Ocular pulse amplitude and retrobulbar blood flow change in dipper and non-dipper individuals.

PURPOSE: To evaluate ocular pulse amplitude (OPA), IOP values, and hemodynamic changes in the ophthalmic artery, central retinal artery, and short posterior ciliary artery in dipper and non-dipper patients. METHODS: A total of 59 right eye measurements of healthy subjects with normotensive were included to the study. Ambulatory blood pressure (BP) monitoring measurement (ABPM), Doppler imaging, and OPA measurements were performed in the same day. The patients in which systolic BP decreased during the nocturnal time by 10% of the diurnal BP or more were called dippers. A patient whose nocturnal systolic BP fell by <10% or even rose was defined as non-dipper. Color Doppler imaging was used for blood flow velocity assessment of ophthalmic, central retinal, and posterior ciliary arteries. For each artery, peak systolic and end-diastolic velocities (PSV and EDV, respectively), resistive index (RI), and pulsalite index (PI) were automatically calculated by the machine. Mean IOP and OPA values were calculated after three consecutive measurements. RESULTS: The mean OPA in non-dipper patients was significantly lower compared with that of dipper patients (P=0.011). There was no significant difference in IOP levels between groups. There was no significant difference in the PSV, EDV, RI, and PI in the ophthalmic, posterior ciliary, and central retinal arteries between the groups. CONCLUSION: Our study demonstrated that OPA level in non-dippers is lower than dippers. This may give additional information about the effect of BP changes on OPA values.

Comparison of dynamic contour tonometry and noncontact tonometry in ocular hypertension and glaucoma.

PURPOSE: To assess the agreement in the measurement of intraocular pressure obtained by dynamic contour tonometer (DCT) and noncontact tonometer (NCT) in patients with glaucoma and ocular hypertension, to investigate the effect of corneal thickness on pressure readings by both instruments, and to assess the reproducibility of dynamic contour tonometer. METHODS: NCT and DCT measurements were made on 104 eyes of 104 patients with primary open-angle glaucoma (n=75) or ocular hypertension (n=29), and agreement was assessed by means of Bland-Altman plots. The effect of corneal thickness on both tonometers was assessed by linear regression analysis. Interobserver and intraobserver variations for dynamic contour tonometer were assessed in 41 eyes of 41 patients. RESULTS: The mean difference+/-SD (95% limits of agreement) between NCT and DCT was -0.80+/-2.98 (-6.6 to 5.1) mm Hg (P=0.009) and no relation between NCT/DCT differences and average was found. The intraocular pressure readings obtained by noncontact tonometer depended on central corneal thickness (P<0.001, adjusted r(2)=0.301). However, dynamic contour tonometer readings showed no effect of corneal thickness (P=0.388, adjusted r(2)=-0.002). The coefficient of repeatability for DCT was 0.92 (95% CI 0.85-0.96, P=0.001). CONCLUSION: In subjects with primary open-angle glaucoma and ocular hypertension, NCT and DCT readings are not interchangeable. DCT measurements, unlike NCT measurements, did not depend on corneal thickness.

24-h IOP control with latanoprost, travoprost, and bimatoprost in subjects with exfoliation syndrome and ocular hypertension.

PURPOSE: To compare the 24-h IOP reductions induced by latanoprost, travoprost, and bimatoprost in eyes with exfoliation syndrome (XFS) associated with ocular hypertension (OH). METHODS: This was a prospective, randomized, single masked, and parallel design study with 15 patients in each treatment group. After washout of any previous medications, each patient underwent a baseline 24-h IOP curve testing at 0600, 0900, 1200, 1500, 1800, 2100, and at 2400 (midnight) hours. Patients were then randomized to receive latanoprost, travoprost, or bimatoprost once a day for 3 months. The 24-h curve testing was repeated at first week, and first and third months. RESULTS: Maximal and minimal IOP was recorded at 0600 and 1800-2100 hours. There was no significant difference among treatment groups at any time-point except for the first week. At the first week, the travoprost group had significantly lower IOP levels than the latanoprost and bimatoprost groups. All medicines significantly lowered 24-h IOP from baseline (P=0.001 for each). Although there was no significant difference in IOP reduction among groups at first week and first month, bimatoprost reduced the 24-h IOP (7.9+/-1.4) more than travoprost (6.6+/-0.5) at the end of the third month (P=0.003). The mean 24-h range of IOP was lowest with travoprost in all visits, and between-group differences was significant for travoprost vslatanoprost (P=0.007) and travoprost vsbimatoprost (P=0.001) at the third month. CONCLUSION: Latanoprost, travoprost, and bimatoprost were effective in reducing the 24-h IOP in patients with XFS and OH, and more research is required with a larger study.

