Serum Vitamin D Levels in Patients with Acute Anterior Uveitis.

PURPOSE: To evaluate serum 25-hydroxyvitamin D levels in patients with acute anterior uveitis (AAU). METHODS: This observational case-control study involved 20 patients with AAU, and 20 consecutive, age and sex-matched healthy subjects without any ocular or systemic diseases. Serum 25-hydroxyvitamin D was quantified with electrochemiluminescence technique. RESULTS: No significant differences were found between the groups with respect to age (p = 0.185) and sex (p = 0.465). Serum vitamin D levels of the subjects with AAU (mean 5.75 ± 4.50 ng/mL, median 4.00 ng/mL, range: 3.00-19.00 ng/mL) were significantly lower than the control group (mean 12.96 ± 5.89 ng/mL, median 11.00 ng/mL, range: 5.20-25.92 ng/mL) (p<0.001). CONCLUSIONS: We found significantly low serum levels of vitamin D in patients with AAU, which suggest that vitamin D deficiency may play a role in the pathogenesis of anterior uveitis. Further studies are necessary to demonstrate the efficacy of vitamin D supplementation in the management of patients with anterior uveitis.

Pain Perception in Phacoemulsification with Topical Anesthesia and Evaluation of Factors Related with Pain.

OBJECTIVES: Evaluation of pain during and after phacoemulsification with topical anesthesia in patients with senile cataract and investigation of factors related with pain. MATERIALS AND METHODS: Ninety-two adult patients scheduled for routine clear corneal phacoemulsification with topical anesthesia who had no previous cataract surgery in their fellow eyes were included in the study. Verbal pain scale and visual analog scale were used to measure pain intensity. Demographic characteristics, concomitant systemic diseases, drug consumption, need of additional anesthesia during surgery, surgical complications, duration of surgery and surgeon comfort were also evaluated for each patient. RESULTS: Seventy-two patients (78.3%) reported pain during surgery and 68 patients (73.9%) reported pain in the period after the surgery. When the intensity of pain during the surgery was evaluated, the percentage of patients reporting mild, moderate and intense pain was 35.9%, 25.0% and 17.4%, respectively. The average verbal pain score during the surgery was 1.4±1.0 (0-3). Reported pain level was not associated with age or gender (p>0.05). Diabetic patients and patients who consumed nonsteroidal anti-inflammatory drugs in the morning before operation reported less pain during and after the surgery (p<0.05). There were no complications except posterior capsule rupture in one patient. Duration of surgery was longer in patients who reported pain during surgery (p<0.05). There was no significant difference between pain reported during surgery and surgeon comfort (p>0.05). CONCLUSION: Patients frequently experience pain during phacoemulsification with topical anesthesia. Although pain perception does not affect surgical success, preoperative administration of analgesics in suitable patients or giving additional anesthesia to patients reporting severe pain during surgery may increase patient comfort.

Oxidative stress parameters and serum magnesium levels in patients with seasonal allergic conjunctivitis.

OBJECTIVE: To evaluate oxidative stress parameters and serum magnesium (Mg) levels in patients with seasonal allergic conjunctivitis (SAC) during the pollen season. METHODS: This observational cross-sectional study involved 35 patients with SAC without any other ocular and systemic diseases, and 38 consecutive, age- and sex-matched healthy subjects. Serum malondialdehyde (MDA), adjusted ischemia modified albumin (IMA), and Mg levels were quantified, and the results were compared between the groups. RESULTS: No significant differences were found between the groups with respect to age (p = 0.416) and sex (p = 0.362). Serum MDA and adjusted IMA levels of the subjects with SAC (69.54 ± 7.71 µM and 0.74 ± 0.39 ABSU) were significantly higher than the control group (64.61 ± 5.89 µM and 0.57 ± 0.19 ABSU) (p = 0.002 and p = 0.025, respectively). There was no significant difference for serum Mg levels between the groups (p = 0.177). CONCLUSION: We demonstrated higher levels of oxidative stress parameters in patients with SAC compared to the control group, which imply a possible role of oxidative stress in the pathogenesis of SAC.

