Association between age-related macular degeneration and 25(OH) vitamin D levels in the Turkish population.

PURPOSE: Age-related macular degeneration is the most common cause of blindness in developed countries, and several factors have been attributed for its etiology. This study was conducted to explore the relationship between serum vitamin D levels and age-related macular degeneration. METHODS: We retrospectively analyzed the data of 114 patients with age-related macular degeneration. A total of 102 patients who did not have any other diseases than refractive error were allocated to the control group. The best-corrected visual acuity, fundus findings, and spectral domain optical coherence tomography findings were analyzed. Patients were allocated to groups based on the Age-related Eye Disease Study classification. Serum 25(OH) vitamin D levels were measured. The central foveal thickness and the subfoveal choroidal thickness were measured by optical coherence tomography. RESULTS: The 25(OH) vitamin D levels in age- and gender-matched patients with age-related macular degeneration and in healthy subjects were 14.6 ± 9.8 and 29.14 ± 15.1 ng/ml, respectively. The age-related macular degeneration group had significantly lower vitamin D levels than the control group (p>0.001). The subfoveal choroidal thickness was lower in patients with age-related macular degeneration (p>0.001). The 25(OH) vitamin D level showed a weak positive correlation with choroidal thickness (r=0.357, p=0.01). When the level of 25(OH) vitamin D was evaluated according to the stages of age-related macular degeneration, it was found to be lower in the advanced-stage disease (p=0.01). The risk for the development of choroid neovascular membrane and subretinal fibrosis was found to increase with decreased vitamin D levels. CONCLUSIONS: Significantly decreased levels of 25(OH) vitamin D in advanced-stage age-related macular degeneration suggest a significant correlation existing between vitamin D deficiency and age-related macular degeneration development. Further studies are required to examine whether vitamin D supplementation has an effect on the development and progression of age-related macular degeneration.

Management of the regression of papilledema with regional axon loss in idiopathic intracranial hypertension patients.

PURPOSE: To use optic coherence tomography (OCT) to evaluate idiopathic intracranial hypertension (IIH) patients with subclinical segmental optic atrophy despite being under apparently effective treatment. METHODS: IIH patients underwent an OCT examination including the peripapillary retina never fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, focal loss volume (FLV) and global loss volume (GLV) of the GCC, and total macular thickness measurements at presentation and at 3, 6, 9, and 12 months after the diagnosis. The obtained data were compared with healthy subjects. Subjects with and without subclinical segmental atrophy at the 12th month were compared according to the demographics, clinical findings, and the OCT parameters recorded at the beginning of the disease. RESULTS: Both eyes of 56 patients with papilledema due to IIH and 50 age- and sex-matched control subjects were included in this prospective case-control study. Regression of papilledema with regional axon loss on the peripapillary RNFL thickness map was found in 37 (33%) eyes in the IIH group. IIH patients with segmental atrophy had the following characteristics when compared to those without segmental atrophy at the beginning of the disease: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, thinner GCC layer, greater FLV and GLV loss, and severe visual field loss. CONCLUSIONS: Axonal loss occurred in the patients despite apparent treatment. It would be appropriate to follow-up with aggressive medical treatment those patients who present with the following characteristics: higher CSF opening pressure, higher grade of papilledema, thicker mean peripapillary RNFL thickness, and thinner GCC.

Effects of Topical Ozone Application on Outcomes after Accelerated Corneal Collagen Cross-linking: An Experimental Study.

PURPOSE: Ozone is a trioxygen molecule that spontaneously degrades into oxygen and oxygen free radicals. This study was designed to assess the effects of topical ozone application on outcomes after corneal collagen cross-linking (CXL). METHODS: Enucleated fresh cadaver yearling sheep eyes (n = 28) were divided into five groups: control (C, n = 6), sham (S, n = 6), ozone only (Z, n = 6), CXL only (X, n = 5), and Ozone + CXL (ZX, n = 5). In all groups, except C, the epithelial layer was removed. In group Z, 20 µg/mL liquid ozone was topically applied. In group X, CXL was performed in the accelerated pulse mode. In group ZX, both CXL and ozone were applied. Post-interventional oxygen levels were determined and corneal confocal microscopy and optical coherence tomography were performed. Corneas were evaluated using light and electron microscopy. RESULTS: Pre-interventional central corneal thickness (CCT) was highest in the control group and considerably similar in the remaining groups (P = 0.006). Pre- and post-interventional CCT were significantly different in the ozonated groups (Z and ZX) (P = 0.028; P = 0.043). Demarcation line depths were similar in groups Z, X, and ZX (P = 0.343). Increased stromal tissue reflectivity was observed in groups Z, X, and ZX. Oxygen levels were higher in the ozonated groups (Z and ZX) (P = 0.006), and caspase activity was higher in the CXL groups (X and ZX) (P = 0.028) as compared to the other groups. Group ZX showed tighter, more regular, and parallel fibrils. CONCLUSION: Ozone increases corneal stromal oxygenation which can probably augment the effect of CXL. Future studies should investigate the safety and feasibility of ozone application during CXL.