The effect of reading and near-work on the development of myopia in emmetropic boys: a prospective, controlled, three-year follow-up study.

This study aimed to investigate the effect of reading and near work on myopic development in emmetropic boys in school age. It involved totally 114 children in two groups. Right eyes of 67 randomly selected students (mean age=12.93) with mean 6 h of reading and near work (Group 1) were compared with the right eyes of 47 apprentices (mean age=12.96) working as skilled laborers (Group 2). Cycloplegic refraction, keratometric readings and biometric measurements including anterior chamber depth (ACD), lens thickness (LT), vitreous chamber depth (VCD) and axial length (AL) were performed for 3 years at 18 month intervals. Two analyses were conducted: (1) for subjects in both groups with baseline refractive error from +0.50 to -0.50 D; (2) for all subjects in both groups with baseline refractive error from +1.00 to -1.00 D. For subjects with baseline refractive error of +/-0.50 D, myopic shift was present in 20 of 41 (48.8%) in group 1 and in seven of 37 (18.9%) in group 2 at the end of the study. The magnitude of the myopic shift was 0.56 and 0.07 D in group 1 and 2, respectively. For subjects with a baseline refractive error of +/-1.00 D, myopic progression was present in 40 of 67 (59.7%) in group 1 and in 10 of 47 (21.3%) in group 2 at the last readings. In this larger refractive range, the magnitude of the myopic shift was 0.61 and 0.12 D in group 1 and 2, respectively. The mean ACD, VCD and AL were significantly higher in the last readings after 36 months than in the first readings (for each, P=0.0001) in group 1. There was no statistically significant difference between two measurements of these parameters in group 2. The final keratometric dioptric readings were lower than the first values (for each, P=0.0001) in both groups at the end of the study. This prospective and controlled study suggested that reading and near work, important environmental factors, might cause refractive myopic shifts in emmetropic students. The myopic shift was primarily related to significant increases in ACD, VCD and AL in this young age group.

Bilateral myopia following blunt trauma to one eye.

PURPOSE: To evaluate bilateral myopia following blunt trauma to one eye. CASE REPORT: Traumatic myopia is a rare transient situation which may be seen in the injured eye or both eyes after blunt ocular trauma. We examined one case with transient myopia in the left eye which had been exposed to a blunt ocular injury. Myopia was also observed in the right eye 12 hours after the trauma. The right eye and left eye had reverted to emmetropia respectively two and six weeks after trauma. DISCUSSION: The myopia may have been due to ciliary spasm arising from stimulation of the efferent autonomic system in the right eye and ciliary body edema in the left eye. CONCLUSIONS: To our knowledge, this is the first reported case developing bilateral transient myopia after the blunt trauma to only one eye.

Incidence of keratoconus in subjects with vernal keratoconjunctivitis: a videokeratographic study.

PURPOSE: To detect the incidence of keratoconus by videography in patients with vernal keratoconjunctivitis (VKC) and to evaluate the clinical characteristics of VKC associated with keratoconus. DESIGN: a prospective, cross-sectional (prevalence) study. PARTICIPANTS: Eighty-two consecutive subjects with the diagnosis of VKC. METHODS: Both eyes of VKC subjects were investigated by videokeratography in comparison with slit-lamp biomicroscopy and keratometry. To detect keratoconus, corneal topography maps were examined with modified Robinowitz-McDonnell test. MAIN OUTCOME MEASURES: In this test, maps with central corneal power greater than 47.2 diopters and/or the inferosuperior asymmetry value greater than 1.4 were considered to have a keratoconus pattern. The findings of VKC were also recorded, RESULTS: The distribution of clinical forms of VKC were as follows: 46.34% mixed, 43.90% palpebral, and 9.76% limbal types. Twenty-six (31.7%) of 82 subjects had complications with keratopathy such as pseudo-genontoxon, punctate keratitis, and shield ulcer. Forty-four eyes (26.8%) were detected as keratoconus by quantitative evaluation of videokeratography maps. 14 eyes (8.5%) by biomicroscopy, and 30 eyes (18.3%) by keratometry. The increased incidence of keratoconus was associated with male gender, long-standing disease, mixed and palpebral forms, and advanced corneal lesions. CONCLUSIONS: The higher incidence of keratoconus in our study compared with the previous reports may result from early detection of mild keratoconus by interpretation of color-coded videokeratographic maps with a sensitive quantitative method.