Evaluation of the peripapillary retinal nerve fiber layer and ganglion cell-inner plexiform layer measurements in patients with iron deficiency anemia with optical coherence tomography.

OBJECTIVE: To evaluate the thickness of the peripapillary retinal fiber layer (RNFL) and macula ganglion cell-inner plexiform layer (GCL+) using optical coherence tomography (OCT) in patients with iron deficiency (ID) anemia. METHODS: This study included 73 eyes of 39 patients with ID anemia and 68 eyes of 34 age- and sex-matched healthy subjects. The measurements included the peripapillary RNFL thicknesses as average, 4 quadrant and 12 clock-hour (CH) based and macula GCL+ thicknesses as average and 6 quadrant based. All measurements were completed with Cirrus HD-OCT and the results were compared between the groups. RESULTS: A total of 73 eyes of 39 patients with ID anemia and 68 eyes of 34 healthy subjects were included to the study. Regarding peripapillary RNFL thicknesses of the study and control patients, the values of average and quadrants revealed no significant differences between the groups. In CH sectors comparison, peripapillary RNFL thicknesses were significantly decreased only in CH4 (68.7 ± 14.5 µm in study versus 72.0 ± 13.4 µm in control patients, p = 0.049) and CH5 (93.4 ± 20.0µm in study versus 102.2 ± 20.1 µm in control patients, p = 0.01) sectors. All measured quadrants were statistically similar, when macula GCL+ thicknesses were compared between the groups. When the correlations between peripapillary RNFL and macula GCL+ thicknesses and serum hemoglobin and ferritin levels of study and control patients were calculated, the only statistically significant parameter was the correlation of peripapillary RNFL thickness in CH10 sector with serum ferritin level (p = 0.032, Spearman correlation coefficient: 0.369). CONCLUSION: The study revealed that peripapillary RNFL is thinner in nasal-inferior quadrant in patients with ID anemia. The measurements of macula GCL+ thicknesses were similar between the groups. Analyzing the retinal layers using OCT may provide valuable information in neurodegenerative events.

Comparison of brimonidine-timolol and dorzolamide-timolol in the management of intraocular pressure increase after phacoemulsification.

AIM: To compare the effectiveness of brimonidine/timolol fixed combination (BTFC) and dorzolamide/timolol fixed combination (DTFC) in the management of short-term intraocular pressure (IOP) increase after phacoemulsification surgery. METHODS: Eighty eyes of 80 patients undergoing phacoemulsification and intraocular lens (IOL) implantation were randomly assigned into three groups. Group 1 consisted of 28 eyes and represented the control group. Group 2 consisted of 25 eyes undergoing phacoemulsification surgery and BTFC was instilled at the end of surgery. Group 3 consisted of 27 eyes undergoing phacoemulsification surgery and DTFC was instilled at the end of surgery. IOP was measured preoperatively and 6, 24h and 1wk postoperatively. RESULTS: There was no statistically significant difference in preoperative baseline IOP among the three groups (P=0.84). However, IOP was significantly lower in groups 2 and 3 compared to the control group (P<0.05 for all comparisons) at all postoperative visits. There was no significant difference between groups 2 and 3 at any visit. Eight eyes (28.6%) in the control group, two (8%) in Group 2 and one (3.7%) in Group 3 had IOP >25 mm Hg at 6h after surgery (P=0.008). However, IOP decreased and was >25 mm Hg in only one eye in each group at 24h after surgery. CONCLUSION: BTFC and DTFC have similar effects in reducing increases in IOP after phacoemulsification surgery and can both be recommended for preventing IOP spikes after such surgery.

Changes in choroidal thickness during pregnancy detected by enhanced depth imaging optical coherence tomography.