The Effects of Adjuvant Tamoxifen Use on Macula Pigment Epithelium Optical Density, Visual Acuity and Retinal Thickness in Patients with Breast Cancer.

Purpose: We aimed to compare best corrected visual acuity, macular pigment optical density and macular thickness in patients with breast cancer, who received oral adjuvant hormone therapy.Materials and Methods: We enrolled consecutive eligible patients with breast cancer who were receiving regular medical tamoxifen treatment. The participants were divided into two groups as cases and controls. Best-corrected visual acuity and retinal thickness were examined. Macular pigment optical density was measured by fundus reflectometry using the one-wavelength reflection method. The output parameters included max optical density, mean optical density, volume and area of the right eye.Results: A total of 104 eyes, cases (n: 50) and controls (n: 54) were included in the study. Mean age in cases was 49.95 ± 9.2 years and 50.21 ± 9.3 years in controls (p = .151). The mean foveal optical density and the maximum optical density differed between cases (0.13 ± 0.03 density units (DU)/0.35 ± 0.07 DU) and controls (0.18 ± 0.04 DU/0.41 ± 0.06 DU) (p = .002/p = .009). Macular pigment optical density volume was 8102.84 ± 2412.67 in cases versus 8280.18 ± 2904.56 in controls (p = .034), and mean MPOD area was 59567.79 ± 11538.06 in cases versus 61748.14 ± 10591.19 in controls (p = .023). The best corrected visual acuity and retinal thickness were similar in both groups (p > .05).Conclusions: Patients in care of oral tamoxifen therapy were found to have significantly reduced macular pigment optical density. In addition, higher drug use duration correlated significantly with reduced macular pigment optical density, suggesting that the poor long-term effects may play a role in macular pigment absorption and incorporation in the retinal tissue.

The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients.

OBJECTIVES: The aim of our study was to detect the presence of conjunctivochalasis (CCh) in obstructive sleep apnea (OSA) patients. METHODS: We included 54 subjects (41 OSA patients and 14 control subjects) in the study. All the patients were assessed regarding the presence and stage of CCh. RESULTS: The patients were grouped according to their apnea-hypopnea index as determined during nocturnal polysomnography in our laboratory as mild (12 patients), moderate (16 patients), and severe (13 patients) OSA. The CCh rate was 87.8% in the OSA group and 57.1% in the control group (P=0.022). Mean CCh stage was 1.58±1.24, 2.38±0.88, and 2.15±0.98 in the mild, moderate, and severe OSA groups, respectively, and 0.71±0.72 in the control group (P=0.0001). CONCLUSIONS: The moderate and severe OSA groups were associated with higher rates and more advanced stages of CCh. We believe that detailed conjunctival assessment is necessary for patients with complaints such as burning, stinging, and foreign body sensation, which we frequently confront in daily practice. In particular, young patients diagnosed with CCh must be carefully assessed regarding sleep apnea. In light of the above findings, we suggest that patients with ocular surface symptoms that are not relieved by topical medical treatment should be assessed for CCh and OSA. Longitudinal studies monitoring the response of CCh to OSA treatment are needed to clarify the relationship between CCh and OSA.

OCULAR FINDINGS IN A PATIENT WITH ECTODERMAL DYSPLASIA.

PURPOSE: Ectodermal dysplasia (ED) results from abnormal development of the ectodermal layer. Although coexistence of ED and retinal pathology has been described, concomitance with retinal venous tortuosity has not been reported in the literature. METHODS: Case report. RESULTS: We report the case of a 23-year-old man with ED with bilateral retinal venous tortuosity, trichomegaly, meibomian gland dysfunction, and dry eye. Although the coexistence of ED with trichomegaly and meibomian gland dysfunction has been previously reported, to the best of our knowledge, this is the first reported case of retinal venous tortuosity associated with ED. CONCLUSION: Coexistence of retinal venous tortuosity and ED may be the consequence of a genetic mutation affecting cellular signaling pathways during retinal angiogenesis.

Association Between Conjunctival and Corneal Calcification and Atherosclerotic Changes in the Carotid Artery in Maintenance Hemodialysis Patients.