Defective visual field tests in chronic heavy smokers.

PURPOSE: To evaluate the visual field changes in smokers. METHODS: In 24 healthy, chronic, heavy cigarette smokers and 16 age and sex-matched healthy non-smokers, central 30-2 threshold tests were evaluated. The quantitative perimetric indices as objective retinal sensitivity measures were recorded in both eyes, but only those from the second eye were chosen for analysis. The visual field defects were also assessed. RESULTS: All subjects had normal visual acuity. The central visual fields in smokers showed relative to absolute scotomas in 20 degrees to 30 degrees. Quantitative perimetric indices including total threshold dB with red and white target, MD, PSD, and CPSD values were significantly different (p<0.05) between the groups. Smokers showed both diffuse and localised retinal sensitivity decrease. SF showed no significant difference (p>0.05) between the groups. CONCLUSION: In healthy, chronic, heavy cigarette smokers, retinal sensitivity was found to be decreased although central vision was not affected. This is possibly due to a cumulative effect of chronic smoking onto the retinal and/or optic nerve functions without clinically evident optic neuropathy.

Small incision extracapsular cataract surgery with manual phacotrisection.

PURPOSE: To evaluate the safety and efficacy of small incision extracapsular cataract extraction (ECCE) using the manual phacotrisection technique. SETTING: Department of Ophthalmology, Turgut Ozal Medical Center, InönüUniversity, Malatya, Turkey. METHODS: Fifty-nine eyes of 54 patients had small incision ECCE by the manual phacotrisection technique. Mean follow-up was 10 months. After capsulorhexis and hydrodissection were performed, the endonucleus was prolapsed into the anterior chamber and trisected using an anteriorly positioned triangular trisector and posteriorly placed solid vectis. Pieces were extracted with a forceps through a small incision. RESULTS: Postoperatively, best spectacle-corrected visual acuity of 20/40 or better was achieved in 48 eyes (83%) and of 20/25 or better in 28 eyes (47%). The most frequent intraoperative complication was posterior capsule rupture (n = 5). Of eyes that developed posterior capsule rupture, 3 had vitreous loss and 2 had implantation of an anterior chamber intraocular lens (IOL). In 44 eyes, the IOL was implanted in the bag and in 12 eyes, in the ciliary sulcus. The most significant postoperative complication was transient corneal edema, which developed in 32 eyes (54%). No permanent complications (e.g., corneal endothelial decompensation) occurred in any case. CONCLUSIONS: Manual phacotrisection has several advantages such as nucleus safety, less dependence on assistant personnel, the elimination of the phaco machine, and cost effectiveness.

Topically applied water extract of propolis to suppress corneal neovascularization in rabbits.

PURPOSE: Propolis, a natural honey bee hive product, has anti-inflammatory and antioxidative properties. We aimed to assess the possible contribution of topically applied propolis to the suppression of corneal neovascularization (CNV). METHODS: The effect of a water extract of propolis (WEP) 1% drops (group 1) in comparison with dexamethasone 0.1% (group 2) and saline (group 3) on CNV was tested in rabbit corneas injured by silver nitrate cauterization. The extent of CNV was quantitated as the area of CNV and the percent area of CNV for each cornea of the three groups (12 right eyes per group) in the first week of the treatment. The mean percent CNV was used for statistical analysis. RESULTS: The corneas treated with the topical WEP 1% had an almost equal percent CNV as compared with the corneas treated with topical dexamethasone 0.1% and had less percent CNV than the control eyes. The quantitative analysis in groups 1, 2 and 3 revealed that the mean percent CNV was 41.0 +/- 14.1, 39.4 +/- 11.0 and 56.9 +/- 18.4, respectively. The differences between both groups 1 and 3 as well as groups 2 and 3 were statistically significant (p = 0.02 and p = 0.01, respectively), whereas the difference between groups 1 and 2 was not significant (p = 0.86). CONCLUSIONS: The topical application of a WEP 1% has an inhibitory effect on CNV in the rabbit's cornea. The inhibitory effect of propolis was shown to be comparable to that of topical dexamethasone 0.1%, a potent inhibitor of angiogenesis. We suggest that the effect of propolis may partially be due to its inhibitory effect on the activity of both cyclo-oxygenase and lipo-oxygenase.

Does convergence, not accommodation, cause axial-length elongation at near? A biometric study in teens.