AIM: To compare the choroidal thickness measurements of healthy pregnant women obtained in the first trimester with measurements obtained in the third trimester using enhanced depth imaging optical coherence tomography (OCT). METHODS: 54 eyes of 27 healthy pregnant women and 50 eyes of 25 age matched healthy women were enrolled in this observational, cross-sectional study. The pregnant women underwent two OCT scans, one in the first trimester at gestational weeks 6-8, and the other during the third trimester at gestational weeks 32-37; the control group had OCT scanning during the follicular phase of the menstrual cycle, using the enhanced depth imaging mode. Choroidal thicknesses were measured at the fovea, at three locations nasal, and at three locations temporal to the fovea at 500 µm intervals. RESULTS: The choroidal thickness measurements obtained in the third trimester were significantly decreased in all measured points in both eyes compared to the measurements obtained in the first trimester (p<0.05). At the fovea, the mean (±SD) choroidal thickness measured in the first trimester was 349.22±82.11 µm in the right eyes and 341.30±85.22 µm in the left eyes, which decreased to 333.56±76.61 µm in the right eyes (p=0.014) and 326.93±75.84 µm in the left eyes (p=0.024) in the third trimester. Although not statistically significant, choroidal thicknesses of the control group were less than the choroidal thicknesses of the pregnant women (p>0.05). CONCLUSIONS: Choroidal thickness was found to be significantly decreased in healthy pregnant women during the third trimester compared to the first trimester. This finding can provide valuable information when interpreting pregnancy related ocular disorders.

Self-declaration of diabetes and factors associated with having regular eye examinations among patients with type 2 diabetes in Turkey.

PURPOSE: To assess the awareness of diabetic retinopathy (DR), decided by self-declaration of diabetes, and the factors associated with having regular eye examinations among patients with type 2 diabetes in Turkey. METHODS: Between January and June 2014, 3322 adult patients attending an outpatient ophthalmology clinic were screened and 160 patients with type 2 diabetes with a known duration of at least 5 years were included. All patients were asked for their complaints and self-declaration of diabetes was noted. A questionnaire including questions about demographic characteristics, disease process, and follow-up was applied to responders, and all patients underwent a detailed ophthalmologic examination with dilation. RESULTS: A total of 31.9% of the patients self-declared that they had diabetes and/or requested examination for DR. A total of 29.4% reported that they had regular eye examinations. In regression analyses, factors associated with having regular eye examination were longer duration of diabetes (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.01-5.8; p = 0.049), insulin use (OR 4.45; 95% CI 1.7-10.7; p = 0.001), and self-declaration of diabetes (OR 8.16; 95% CI 3.5-19.2; p<0.001). CONCLUSIONS: The rates of self-declaration of diabetes and having regular eye examinations among patients with type 2 diabetes are low in Turkey. All adults undergoing an eye examination should be questioned for diabetes. Education of both patients with diabetes and the health care stuff dealing with them could improve the rates of patients having regular eye examinations and enhance the early detection of DR.

Acute central retinal vein occlusion secondary to reactive thrombocytosis after splenectomy.

The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. The patient was treated with steroids for papilledema and administered coumadin and aspirin. The symptoms resolved, and the findings returned to normal within three weeks. Current paper emphasizes that, besides other well-known thrombotic events, reactive thrombocytosis after splenectomy may cause central retinal vein occlusion, which may be the principal symptom of this risky complication. Thus, it can be concluded that followup for thrombocytosis and antithrombotic treatment, when necessary, are essential for these cases.

Plasma vitamin D and serum total immunoglobulin E levels in patients with seasonal allergic conjunctivitis.

PURPOSE: To evaluate plasma 25-hydroxyvitamin D and serum total immunoglobulin E (IgE) levels in patients with seasonal allergic conjunctivitis (SAC). METHODS: This observational case-control study involved 49 patients with SAC without any other ocular and systemic diseases, and 44 consecutive, age- and sex-matched healthy subjects. Plasma 25-hydroxyvitamin D and serum total IgE levels of all subjects were quantified with electrochemiluminescence technique. Results were compared between the groups, and p values of <0.05 were considered as statistically significant. RESULTS: No significant differences were found between the groups with respect to age (p = 0.41) and sex (p = 0.98). Plasma vitamin D levels of the subjects with SAC (median 8.03 ng/ml, range 3.00-17.97 ng/ml) were significantly lower than the control group (median 10.52 ng/ml, range 3.30-25.92 ng/ml) (p = 0.007). Serum total IgE levels of patients with SAC (median 48.65 IU/ml, range 1.77-812.00 IU/ml) were significantly higher when compared to the control group (median 32.49 IU/ml, range 0.14-104.60 IU/ml) (p = 0.003). CONCLUSIONS: We found lower plasma vitamin D levels and higher serum total IgE levels in patients with SAC.

