Corneal nerve fibre damage precedes diabetic retinopathy in patients with type 2 diabetes mellitus.

AIMS: To quantify the morphological alterations in corneal nerve fibres and cells in patients with type 2 diabetes mellitus in relation to the severity of diabetic retinopathy. METHODS: One hundred and thirty-two eyes of 132 patients with type 2 diabetes and 32 eyes of 32 healthy control subjects were evaluated with in vivo corneal confocal microscopy. Patients with diabetes were classified into three groups: patients without diabetic retinopathy, patients with non-proliferative diabetic retinopathy and patients with proliferative diabetic retinopathy. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve fibre structure were evaluated. RESULTS: Significant reductions in basal epithelial cell, anterior stromal keratocyte and endothelial cell densities were observed only in patients with diabetic retinopathy. However, nerve fibre density, nerve branch density and nerve fibre length were reduced in patients without diabetic retinopathy and worsened progressively with increasing severity of retinopathy. CONCLUSIONS: Corneal cell pathology occurs in patients with diabetic retinopathy, but corneal nerve fibre damage seems to precede the development of diabetic retinopathy.

Follow-up of lupus choroidopathy with optical coherence tomography.

A 36-year-old female followed with the diagnosis of systemic lupus erythematosus complained of bilateral visual loss. Ophthalmological examination revealed disc edema with irregular borders, edematous and pale retina with widespread cotton wool spots, intraretinal hemorrhages and serous retinal detachment in both eyes. Optical coherence tomography (OCT) scans showed intraretinal and subretinal fluid creating cystic cavities with central subfield macular thickness values of 994 and 912( )µm in the right and left eye, respectively. The follow-up scans after the treatment with systemic steroid, acetylsalicylic acid and cyclosporine documented resolution of this fluid accumulation and a decrease in macular thickness measurements. These clearly demonstrated that OCT, which is a fast, objective and non-invasive technology, may be an adjunctive imaging tool for the diagnosis and follow-up of lupus choroidopathy.

Association of age-related macular degeneration with age-related hearing loss.

OBJECTIVE: To assess the association between age-related macular degeneration and age-related hearing loss in Turkish subjects aged 50 years or older. STUDY DESIGN AND SETTING: Prospective, case-control study within a tertiary university hospital. SUBJECTS AND METHODS: Fifty subjects with age-related macular degeneration and 43 healthy subjects underwent ophthalmological and otolaryngological examination. Statistical analyses were conducted for the poorer eye and ear, comparing age-related hearing loss and pure tone average in the macular degeneration group versus controls. RESULTS: Median pure tone average was significantly poorer in the macular degeneration group (35 dBHL) compared with controls (23 dBHL). In the macular degeneration group, hearing loss was significantly greater in dry type (43 dBHL) than wet type (32 dBHL) cases. There was a significant difference between the prevalence of varying degrees of hearing loss in the macular degeneration versus control groups, being respectively: mild, 50 and 35 per cent; moderate, 20 and 5 per cent; and severe, 6 and 0 per cent. There was a weak, but significant correlation between each patient's visual acuity and pure tone average results (r(s) = -0.37, p < 0.001). CONCLUSION: Age-related hearing loss is more common in patients with age-related macular degeneration. Such patients should be questioned regarding hearing difficulty, and referred to an otolaryngologist if appropriate.

Effect of altered eating habits and periods during Ramadan fasting on intraocular pressure, tear secretion, corneal and anterior chamber parameters.

PURPOSE: To determine whether altered eating habits and periods, especially the pre-dawn meal, during Ramadan fasting have any significant effect on intraocular pressure (IOP), tear secretion, corneal and anterior chamber parameters. METHODS: IOP, basal tear secretion (BTS), reflex tear secretion (RTS), and Pentacam measurements of 31 healthy volunteers were performed at 0800 and 1600 hours during Ramadan fasting and 1 month later during non-fasting period. RESULTS: Comparison of measurements between fasting and non-fasting periods at 0800 hours revealed significantly higher values for IOP (P=0.005), RTS (P=0.006), and BTS (P=0.014) during fasting. Conversely at 1600 hours, IOP was significantly lower during fasting (P=0.013) and no statistically significant difference was noted for RTS and BTS. IOP showed a diurnal variation of 2.45 mmHg (P<0.001) and BTS showed a 3.06 mm decrease (P=0.04) during the fasting period. No significant differences could be found in the corneal and anterior chamber parameters during fasting and non-fasting periods. CONCLUSIONS: Our results revealed that fluid loading at the pre-dawn meal during Ramadan fasting might increase the IOP and tear secretion in the early morning period and these values decrease remarkably at the end of 12 h of fasting due to dehydration.

Long-term results of Nd:YAG laser treatment for premacular subhyaloid haemorrhage owing to Valsalva retinopathy.

AIMS: Valsalva retinopathy produces sudden visual loss, which may be prolonged if untreated. Nd:YAG laser enables rapid diffusion of premacular subhyaloid haemorrhage. This study was performed to assess the long-term results and safety of Nd:YAG laser treatment in cases with Valsalva retinopathy. METHODS: Sixteen patients had Nd:YAG laser treatment to drain premacular haemorrhage. The follow-up period was 24 months. RESULTS: All eyes had marked clearing of haemorrhage and immediate improvement of vision following laser treatment. In 14 eyes visual acuity improved to 20/20 level at the end of the first week and the remaining two patients achieved 20/20 level within 1 month. No patient had evidence of retinal or choroidal damage. CONCLUSION: Nd:YAG laser treatment for Valsalva retinopathy is an effective, non-invasive, and safe procedure for patients with a premacular subhyaloid haemorrhage larger than 3 disc diameter and no longer than 3 weeks of duration.

Corneal neovascularization possibly associated with latanoprost therapy.

PURPOSE: To report a case of corneal neovascularization possibly associated with latanoprost therapy. CASE REPORT: A 67-year-old man developed a progressive stromal corneal neovascularization in his right eye within eight months of a corneal trauma. At admission, he was receiving latanoprost 0.005% therapy. His topical medications were rearranged: latanoprost was replaced with carteolol hydrochloride 1% twice daily bilaterally and prednisolone acetate 1% was added twice daily in the right eye. RESULTS: One month later, he presented regression of the corneal neovascularization and an increase in visual acuity. CONCLUSIONS: Latanoprost, an arachidonic acid derivative, could have directly or indirectly stimulated the corneal neovascularization in this patient with a history of nonpenetrating corneal trauma.