To determine whether convergence rather than accommodation has a primary effect on the changes in axial length and other biometric components during near fixation, we measured the anterior chamber depth, lens thickness, vitreous length and axial length in the right eyes of 124 young male subjects while their left eyes focused at distance (6 m) and near (20 cm). The measurements were performed before and after cycloplegia in the right eye, so we aimed to study biometric components of the eye in the states of accommodation and nonaccommodation, but converging at near. While the left eye focused at near, the axial length increased significantly with and without cycloplegia (p < 0.0005 and p < 0.0005). The vitreous length was the main increasing ocular biometric component at near both with and without cycloplegia (p < 0.044 and p = 0.001, respectively). At near, there was no difference between two mean axial length and two vitreous length measurements both with and without cycloplegia (p = 0.672 and p = 0.595, respectively). Under cycloplegia, anterior chamber depth also increased significantly at near fixation (p = 0. 012). Axial elongation at near fixation, mainly due to an increase in vitreous length, may result from the effect of accommodative convergence rather than accommodation itself. Much use of convergence, not accommodation, may be one of the contributing factors in adult onset and adult progression of myopia.

Effects of some probable antioxidants on selenite-induced cataract formation and oxidative stress-related parameters in rats.

The effect of several natural and synthetic compounds on selenite-induced cataract was investigated in rat pups. Simultaneous determination of glutathione S-transferase (GST), selenium dependent glutathione peroxidase (Se-GPx), catalase (CAT), superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels were carried out in the lens, erythrocyte and plasma. The results showed that propolis, diclofenac, vitamin C (Vit-C) and quercetin prevented cataract formation to the extent of 70, 60, 58.4, and 40%, respectively. Standardized extract of Ginkgo biloba (Egb 761) did not affect the cataract formation. Selenite treatment caused a significant decrease in the activity of erythrocyte SOD. This was accompanied by a simultaneous increase in the levels of MDA either in lens and in plasma. A significant increase was shown in erythrocyte GST (substrate ethacrynic acid; eaa), and GPx activities and lens GST (substrate chlorodinitro benzene; cdnb) activity. Antioxidant treatment caused significant changes in enzyme activities and MDA levels. There was no effect of selenite and antioxidants on total body weight increase during the course of the study. Blood parameters did not correlate to lens parameters following selenite treatment. Our results suggest that antioxidant supplementation following selenite exposure may prevent the cataract formation and may enhance antioxidant defence of blood and lens.

Weill-Marchesani syndrome in three generations.

BACKGROUND: Weill-Marchesani syndrome is a rare systemic connective tissue disorder consisting of brachymorphy, brachydactyly, ectopia lentis, spherophakia and glaucoma. METHODS: We report 6 patients with Weill-Marchesani syndrome (with or without ocular involvement) in three generations, identified by screening 26 members of two families. This is the largest family in the literature showing an autosomal dominant pattern of inheritance. RESULTS: Presenile vitreous liquefaction was present in all the younger cases. Weill-Marchesani syndrome was full-blown in two cases in the third generation, in which asymmetrical axial length and glaucomatous damage were present. To our knowledge this is the first report regarding asymmetrical axial length and glaucomatous damage, and presenile vitreous liquefaction in Weill-Marchesani syndrome with or without ocular involvement. CONCLUSIONS: The longer axial length might be the precursor of impending severe glaucomatous damage. Presenile vitreous liquefaction in subtle young cases should alert the physician to the diagnosis of Weill-Marchesani syndrome on screening of the family members.

Autonomic nervous system involvement in Behçet's disease: a pupillometric study.

The aim of this study was to elucidate whether autonomic nervous system dysfunction exists in patients with Behçet's disease by pupillometric tests. Thirty-one patients with Behçet's disease with a mean age of 41.3 years (range 21-64) and 41 control subjects with a mean age of 39.5 years (range 18-66) were selected for the study. To test the autonomic nervous system, four pupillometric techniques were used: pupil cycle time (PCT), dark-adapted pupil size (DAPS), 0.05% pilocarpine drop test, and 1% phenylephrine drop test. In all four tests, there were significant differences between the patients and controls. Mean PCTs were 1,156 ms (range 856-1,560 ms) and 919 ms (range 650-1,261 ms) in the patients and controls, respectively (p < 0.0001). The mean DAPS was 0.45 (range 0.31-0.66) in the patients, whereas it was 0.56 (range 0.42-0.67) in controls (p < 0.001). Iris sensitivity to both 0.05% pilocarpine and 1% phenylephrine showed significant differences between patients and controls, respectively (p < 0.05, p < 0.05). Among all four tests, only 0.05% pilocarpine sensitivity was correlated with the duration of Behçet's disease (p < 0.05). The results suggest that the autonomic nervous system innervating the iris is affected in Behçet's disease. This involvement may be due to the vasculitic nature of Behçet's disease.