Enhanced depth imaging optical coherence tomography of the choroid in migraine patients: implications for the association of migraine and glaucoma.

AIM: To compare the choroidal thickness measurements obtained during the attack period and during the pain-free interval in migraine patients using enhanced depth imaging optical coherence tomography (OCT). METHODS: 58 eyes of 29 subjects with a diagnosis of migraine with or without aura were enrolled in this observational, cross-sectional study. Two OCT scans were performed for each patient, one during the peak period of the migraine attack and the other during the headache-free interval, using the enhanced depth imaging mode. Choroidal thicknesses were measured at the fovea, at three locations nasal and at three locations temporal to the fovea at 500 µm intervals. RESULTS: In patients with unilateral headaches, the choroidal thickness measurements obtained during the attack period were significantly increased only in the eyes on the headache side (p<0.001) compared to basal levels. At the fovea, the choroidal thickness measured in the pain-free interval was 373.45 ± 76.47 µm (mean ± SD), which increased to 408.80 ± 77.70 µm during the attack period (p<0.001). When the choroidal thickness measurements of patients with bilateral headaches were compared to basal levels, a statistically significant increase was observed at five out of the seven measured points in the right eyes (p<0.05) and at all seven measured points in the left eyes (p<0.05). CONCLUSIONS: Choroidal thickness was found to be significantly increased in migraine patients during the attack period when compared to basal levels. The possible implications of this finding on the association between migraine and glaucoma are discussed.

Decreased aortic root elasticity-as a novel systemic manifestation of the pseudoexfoliation syndrome: an observational study.

OBJECTIVE: To assess the aortic root function in patients with pseudoexfoliation syndrome (PEXS). METHODS: In this case- controlled observational study, aortic root function in 31 PEXS patients (mean age 71 ± 9 years) and 29 controls of similar ages (mean age 69 ± 9 years) were evaluated by M-mode transthoracic echocardiography. Aortic cross-sectional compliance (CSC), Peterson's elastic modulus (index beta), aortic stiffness index (ASI) and aortic root distensibility (ARD) were calculated by M-mode echocardiography to evaluate the aortic root function. The findings of two groups of patients were compared by Mann-Whitney U test. RESULTS: The CSC and ARD were significantly decreased in patients with PEXS. The CSC was 12.2 ± 6.3 cm²/mmHg in patients with PEXS and 17.5 ± 11.6 cm²/mmHg in the control group (p=0.015). The ARD was 1.56 ± 0.80 cm²/dyne in patients with PEXS and 2.23 ± 1.48 cm²/dyne in the control group (p=0.021). The other two indices of aortic root function were not significantly different between the two groups. CONCLUSION: Aortic root function decreases in patients with PEXS. PEXS may be regarded as a risk factor for cardiovascular and cerebrovascular events.

Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis.