PURPOSE: We aimed to investigate the association between atherosclerotic changes in the common carotid artery (CA) and conjunctival and corneal calcification (CCC) in maintenance hemodialysis (MHD) patients. METHODS: Fifty eyes of MHD patients with the highest CCC scores were enrolled. CCCs were scored according to the method described by Tokuyama et al. The eyes with the highest CCC scores were selected for further analysis. According to their CCC scores, the patients were classified into 3 groups: mild (0-2 score), moderate (3-5), and severe (6-10 score). Atherosclerosis of the common CA was evaluated by determination of intima-media thickness (IMT), peak systolic (PSV) and end diastolic (EDV) flow velocities, pulsatility index, and resistive index values by using Doppler ultrasonography. RESULTS: The mean IMT of the CA was 0.61 ± 0.09 mm in the mild group, 0.82 ± 0.16 mm in the moderate group, and 1.21 ± 0.32 mm in the severe group (P < 0.001). The PSV and EDV were significantly higher in the severe group than in the mild and moderate groups (all, P < 0.001). The CCC score was positively correlated with the duration of hemodialysis, ocular surface disease index score, IMT, PSV, EDV, lymphocyte, calcium, and sedimentation rate. In multiple stepwise linear regression analysis, IMT was the best predictive factor for the CCC score (R = 0.812, ß = 9.526 ± 1.05, and P < 0.001). CONCLUSIONS: Our results suggest that chronic ocular ischemia due to atherosclerotic changes may have a role in the formation or progression of CCC in MHD patients.

Choroidal Thickness in Patients with Graves' Ophthalmopathy.

PURPOSE: The purpose of the study is to compare choroidal thickness (CT) in patients with active and inactive Graves' ophthalmopathy (GO) and that in healthy subjects by using spectral domain optical coherence tomography (SD-OCT). METHODS: We conducted an observational, cross-sectional study of 28, 48, and 74 eyes of 14 patients with active GO (group 1), 24 patients with inactive GO (group 2), and 37 age-matched healthy subjects (group 3), respectively. Activity of GO was assessed by using initial clinical activity score (CAS). CT was measured by using SD-OCT. The differences in CT among the groups were compared, and the factors affecting subfoveal CT were analyzed. RESULTS: The mean subfoveal CT was significantly greater in group 1 (395.84 ± 9.68 µm) than that in group 2 and group 3 (319.76 ± 7.07 µm and 314.22 ± 5.74 µm, respectively; p < 0.001) after adjusting for age, axial length, and intraocular pressure (IOP). Subfoveal CT was positively correlated with CAS (p < 0.001; r = 0.567). In multivariate analysis, thicker subfoveal CT was associated with younger age (p < 0.001; correlation coefficient B, -1.67; 95% CI, -2.57 to -0.78); disease activity (p < 0.001; correlation coefficient B, 95.28; 95% CI, 73.14-117.43); and lower IOP ((p < 0.001; correlation coefficient B, -4.09; 95% CI, -8.03 to -0.15). CONCLUSIONS: To our knowledge, this is the first study showing that the mean subfoveal CT increases in patients with active GO. Subfoveal CT may be a useful parameter to monitor disease activity.

Changes in the Choroidal Thickness and Axial Length Upon Mannitol Infusion in Patients With Asymmetric Intraocular Pressure.

BACKGROUND/AIMS: To evaluate the changes in the choroidal thickness (CT) and axial length (AL) upon systemic mannitol infusion in glaucoma patients with asymmetric intraocular pressure (IOP). MATERIALS AND METHODS: Forty glaucoma patients with asymmetric IOP, with the IOP of 1 eye ≥40 mm Hg and the fellow eye <25 mm Hg, were administered 150 mL of a 20% mannitol infusion to reduce the IOP. The CT and AL were measured before and an hour after the infusion. The relationship between the IOP reduction and the changes in the CT and AL were investigated. RESULTS: The mean decrease in the IOP was -14.23 mm Hg (32.15%) and -4.13 mm Hg (21.40%) in the eyes with higher IOP and their fellow eyes, respectively. The mean changes in the subfoveal CT were 19.28 µm (9.20%; P<0.001) and 2.60 µm (1.93%; P=0.452) in the eyes with higher IOP and their fellow eyes, respectively. The mean changes in the AL were -0.10 µm (0.42%; P<0.001) and -0.33 mm (0.14%; P=0.008) in the eyes with higher IOP and their fellow eyes, respectively. Stepwise analysis revealed that the percent IOP change is the most influential factor on the percent change of the subfoveal CT (P<0.0001; R=0.3). CONCLUSIONS: These results suggest that large IOP changes upon mannitol infusion cause the shortening of the AL in both the eyes and the thickening of the choroid only in the eyes with a higher IOP.

