment parameters in full-term children without low birth weight using the Galilei Dual-Scheimpflug Analyzer. DESIGN: Retrospective cohort study. METHODS: The right eyes from 110 healthy children, 3-6 years of age, were scanned with the Galilei Dual-Scheimpflug Analyzer. A total of 78 eyes were measured in full-term children with birth weight of >2500 g. Central, paracentral, pericentral, and the thinnest corneal thicknesses; anterior and posterior keratometry (average, steep, flat); axial curvatures; asphericity of cornea; anterior chamber depth and volume; and iridocorneal angle values were measured. Axial length, lens thickness, and vitreous length were obtained by ultrasound biometry. RESULTS: The mean age of children was 55.86 ± 12.52 (mean ± SD) months. Mean birth weight and gestational age were 3426.3 ± 545 g and 39.4 ± 1.2 weeks, respectively. Although lens thickness, vitreous length, axial length, and anterior chamber volume were moderately correlated with birth weight (P < .05), there was no relationship between birth weight and anterior chamber depth. With the exception of pericentral corneal thickness, all regions of corneal thicknesses were correlated with birth weight (P < .05). Birth weight was negatively correlated with anterior curvature (P < .05) and had no relationship to posterior curvature. While central and paracentral axial curvatures correlated with birth weight (P < .05), pericentral axial curvature did not. CONCLUSION: Preschoolers who were born heavier had thicker cornea and lens, longer axial length, and flatter corneal curve. The thicknesses and axial curves of central cornea within 7 mm may be particularly associated with birth weight.

Incidence of retinopathy of prematurity in the middle Black Sea region of Turkey over a 10-year period.

PURPOSE: To report the incidence of retinopathy of prematurity (ROP) in babies with a birth weight of ≤1750 g over a 10-year period in the north of Turkey. METHODS: The medical records of 2,365 preterm babies who had been referred for ophthalmological examination were retrospectively reviewed, and children with a birth weight of ≤1750 g were included. The incidence of ROP was compared between two successive 5-year periods: 2004-2008 and 2009-2013. RESULTS: A total of 1,565 babies were included: 624 in the first period and 941 in the second. The incidence of ROP significantly increased during the second period compared to the first (35.3% vs 48.2% [P < 0.001]). The number of patients who required treatment was 11.9% in the first period and 11.4% in the second (P = 0.768). CONCLUSIONS: Although the incidence of ROP increased during the latter period of study (2009-2013), the numbers of treatment-requiring cases were similar in both periods.

Hyaluronidase in ophthalmic evisceration surgery.

BACKGROUND: To research the effectiveness of hyaluronidase in evisceration surgery. METHODS: A total of 34 patients were studied as three groups: conventional surgery group (n = 13); isotonic fluid group (n = 8); and hyaluronidase group (n = 13). Hyaluronidase and isotonic fluid were introduced into the uveo-scleral space. Intraocular content was removed, if possible by a one-scoop method, with the aid of a spoon. RESULTS: Removing all the intraocular content as a one-scoop method was achieved in 10 of 13 (77%) in the hyaluronidase group and four of eight (50%) in the isotonic fluid group. The one-scoop method was not possible in any case without the introduction of fluid. The mean durations for the evisceration procedure were 32, 36.6 and 40.5 min in the three groups, respectively (P < 0.05). CONCLUSIONS: Using hyaluronidase in evisceration surgery greatly facilitates and speeds up the removal of all the intraocular content in ophthalmic evisceration surgery.

Papillophlebitis: Treatment of Vision Loss Due To Subretinal Fluid with Intravitreal Ranibizumab.

There are no specific treatment protocols for papillophlebitis, which is basically a central retinal vein occlusion (CRVO) occurring in young adults. The present report is that of a 14-year-old girl, who presented with blurred vision in her right eye. Although her visual acuity (VA) was initially 20/20, there were venous engorgements, blurry disc margins, and a substantial collection of subretinal fluid. She was diagnosed with papillophlebitis. When, 2 weeks later, her VA had decreased to 20/200, she was administered intravitreally injected ranibizumab. One week post-injection, her VA had returned to normal (20/20) and the subretinal fluid had diminished markedly. Intravitreal ranibizumab injection appears to be an effective treatment modality for this condition.

Suspected endothelial pencil graphite deposition.

A 14-year-old male patient had an ocular trauma with a pencil. Biomicroscopic examination revealed a broken part of pencil into the cornea. Foreign body removal and corneal wound closure were performed in the same day. After corneal repair, there was a grade 4+ anterior chamber reaction just like in preoperative examination. Dilated examination showed a very small piece broken tip of pencil on the upper nasal quadrant of the lens. A small and linear deposition was also seen on endothelial surface. Endothelial deposition and foreign body disappeared with intensive topical steroid treatment.

Is symptomatic atherosclerotic cerebrovascular disease a risk factor for normal-tension glaucoma?

OBJECTIVE: To compare the incidence of glaucomatous optic disk appearance between patients with symptomatic atherosclerotic stroke and healthy individuals with normal intraocular pressures (IOP). SUBJECTS AND METHODS: 46 patients with ischemic stroke with evident lacunar infarction or large vessel atherosclerosis, and 93 age- and sex-matched healthy individuals, all with normal IOP, were included. Patients and controls were examined for the presence of high cup-to-disk ratios (> 0.5). RESULTS: Seven patients (15.22%) in the ischemic cerebrovascular disease (CVD) group and 3 controls (3.23%) had glaucomatous optic disk appearance. All subjects with glaucomatous optic disk appearance in the control group and 3 patients in the study group had visual field defects in concordance with normal-tension glaucoma (NTG). The incidence of glaucomatous optic disk appearance was significantly higher in the group with symptomatic atherosclerotic CVD. CONCLUSION: Atherosclerotic CVD is a risk factor for having glaucomatous optic disk appearance. Symptomatic atherosclerosis involving the brain vasculature may also affect the eye and lead to NTG. Patients with ischemic strokes due to large artery atherosclerosis or small artery occlusion must be examined and followed for NTG.

Necrotizing scleritis due to varicella zoster infection: a case report.

PURPOSE: To report a case with necrotizing scleritis due to varicella-zoster infection. METHODS: The patient records were evaluated. The present literature was investigated using MEDLINE. A six-year-old boy with varicella infection was admitted to our clinic with redness, pain, and lid edema on the right eye. Slit lamp examination revealed lid edema, purulent secretion, conjunctival injection and chemosis, and inferotemporal scleral necrosis. Sclera was avascular and the conjunctiva was spontaneously detached from sclera in the necrotic region. RESULTS: Systemic and topical acyclovir treatment was started and a rapid improvement achieved in signs and symptoms. CONCLUSIONS: Ophthalmic manifestations of varicella infection are potentially blinding especially in the absence of appropriate diagnosis and medical intervention. Distinctive skin eruptions are specifically helpful in the early diagnosis of the disease.