PURPOSE: To evaluate the clinical findings, tear film functions and ocular surface changes in patients with seborrhoeic dermatitis. METHODS: This prospective study involved 63 patients with seborrhoeic dermatitis (Group 1) and 65 control subjects (Group 2). Best-corrected visual acuity measurement, slit-lamp examination, Schirmer I test, tear film break-up time (BUT), Rose Bengal staining and conjunctival impression cytology were performed in all patients. Subjective ocular complaints were scored using an Ocular Surface Disease Index (OSDI) questionnaire. Results between the two groups were compared. RESULTS: In group 1, meibomitis, blepharitis and conjunctival hyperemia were seen significantly more frequently than in group 2 (p < 0.001). Impression cytology revealed grade 0 changes in 25 (39.6%) eyes, grade 1 changes in 22 (34.9%) eyes, grade 2 changes in 13 (20.6%) eyes and grade 3 changes in 3 (4.7%) eyes in group 1, whereas grade 0 changes in 48 (73.8%) eyes, grade 1 changes in 11 (16.9%) eyes and grade 2 changes in 6 (9.2%) eyes were seen in group 2 (p = 0.032). Mean goblet cell density was 795 ± 55 cells/mm(2) in group 1 and 1820 ± 100 cells/mm(2) in group 2 (p < 0.001). Mean Schirmer I and mean BUT results were statistically lower in group 1 than in group 2 (p = 0.043 and p < 0.001, respectively). Mean Rose Bengal scores and mean OSDI scores were statistically higher in group 1 than in group 2 (p = 0.002 and p < 0.001, respectively). CONCLUSIONS: Our data show that patient with seborrhoeic dermatitis has decreased tear production, tear film instability and significant degeneration of the ocular surface epithelium, compared with normal subjects.

Successful treatment of necrotizing scleritis after conjunctival autografting for pterygium with amniotic membrane transplantation.

PURPOSE: To report a case of necrotizing scleritis after pterygium surgery with conjunctival autografting (CA) and intraoperative Mitomycin C (MMC) and its treatment with amniotic membrane transplantation (AMT) and systemic steroid. METHODS: A 41-year-old woman who had recurrent nasal pterygium underwent pterygium excision with CA and intraoperative MMC. Two weeks after surgery, graft necrosis and necrotizing scleritis associated with severe pain and irritation were observed on her operated eye. RESULTS: Pulse steroid treatment (intravenous 1 g methylprednisolone for 3 days) was initiated and AMT was performed for ocular surface reconstruction. Over the next 2 weeks, the graft vascularization was complete and there was no complication which required further treatment. CONCLUSIONS: Necrotizing scleritis is a rare complication of CA with MMC. Systemic steroid therapy is necessary for subsiding ocular inflammation and AMT can be performed for ocular surface reconstruction.

Aqueous humor and plasma levels of vascular endothelial growth factor and nitric oxide in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

PURPOSE: To investigate levels of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in the aqueous humor and plasma of patients with pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG), compared with controls. METHODS: This prospective study involved 37 patients with PXS, 15 with PXG, and 32 control subjects in whom cataract surgery was indicated. Aqueous humor and plasma VEGF and NO levels were measured with enzyme-linked immunosorbent assay and chemiluminescence methods, respectively. RESULTS: Aqueous humor and plasma VEGF concentrations were higher in patients with PXS and PXG than in controls (P<0.001). Aqueous humor NO concentrations were higher in patients with PXS and PXG than in controls (P<0.05 and P=0.001, respectively). Plasma NO concentrations did not differ between the 3 groups. Aqueous humor and plasma VEGF and NO levels were not significantly different in patients with PXS versus PXG. VEGF and NO levels showed no significant correlation among the 3 groups (P>0.05). CONCLUSIONS: Elevated aqueous humor VEGF and NO levels and plasma VEGF concentrations in eyes with PXS and PXG can be explained by the ischemic nature of these disorders. The lack of correlation between VEGF and NO levels may indicate impaired downregulation, which may have a role in the progression to PXG.

[Function of outer hair cells in patients with pseudoexfoliation]. / Psödoeksfoliyasyon sendromunda dis tüylü hücre fonksiyonu.

OBJECTIVES: In this study, we aimed to assess whether outer hair cell function in patients with pseudoexfoliation syndrome (PES) was affected or not. PATIENTS AND METHODS: Thirty-two patients (21 males, 11 females; mean age 69.8+/-9.3 years; range 49 to 86 years) with the diagnosis of PES and 23 healthy subjects (12 males, 11 females; mean age 65.3+/-9.1 year; range 51 to 79 years) as control group were included in the study. All of the subjects were evaluated with pure tone audiometry, tympanometry, and transient otoacoustic emission tests. RESULTS: Sensorineural hearing loss was present in 28 patients with PES and in 13 healthy subjects (p<0.05). Transient otoacoustic emissions were present in 42 ears of patients with PES and in 32 ears of healthy subjects and there was no statistically significant difference between these two groups (p>0.05). Signal to noise ratios for PES and control groups were 5.1+/-4.4 dB and 5.2+/-4.2 dB, respectively (p>0.05). CONCLUSION: Our results confirmed the presence of sensorineural hearing loss in PES patients. However, we failed to show a difference in outer hair cell functions of this group. Further postmortem histopathologic studies are needed to delineate the causes of sensorineural hearing loss in patients with PES.