Effect of hemodialysis on intraocular lens power calculation.

BACKGROUND: To evaluate changes in ocular biometric parameters after hemodialysis (HD) in patients with end-stage renal disease (ESRD). METHODS: Forty eyes of 40 patients undergoing HD were included in this cross-sectional study. Keratometry (K) readings, white-to-white (WTW) distance, central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter, lens thickness (LT), axial length (AL), and intraocular lens (IOL) power calculation were measured with Lenstar LS 900 (Haag Streit AG, Koeniz, Switzerland) before and after hemodialysis. Intraocular pressure (IOP) was measured with a non-contact tonometer (Tonopachy NT-530P, Nidek Co., LTD, Tokyo, Japan). Main outcomes were changes in biometric parameters after HD. Reliability of the measurements (intraclass correlation coefficients (ICCs)) and the effect size (Cohen's d) were also calculated. RESULTS: Mean difference in AL before and after HD was -0.041 ± 0.022 mm with ICCs > 0.90 (p < 0.001 and Cohen's d = 0.06). Pupil diameter was also significantly different before (4.28 ± 0.81 mm) and after (4.44 ± 0.79 mm) HD with ICCs > 0.90 (p = 0.041 and Cohen's d = 0.20). Hemodialysis had no significant effect on K readings, WTW distance, CCT, ACD, LT, or IOP. CONCLUSION: Axial length and pupil diameter increase after HD with small effect size, while HD does not significantly affect IOL power calculations.

The Acute Effect of Hemodialysis on Choroidal Thickness.

Objective. To determine the effect of hemodialysis (HD) on choroidal thickness (CT). Methods. The right eyes of 41 patients with end-stage renal disease (ESRD) undergoing HD were included. All patients underwent an ophthalmic examination, including CT measurement via optical coherence tomography, intraocular pressure (IOP), blood pressure, and body weight measurement immediately before and after a HD session. Results. Mean subfoveal choroidal thickness (SFCT) after HD decreased significantly from 254.59 ± 84.66 µm to 229.34 ± 77.79 µm (p < 0.001). CT at the temporal and nasal regions also decreased significantly after HD (both p < 0.001). IOP changes after HD were insignificant (p = 0.958). CT difference was insignificant in patients with diabetes mellitus (DM) and without DM before and after HD, respectively (p = 0.285 and p = 0.707). Stepwise multivariate linear regression analysis showed that diastolic blood pressure was the best fitted factor to explain the changes in CT (r = 0.327 and p = 0.040). Conclusion. CT was decreased in the patients with ESRD following a HD session. This study suggested that the changes in CT may be related to the changes in systemic blood pressure.

Tear function in patients with chronic renal failure undergoing hemodialysis.

OBJECTIVES: To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF). MATERIALS AND METHODS: Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed. RESULTS: OSDI scores were significantly higher (p<0.01) and TBUT tests were significantly lower (p=0.01) in CRF patients than in the control group. Schirmer test results were also lower in the CRF patients group, but lacked statistical significance (p=0.20). CONCLUSION: Patients with CRF should be advised to obtain an ophthalmic examination, especially for dry eye.

Assessment of the central corneal thickness and intraocular pressure in premature and full-term newborns.

PURPOSE: To assess the central corneal thickness (CCT) and intraocular pressure (IOP) in premature and full-term newborns. MATERIALS AND METHODS: In this study, we evaluated measurements of CCT and IOP in 45 premature and 45 full-term newborns. IOP was determined with topical anesthesia using a Tono-Pen AVIA, applanation tonometer and a wire lid retractor in premature newborns undergoing screening for retinopathy. Full-term newborns were used as a control group. CCT was determined with a portable pachymeter after IOP measurements had been made in both groups. Because there was high correlation of CCT and IOP between right and left eyes, only the right eye data were used for further analyses. RESULTS: The mean gestational age was 31.5 ± 2.7 weeks (ranging 25-35 weeks) and the mean age at measurement after birth was respectively 36.3 ± 0.9 weeks (ranging 33-37 weeks) in premature newborns and 38.2 ± 0.7 weeks (ranging 38-41 weeks) and 42 ± 2.2 weeks (ranging 39-46 weeks) in full-term newborns. The mean IOP was 16.2 ± 2.7 mmHg (ranging 10-22 mmHg) in premature and 16.6 ± 2.3 mmHg (ranging 10-22 mmHg) in full-term newborns. The mean CCT was found 600 ± 50 µm (ranging 515-790 µm) in the premature group and 586 ± 48 µm (ranging 475-730 µm) in the full-term group. Mean CCT was greater in premature newborns than in full-term newborns, but the difference between groups was not statistically significant (P = 0.7). Mean IOP measurement in two groups was found very similar and the difference also was not statistically significant (P = 0.27). There was no correlation between IOP and CCT, gestational age, gestational weight, age at measurement, weight at measurement neither right nor left eye in both groups in multiple regression analysis. CONCLUSION: We found that premature infants have slightly thicker corneas but no high IOP measurements than full-term newborns. It could be concluded that in premature at the mean gestational age of 36 weeks CCT is not different from that of full-term newborns.