Comparison of the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lens.

PURPOSE: To assess and compare the results of primary and secondary implantation of flexible open-loop anterior chamber intraocular lenses (AC-IOLs). METHODS: A series of 57 eyes of 56 patients with flexible AC-IOLs were reviewed in two groups. In group I (n = 35) an AC-IOL was implanted primarily, because of posterior capsule problems during extracapsular cataract extraction (ECCE), and in group II (n = 22) secondarily after intracapsular cataract extraction (ICCE). Follow-up was from 12 to 38 months. RESULTS: Mean post-operative best-corrected visual acuity in group I was significantly lower (20/37.38) than that of group II (20/29.20) (p = 0.044). Best corrected visual acuity of 20/40 or better was achieved in 19 of 29 eyes (65%) in group I, and in 16 of 21 eyes (76%) in group II. The difference was not statistically significant (p > 0.05). In group II 18 eyes (86%) maintained or improved visual acuity. In group I, 17 eyes (49%) had a total of 22 complications, while 7 eyes (32%) had 9 complications in group II (p > 0.05). CONCLUSIONS: Flexible open-loop AC-IOLs are suitable for both primary and secondary implantation to correct aphakia. Secondary implantation of flexible open-loop AC-IOLs after ICCE seems to have a more favourable visual outcome and a lower complication rate than primary implantation in complicated ECCE cases.

Aqueous humor penetration of topically applied ciprofloxacin, ofloxacin and tobramycin.

UNLABELLED: The purpose of this study was to determine the aqueous humor concentrations of topically applied ciprofloxacin (CAS 86393-32-0), ofloxacin (CAS 82419-36-1) and tobramycin (CAS 79645-27-5). Thirty patients undergoing cataract extraction or trabeculectomy were randomly divided into three groups and each of the group received either 0.3% ciprofloxacin, ofloxacin or tobramycin topical drops preoperatively. Eyedrops were instilled for six times at a frequency of one drop every 15 minutes, beginning 90 minutes before initiation of the surgery. At the time of surgery, 0.1 ml aqueous fluid was aspirated from the anterior chamber. Concentrations of the antimicrobial agents were determined using the microbroth dilution procedure outlined by the National Committee for Clinical Laboratory Standards. Escherichia coli (ATCC 25922) was used as a standard strain for determination of minimal inhibitory concentrations (MICs). The mean aqueous levels of ciprofloxacin and ofloxacin were found to be 0.092 +/- 0.077 microgram/ml, 0.964 +/- 0.693 microgram/ml, respectively. Tobramycin did not reach the concentration that could be detected by applied method. CONCLUSION: The mean aqueous humor levels of ofloxacin and ciprofloxacin were more than the MICs levels for most of the ocular pathogens which may cause postoperative endophthalmitis.

Caffeic acid phenethyl ester to inhibit posterior capsule opacification in rabbits.

PURPOSE: To assess whether caffeic acid phenethyl ester (CAPE) prevents posterior capsule opacification (PCO) by suppressing the transformation of the lens epithelial cells. SETTING: Departments of Ophthalmology, Chemistry, and Pathology, Turgut Ozal Medical Center, University of Inonu, Malatya, Turkey. METHODS: Twenty pigmented island rabbits having phacoemulsification in their right eyes were randomized into two groups. In group 1, 10 micrograms/ml of CAPE was added to the anterior chamber irrigating solution and a 1% solution of CAPE was injected subconjunctivally for 3 weeks postoperatively. The irrigating solution in Group 2 (control) did not include CAPE. The development of PCO was assessed weekly and its density was graded by slitlamp biomicroscopy. Histologic analysis was performed 3 months after surgery. RESULTS: Group 1 had clear capsules or minor PCO. Group 2 developed more severe PCO or complete opacification. The difference between the two groups was statistically significant (P = .04). CONCLUSION: These preliminary results indicate that CAPE is effective in suppressing PCO in pigmented rabbits and may be beneficial in clinical use in humans because it has no documented harmful effects on normal cells.

Computed tomography dacryocystography.

Twenty-one patients with epiphora were examined by conventional dacryocystography, using Lipiodol as a contrast medium, and CT dacryocystography, using a water soluble contrast medium. In the latter, the material was not introduced under pressure but three or four drops were administered, providing a physiological method of investigation. Subsequently, CT dacryocystography provides functional information about lacrimal disorders and is easy to use.