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%.

PURPOSE: To determine and compare the amount of apoptosis and changes in rabbit corneal endothelial cell morphology after intracameral administration of different anesthetic agents. SETTING: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. METHODS: Right eyes of 64 Vienna white rabbits were injected intracamerally with preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, levobupivacaine 0.75%, or fortified balanced salt solution (BSS Plus) (control). Animals were humanely killed 1 day or 7 days later. Terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was used to detect apoptosis. Corneal endothelial cells and apoptotic cells were counted by light microscopy. The morphologic appearance was determined by transmission electron microscopy (TEM). RESULTS: Apoptotic cell density was high in the anesthetic groups on day 1 (P<.01); there was no significant difference between groups at 7 days. Apoptotic cell density declined significantly between 1 day and 7 days in the anesthetic groups (P<.05) but not in the control group. There was no difference in endothelial cell density between the 4 groups at 1 or 7 days. All anesthetic groups showed degenerative changes on TEM, with the least change in the preservative-free lidocaine hydrochloride 2% group. CONCLUSIONS: Intracameral injections of preservative-free lidocaine, ropivacaine, and levobupivacaine induced significantly more apoptotic endothelial cell loss than BSS Plus and led to morphologic changes in the corneal endothelial cells in the early period. This effect was temporary, with recovery by 7 days. Considering the limited proliferative capacity in human eyes, the induced apoptosis might result in the permanent cell loss and enlargement in human corneal endothelium.

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin. METHODS: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire. RESULTS: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment. CONCLUSIONS: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.

Conjunctival impression cytology and tear-film changes in patients with familial Mediterranean fever.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients with familial Mediterranean fever (FMF). METHODS: This prospective case-control clinical study examined 35 patients with FMF (group 1) and 35 controls (group 2). All patients underwent a full ophthalmological examination. Ocular surface changes were evaluated by determining cell content of surface conjunctival epithelium using conjunctival impression cytology and tear-film functions using Schirmer-I, break-up time (BUT), corneal fluorescein and Rose Bengal tests. Subjective ocular complaints were scored with a four-point scale. Between-group results were compared. RESULTS: In group 1, impression cytology revealed grade 0 changes in 15 eyes, grade 1 changes in 11 eyes and grade 2 changes in nine eyes in group 1; in group 2, it revealed grade 0 changes in 27 eyes, grade 1 changes in five eyes and grade 2 changes in three eyes (p = 0.013). Mean goblet cell density was 765 +/- 45 cells/mm(2) in group 1 and 1730 +/- 100 cells/mm(2) in group 2 (P < 0.001). Mean results on the Schirmer-I test results were 17.36 +/- 3.18 mm in group 1 and 19.60 +/- 4.17 mm in group 2 (p = 0.364). Mean BUT was 8.20 +/- 1.60 seconds in group 1 and 9.93 +/- 2.33 seconds in group 2 (p = 0.001). Mean corneal fluorescein and Rose Bengal staining scores were 3.26 +/- 1.67 and 0.96 +/- 0.71 in group 1 and 1.37 +/- 0.34 and 0.40 +/- 0.49 in group 2 (p = 0.037, p = 0.005). The presence of subjective ocular complaints was more frequent in group 1 than in group 2. CONCLUSION: Despite normal tear production, the ocular surface and tear-film functions of FMF patients differ from those of healthy individuals. These changes may be related to the chronic inflammatory nature of FMF.

Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo-controlled environmental trial.

PURPOSE: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC). METHODS: This was a prospective, randomized, double-blinded and placebo-controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4-point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology. RESULTS: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo. CONCLUSIONS: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC.