Effect of Hemifacial Spasm on Intraocular Pressure Measurement.

PURPOSE: To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. METHODS: Twenty-four consecutive patients with HFS and 25 age- and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. RESULTS: There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p = 0.33, 0.11) or NCT (p = 0.80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p = 0.63) and NCT (p = 0.54)) in controls. CONCLUSIONS: Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803.

Orbital flourine-18-fluorodeoxyglucose positron emission tomography in patients with Graves' disease for evaluation of active inflammation.

OBJECTIVE: Prediction and early diagnosis of orbitopathy is needed in patients with Graves' disease, especially when radioiodine therapy is planned. Positron emission tomography/computerized tomography (PET/CT) using flourine-18-fluorodeoxyglucose (FDG) is an effective imaging modality in detection of inflammation, however, its ability to detect orbital inflammation has not been well studied. The aim of our study is to determine the ability of FDG PET/CT to detect orbital inflammation related with Graves' disease, identify active orbitopathy, predict the radioiodine-triggered orbitopathy, and find out the effects of radioiodine on orbital inflammation. MATERIALS AND METHODS: Total 31 Graves' disease patients and 17 controls were included. All Graves' disease patients underwent cranial FDG PET/CT imaging prior therapy. Radioiodine therapy and post-treatment PET/CT study was applied to 21 patients. PET/CT images of all examinees were evaluated, measuring extraocular muscle maximum standard uptake value (SUVmax) and muscle thickness. RESULTS: FDG uptake was increased in the majority of extraocular muscles in Graves' disease patients in comparison to controls and this increase was found to be irrelevant from muscle thickness. Extraocular muscle SUVmax values did not increase in Graves' orbitopathy patients who received radioiodine under corticosteroid prophylaxis. SUVmax level of all orbital rectus muscles were increased after radioiodine therapy in nonsmokers, whereas no increase was detected in smokers. CONCLUSION: FDG PET/CT may be helpful in detection of extraocular muscle inflammation and it may show ongoing orbitopathy in early stages of inflammation before anatomical changes occur.

Comparability of Icare Pro Rebound Tonometer with Goldmann Applanation and Noncontact Tonometer in a Wide Range of Intraocular Pressure and Central Corneal Thickness.

PURPOSE: To evaluate the agreement between the reading values of the Goldmann applanation tonometer (GAT), Icare Pro rebound tonometer (IRT) and noncontact tonometer (NCT) in glaucoma patients. METHODS: This cross-sectional study comprised 292 eyes of 292 patients selected from a glaucoma outpatient clinic. The intraocular pressure (IOP) was measured sequentially, at a 10-min interval each, in the following order: NCT, IRT and GAT. The central corneal thickness (CCT) was measured using Pentacam HR before the IOP measurements. RESULTS: The mean IOPs measured by the GAT, NCT and IRT were 20.17 ± 6.73 mm Hg (range: 4-48), 19.77 ± 6.88 mm Hg (range: 3-46) and 19.30 ± 5.15 mm Hg (range: 7.30-44.5), respectively. The correlation coefficients of the GAT and IRT, NCT and IRT, and GAT and NCT measurements were r(2) = 0.673, r(2) = 0.663 and r(2) = 0.938 (all p < 0.001), respectively. The IRT tends to overestimate in the low GAT-measured IOPs, whereas it underestimates in high GAT-measured IOPs. The measurements of all 3 devices were also correlated with the CCT at a statistically significant level (GAT: r(2) = 0.063, NCT: r(2) = 0.063, IRT: r(2) = 0.058). CONCLUSION: The agreement between the IRT and GAT measurements is higher in the IOP range of 9-22 mm Hg, whereas significant discrepancies occur as the IOP deviates from normal values. The variability of the IRT and GAT measurements over a wide range of CCT is minimal.

Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty.

AIM: To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty (PKP). METHODS: In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity (BCVA), corneal endothelial cell count (ECC), and central corneal thickness (CCT). RESULTS: Fifty-five patients were recruited (26 males, 29 females). The mean age was 54.36±4.97y (range 45-64y). All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively, which was statistically significant (P<0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33±1.01s. The mean ECC was 2340.20 cells/mm(2) preoperatively and 1948.75 cells/mm(2) 1mo postoperatively (P<0.001). The increase of 21.09 µm in postoperative pachymetry 1mo after surgery was statistically significant (P<0.001). CONCLUSION: No untoward effects were observed after intracameral injection of moxifloxacin (0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.

Novel method to avoid the open-sky condition in penetrating keratoplasty: covered cornea technique.

PURPOSE: The aim of this study was to present a novel technique to avoid the open-sky condition in pediatric and adult penetrating keratoplasty (PK). METHODS: Seventy-two eyes of 65 infants and children and 44 eyes of 44 adult patients were operated on using this technique. After trephining the recipient cornea up to a depth of 50% to 70%, the anterior chamber was entered at 1 point. Then, only a 2 clock hour segment of the recipient button was incised, and this segment was sutured to the recipient rim with a single tight suture. The procedure was repeated until the entire recipient button was excised and resutured. The donor corneal button was sutured to the recipient corneal rim. The sutures between the recipient button and the rim were then cut off, and the recipient button was drawn out. RESULTS: None of the patients operated on with this technique developed complications related to the open-sky condition. Visual acuities, graft failure rates, and endothelial cell loss were comparable with the findings of studies performed for conventional PK. CONCLUSIONS: The technique described avoids the open-sky condition during the entire PK procedure. Endothelial cell loss rates are acceptable.

Corneal viscoelastic differences between pseudoexfoliative glaucoma and primary open-angle glaucoma.

PURPOSE: The aims of this study were to assess the biomechanical properties of corneas with pseudoexfoliative glaucoma (PEXG) and to compare them with those of patients with primary open-angle glaucoma (POAG). METHODS: This prospective, comparative case series consisted of 73 eyes of 73 patients, 35 eyes with PEXG (PEXG group) and 38 eyes with POAG (POAG group). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPCC), and Goldmann-correlated intraocular pressure (IOPG) were determined by using ocular response analyzer (ORA). IOP using Goldmann applanation tonometer (GAT) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Exclusion criteria included refractive error/astigmatism of >3.00 D, history of intraocular surgery, corneal disease, angle-closure glaucoma, and secondary glaucoma other than PEXG. In cases where both eyes were eligible, the right eye was preferred for analysis. The main outcome measures were CH, CRF, IOPCC, IOPG, and GAT. The results were statistically analyzed by using t test, general linear model, and the Pearson correlation test. RESULTS: The mean CH was found to be significantly lower in patients with PEXG (8.8 ± 1.4 mm Hg) than those with primary open-angle glaucoma (9.9 ± 1.2 mm Hg; P=0.0007). The mean CRF was found to be significantly lower in patients with PEXG (9.5 ± 1.8 mm Hg) than those with POAG (11.1 ± 1.3 mm Hg; P<0.0001). IOPCC was not significantly different between the groups (PEXG, 16.7 ± 2.5 mm Hg; POAG, 16.9 ± 2.4 mm Hg; P=0.72). IOPG was significantly lower in PEXG group (14.7 ± 2.7 mm Hg) compared with the POAG group (16.5 ± 2.5 mm Hg; P=0.004). GAT was significantly lower in the PEXG group (14.6 ± 2.7 mm Hg) compared with the POAG group (16.4 ± 2.8 mm Hg; P=0.007). There was no significant difference between the groups regarding mean CCT (PEXG, 546.1 ± 34.9 µ; POAG, 549.1 ± 25 µ; P=0.66) and mean age (PEXG, 70.3 ± 8.2; POAG, 67.6 ± 8.8; P=0.17). The difference between the IOPCC and the GAT was 2.1 and 0.5 mm Hg in both PEXG and POAG groups, respectively. CONCLUSIONS: Patients with PEXG had lower CH and CRF values than those with POAG. These findings require further investigation to assess the role of differing corneal biomechanical properties between the 2 groups and its association with poor prognosis among patients with PEXG.

Histologic Findings of Corneal Buttons in Decompensated Corneas With Toxic Anterior Segment Syndrome After Cataract Surgery.

PURPOSE: To report the histologic findings of penetrating keratoplasty buttons in decompensated corneas with toxic anterior segment syndrome (TASS) after a cataract surgery is performed. METHODS: We evaluated the histologic findings of 16 corneal buttons of 16 patients who exhibited decompensation findings because of TASS by means of light microscopy. The patients were classified into 3 groups: The first group consisted of 5 corneal buttons with mild symptoms in which the central corneal thicknesses (CCTs) were ≤650 µm, and the visual acuities (VAs) were ≥0.1. The second group consisted of 7 corneal buttons that exhibited moderate symptoms in which the CCTs were between 650 and 750 µm and the VAs were between 0.1 and 0.03. The third group consisted of 4 corneal buttons that had severe symptoms in which the CCTs were ≥750 µm and the VAs were ≤0.03. RESULTS: Light microscopy showed endothelial cell loss, vacuolated and thinned epithelial cell layers, disturbed collagen bonds, and Descemet membrane invaginations in patients in group I. Group II corneal buttons exhibited inflammatory cells (lymphocytes) and extended intercellular space between the epithelial cells, wrinkled Bowman membrane separated from the stroma in some local areas, stromal edema, and early vascularization. In group III, endothelial and epithelial cell layer loss, wrinkled Descemet and Bowman membranes, inflammatory cells, and structurally disturbed collagen bonds located beneath the Bowman membrane, and a greater amount of vascularization in the area of inflammation were observed. CONCLUSIONS: The results of the histologic evaluation of the decompensated corneas caused by the TASS are compatible with the clinical severity of the disease. In mild cases, the histologic findings were insignificant; however, when the clinical situation deteriorated, histologic findings became increasingly worse.

Descemet-stripping automated endothelial keratoplasty in eyes with toxic anterior segment syndrome after cataract surgery.

PURPOSE: To report the results of Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with toxic anterior segment syndrome (TASS) after cataract surgery. SETTING: Department of Ophthalmology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. METHODS: In this prospective study of consecutive patients who had DSAEK for corneal failure due to TASS, the main outcome measures were corneal clarity, mean spherical equivalent (SE) refraction, preoperative and postoperative visual acuities, central corneal thickness, and endothelial cell count (ECC). RESULTS: The mean follow-up in the 10 eyes (10 patients) was 17.1 months +/- 2.4 (SD). There were no graft dislocations postoperatively, and no graft required repositioning. All grafts were clear at 12 months. Two eyes had initial graft rejection that resolved with treatment. All eyes had improved postoperative corrected distance visual acuity, with 7 eyes (70%) attaining 0.5 or better. The mean SE refraction in measurable cases (5 eyes) was 1.2 +/- 0.6 preoperatively and 0.9 +/- 1.0 postoperatively (P = .141). The decrease in mean pachymetry from preoperatively (691 +/- 15 microm) to 12 months postoperatively (614 +/- 23 microm) was statistically significant (P = .005). The mean ECC was 2740 +/- 236 cells/mm(2) preoperatively, 1690 +/- 209 cells/mm(2) at 6 months, and 1683 +/- 206 cells/mm(2) at 12 months. The decrease between preoperatively and 6 and 12 months (P = .05) and between 6 months and 12 months (P = .008) was statistically significant. CONCLUSION: Descemet-stripping automated endothelial keratoplasty was safe and effective in eyes with TASS-associated corneal edema, yielding encouraging surgical and visual outcomes.

Traumatic corneal flap dehiscence 6 years after LASIK.

PURPOSE: To report a case of LASIK flap dehiscence caused by blunt trauma 6 years after uneventful refractive surgery. METHODS: A 32-year-old man presented 3 hours after being struck by a carton edge in his left cornea, causing dehiscence of the LASIK flap. RESULTS: At initial examination, uncorrected visual acuity (UCVA) was 20/200 in the left eye. Minimal flap dehiscence was seen on the inferior corneal quadrant. A therapeutic bandage soft contact lens was placed and topical medical therapy was administered. Ten days after trauma, UCVA was 20/50 and best spectacle-corrected visual acuity was 20/30 in the left eye. At 7-month follow-up, the patient's clinical status did not change. CONCLUSIONS: Blunt corneal trauma occurring several years after uneventful LASIK may cause corneal flap dehiscence. Appropriate and prompt treatment usually is successful.

Interleukin-8, nitric oxide and glutathione status in proliferative vitreoretinopathy and proliferative diabetic retinopathy.

PURPOSE: To evaluate interleukin-8 (IL-8), nitric oxide (NO) and glutathione (GSH) profiles in vitreous humor and blood samples in patients with proliferative diabetic retinopathy (PDR) and in patients with proliferative vitreoretinopathy (PVR) and to compare the levels with those of controls. PATIENTS AND METHODS: NO concentrations were determined by using the Greiss reaction in plasma and vitreous humor samples. GSH levels were determined in both blood and vitreous humor samples, using DTNB, a disulfide chromogen. Vitreous IL-8 were assayed by ELISA. Twenty-three patients with PDR, 18 patients with PVR and 21 cadavers as the control group were included in the study. RESULTS: Plasma and vitreous NO levels were found to be 25.6 +/- 2.1 and 36.9 +/- 3.0 micromol/l in patients with PDR, 27.0 +/- 4.7 and 34.3 +/- 2.9 micromol/l in patients with PVR and 17.4 +/- 2.7 and 15.9 +/- 1.4 micromol/l in controls, respectively. Vitreous humor and plasma NO levels did not show any statistically significant difference between PDR and PVR groups. However, the values for vitreous in both groups were significantly higher than those of controls (p < 0.0001). Although IL-8 levels in vitreous samples of patients with PDR were not significantly different (79.6 +/- 9.7 pg/ml) from those of patients with PVR (42.2 +/- 7.3 pg/ml) (p = 0.06), the levels in both groups were significantly higher than those of controls (19.0 +/- 3.9 pg/ml) (p < 0.0001 and p < 0.05, respectively). Blood and vitreous GSH levels were found to be 5.3 +/- 0.4 micromol/g. Hb and 0.58 +/- 0.16 micromol/l in patients with PDR and 8.4 +/- 0.5 micromol/g. Hb and 15.7 +/- 2.2 micromol/l in patients with PVR and 12.0 +/- 1.1 micromol/g. Hb and 0.26 +/- 0.03 mmol/l in controls, respectively. Vitreous and blood GSH levels were significantly lower in patients with PDR compared to those with PVR (p < 0.0001 for both). CONCLUSION: Elevated levels of vitreous and plasma NO and vitreous IL-8 in PDR and PVR implicate a role for these parameters in the proliferation in these ocular disorders. GSH concentrations both in vitreous and blood samples of the PVR and PDR patients were much less than those observed in the control group. Lower GSH concentrations detected in PDR in comparison with those in PVR in vitreous humor and to a lesser degree in blood may play an important role in pathogenesis of new retinal vessel formation in patients with PDR. This also suggests that oxidative stress may be involved in the pathogenesis of PVR and particularly that of PDR.