Thyroid gland dysfunction and vitamin D receptor gene polymorphism in keratoconus.

OBJECTIVES: To detect the serum level of thyroid hormones, vitamin D and vitamin D receptors (VDR) polymorphism in keratoconus (KC) patients and to identify the association between vitamin D deficiency and thyroid dysfunction in KC. METHODS: This cross sectional study included 177 KC patients with no thyroid disorders compared to 85 healthy controls with normal corneal tomography. Measurements of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4) and serum 25-OH vitamin D were done using Enzyme linked immusoassay (ELISA test). VDR polymorphisms were tested including [Taq I (rs731236), Apa I (rs7975232) and Bsm I (rs1544410)] using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: An increase in frequency of thyroid disorders (P = 0.04), decrease in serum 25(OH) vitamin D level (P < 0.001), Taq 1 and tt genotype (P < 0.001) were significantly distributed in KC patients. A significantly higher serum 25(OH) vitamin D level was reported in TT genotype, while insufficient level was more common in Tt genotype (P < 0.001). A deficient serum 25(OH) vitamin D level was predominant in tt genotype (P < 0.001). A 95% confidence interval was in TSH (1.603, 2.946), FT4 (24.145, 77.06), hypothyroidism (1.062, 67.63), insufficient (2.936, 11.643) and deficient vitamin D (5.283, 28.704) and all were significant risk factors for KC with (P < 0.05). CONCLUSIONS: Both thyroid disorders and low vitamin D are potential factors for KC development. Studying VDR at the molecular level provides interesting avenues for future research toward the identification of new KC cases.

Clinical outcome following reinjection of Ranibizumab for reactivation of retinopathy of prematurity.

BACKGROUND: To assess reactivation after initial intravitreal injection of ranibizumab (IVR) for type 1 retinopathy of prematurity (ROP) or worse and the outcome following reinjection of ranibizumab for this reactivation. METHODS: This retrospective study was performed on infants screened for ROP between March 2013 and February 2020 in Mansoura University Children Hospital, Mansoura, Egypt. Infants treated with ranibizumab 0.25 mg/0.025 mL were identified for review of their clinical outcomes. Data of infants with reactivation and IVR re-injection were analysed. RESULTS: A total of 2318 infants were screened for ROP, 115 (5%) infants (216 eyes) with a mean gestational age of 30 ± 2.5 weeks and mean birth weight of 1290 ± 355.2 g received IVR at mean postmenstrual age (PMA) of 38 ± 3.1 weeks. All treated eyes demonstrated initial regression of ROP. However, ROP reactivation occurred in 5 (2.3%) eyes of 3 patients, at an average of 9.6 ± 2.9 weeks after treatment. None of these eyes had retinal detachment. A second dose IVR was administered and all five eyes showed regression with complete retinal vascularisation, at a mean PMA of 60 ± 5.1 weeks. CONCLUSIONS: IVR is beneficial as an initial and subsequent treatment for type 1 ROP or APROP. A long-term follow-up until complete retinal vascularisation is recommended to avoid disease reactivation.

Corneal Tomographic Analysis Among Patients With Thyroid Gland Dysfunction.

PURPOSE: To analyze the corneal tomographic parameters of patients with thyroid gland dysfunction. METHODS: This case-control study included 100 eyes of 50 patients with thyroid gland dysfunction and 100 eyes of 50 healthy controls. All eyes were examined by Pentacam (Oculus Optikgeräte GmbH). Pentacam parameters were compared between patients with thyroid gland dysfunction and controls. Spearman's correlation coefficient between different Pentacam parameters and the serum level of free thyroxin (T4) and thyroid-stimulating hormone (TSH) was calculated. RESULTS: Patients with hypothyroidism had significantly higher median values of steep and maximum simulated keratometric readings, central corneal thickness (CCT), and thinnest pachymetry (CTmin) than both patients with hyperthyroidism and controls (P⩽ .05). The median values of the average and maximum pachymetric progression index (PPI), posterior elevation, and back difference elevation were significantly higher in patients with hyperthyroidism than in patients with hypothyroidism and controls (P ⩽ .05). The Ambrósio Relational Thickness (ARTmax) was significantly reduced in patients with hyperthyroidism (P ⩽ .001). Both CCT and CTmin showed a moderately positive correlation with serum TSH level and a moderately negative correlation with serum free T4 level. Patients with non-autoimmune thyroid gland dysfunction had significantly thinner CCT, CTmin, and inferior vertical deviation than the autoimmune group (P ⩽ .05). CONCLUSIONS: Thyroid gland dysfunction is associated with significant corneal tomographic changes. Patients with hyperthyroidism tend to have thinner corneas and more abnormal tomographic parameters correlating with keratoconus. No significant tomographic changes were found in association with autoimmune thyroid gland dysfunction. The authors recommend screening and regular follow-up of patients with thyroid gland dysfunction for early detection and management of keratoconus. [J Refract Surg. 2021;37(3):192-197.].

Safety and efficacy of ultrasound ciliary plasty as a primary intervention in glaucoma patients.

AIM: To evaluate the safety and the efficacy of the ultrasound ciliary plasty (UCP) on the intraocular pressure (IOP) control in glaucomatous eyes without previous glaucoma surgery. METHODS: A retrospective study included patients with primary and secondary glaucoma who underwent UCP in Dar AlShifa Hospital, Kuwait between January 2017 to June 2018. High-intensity focused ultrasound procedures were performed under peribulbar anesthesia using the 2nd generation probe with 8s duration of each of the 6 shots. Complete ophthalmologic examinations were scheduled pre-treatment, and at 1d, 1wk, 1, 3, 6 and 12mo post-treatment. Primary outcomes were the IOP reduction and success rates at 12mo, while the secondary outcomes were the occurrence of vision threatening complications and visual acuity. RESULTS: The records of 62 eyes of 62 patients were analyzed with mean age of 63.8y (67.7% males). There was statistically significant reduction in the mean IOP from 35.2±8.3 mm Hg before treatment to 20.6±8.7 mm Hg at 12th month (P<0.0005) with a mean percentage IOP reduction of 42.3% with significant reduction in the mean number of antiglaucomatous drugs from 3.2±0.4 before treatment to 2.1±1.02 at 12mo (P<0.0005). Qualified success was achieved in 77.4% of eyes at 12mo. No major intra- or post-treatment complications were reported. CONCLUSION: Second-generation UCP prove to be effective in reducing IOP in naive glaucoma patients with lower success rates in cases of neovascular and uveitic glaucomas.