Ophthalmomyiasis externa: three cases caused by Oestrus ovis larvae in Turkey.

Ocular involvement of parasitic infections includes external, internal and orbital ophthalmomyiasis. Oestrus ovis (sheep botfly) is the most common cause of ophthalmomyiasis externa. Living in warm climates, particularly in agricultural districts, is a risk factor. Although external ophthalmomyiasis can be treated by removal of the infecting larva(e) and topical drug treatment, the risk remains of its presence leading to further contamination for other people. We describe three cases of external ophthalmomyiasis due to infestation with the first instar larvae of O. ovis An awareness of larval conjunctivitis in endemic areas may avoid misdiagnosis and allow immediate management to prevent complications.

Impact of intelligent phacoemulsification software on torsional phacoemulsification surgery.

BACKGROUND: The purpose of this study was to compare phacoemulsification energy parameters during torsional phacoemulsification with or without the use of intelligent phacoemulsification (IP) software. METHODS: One hundred and twenty-eight eyes with nuclear grades ranging from 1 to 5 were enrolled in this randomized prospective study. Operated eyes were divided into two groups, ie, those operated on using IP software (Group 1, n = 67) and those operated on without IP software (Group 2, n = 61). The two groups were compared in terms of ultrasound energy level, ultrasound energy time, aspiration time, and amount of fluid used during surgery. RESULTS: Operated eyes were further grouped according to soft (grade 1 and 2, n = 37), medium (grade 3, n = 46), and hard (grade 4 and 5, n = 31) nuclear densities. Both the study and the control groups were similar in distribution of nuclear density (P > 0.05). Cumulative dissipated energy was measured as 14.06 ± 9.92 in Group 1 and 14.22 ± 10.99 in Group 2 (P = 0.92). Total ultrasound time was 49 seconds in Group 1 and 52 seconds in Group 2 (P = 0.58). Although the torsional amplitude used was similar (P = 0.86) when IP was either on (71%) or off (68.4%), aspiration time was found to be 4 minutes 17 seconds in Group 1 (P = 0.86) and 5 minutes and 17 seconds in Group 2 (P = 0.007). Total fluid used was measured as 91 cc (P = 0.86) in Group 1 and 109 cc (P = 0.02) in Group 2. CONCLUSION: The new IP software did not cause a difference in ultrasound energy levels. However, the new software was found to be advantageous in regards to fluid use and aspiration time.

Use of a novel haemostatic agent: ankaferd blood stopper in conjunctival incisions.

BACKGROUND: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, ankaferd blood stopper, in a rat conjunctival incision model. METHODS: Twenty Wistar albino rats were divided into two equal groups (A, B). Limbal incisions of 90-120° were performed in both eyes of all rats. In group A, bleeding at the site of incision was controlled by the administration of ankaferd blood stopper to the right eyes and balanced salt solution to the left eyes. In group B, bleeding was controlled by the application of ankaferd blood stopper to the right eyes and cautery to the left eyes. Time to haemostasis was recorded. After a 4-week period, conjunctival vascularity and postoperative adhesion between Tenon's capsule and sclera were assessed. Additionally, eyes were enucleated and evaluated histopathologically. RESULTS: In group A, the mean bleeding times were 15.2 and 66.7 s for right and left eyes, respectively (P = 0.002). In group B, the mean bleeding times were 17.6 and 17.5 s for right and left eyes, respectively (P = 0.939). Cautery was found to cause significantly more adhesion (P = 0.04). Histopathological examination of the conjunctiva and scleral revealed no statistically significant difference between the samples. CONCLUSIONS: Given the ease of use and lack of histopathological side-effects in the conjunctival incision model, ankaferd blood stopper is promising for use in ophthalmic surgery. Ankaferd blood stopper is a potent haemostatic agent. Its use in ophthalmic surgery should be investigated further in a larger cohort of patients and tested in clinical and experimental models.