Evaluation of Anterior Scleral Thickness and Angle Parameters in Eyes with Pseudoexfoliation Syndrome and Glaucoma.

PRCIS: The relationship between anterior scleral thickness and scleral spur length was disrupted in eyes with pseudoexfoliation, and scleral spur length was shorter in eyes with pseudoexfoliative glaucoma. OBJECTIVE: To evaluate anterior scleral thickness (AST) in eyes with pseudoexfoliation (PX) and to examine the relationship between AST and Schlemm's canal (SC), trabecular meshwork (TM), and scleral spur (SS). METHODS: Thirty-eight patients with PX syndrome (PXS), thirty-eight patients with pseudoexfoliative glaucoma (PXG), and thirty-eight healthy subjects were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3 mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated. RESULTS: In all groups, the AST, SC, and TM measurements were similar (P>0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups (P=0.012). There were significant correlations between TM length and AST in the PXG group (P<0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG (P<0.05). There was a significant relationship between AST0 and SS in healthy eyes (P<0.05), but not in other eyes. CONCLUSIONS: The shorter SS length observed in eyes with PXG may be a sign of structural changes. Additionally, disruption of the relationship between AST and SS may be an early sign of pathological processes, especially in eyes with PXS, and may require closer follow-up of these eyes.

Agreement among Goldmann Applanation Tonometer, Easyton Transpalpebral Tonometer, Tonopen, and Icare in Patients with Keratoconus.

Objectives: The objective of the study is to evaluate the agreement between Goldmann applanation tonometer (GAT) and Easyton transpalpebral tonometer, Tonopen, and Icare in patients with Keratoconus. Methods: This cross-sectional study included 46 eyes of 26 patients with keratoconus. Intraocular pressure (IOP) is measured using easyton, icare, tonopen, and GAT. Measurements were compared and the influences of corneal topographic variables on IOP measurement were evaluated. Bland-Altman plots were used for assessing agreement between different tonometers. Results: The mean age of the participants was 24.08±6.76 (range, 18-47) years (15 males and 11 females). The highest of the mean IOP values measured with different tonometers was obtained with Easyton (12.33±1.65), followed by Tonopen (11.59±2.17), GAT (10.67±1.52), and Icare (10.04±2.33). The mean IOP value measured with Easyton was significantly higher than that measured with GAT (p<0.001). There was no significant difference between GAT and either Tonopen (p=0.154) or Icare measurements (p=0.732). There was no significant difference between Tonopen and Easyton measurements (p=0.421). Icare measurements were correlated with central corneal thickness and keratometric values. GAT measurements were correlated with only Kmax. Thirty-eight (82.6%) of the differences were within the agreement limits (assumed clinically important deviation of up to ±2 mmHg) of GAT and Tonopen, 73.9% (n=34) were within the agreement limits of GAT and Icare, and 78.3% (n=36) were within the agreement limits of GAT and Easyton. Conclusion: Compared with GAT, the gold standard method, Easyton IOP readings were higher, while both Tonopen and Icare readings were similar to GAT. All three tonometers showed acceptable agreement with the GAT, however, Tonopen showed the greatest agreement.

Evaluation of Sudden Visual Loss and Central 10-Degree Visual Field Change Following Glaucoma Surgery in Severe and End-Stage Eyes.

Objectives: The purpose of the study was to evaluate the sudden visual loss and central 10-degree visual field (VF) change following glaucoma surgery in eyes with severe and end-stage glaucoma. Methods: This was a single-center retrospective study. The charts of patients with severe and end-stage glaucoma who had undergone trabeculectomy and Ahmed glaucoma valve (AGV) implantation surgery were reviewed. Patients who had 10-2 Humphrey VF automated (HVFA) at follow-up were included and classified into two following groups: With split fixation on 10-2 HVFA before surgery split fixation group (SFG) and those without split fixation (WSFG). Results: The data of 37 patients in SFG and 28 patients in WSFG were reviewed. The mean follow-up duration was 2.06±0.24 years in SFG and 2±0.3 years in WSFG. 10-2 HVFA revealed that SFG had a mean MD -25.8±5.2 dB preoperatively and -25.2±1.1 dB (p=0.18) at last visit, WSFG had a mean MD -9.8±4.8 dB preoperatively and -10.8±1.5 dB at last visit (p=0.10). In SFG, the mean intraocular pressure (IOP) decreased from 30.1±9.5 mmHg to 12.3±0.62 mmHg (p<0.001), and in WSFG, the mean IOP decreased from 30±6.9 mmHg to 12.3±0.90 mmHg at last visit (p<0.001). There was no statistical difference for visual acuity of both the groups at the follow-up (p=0.30 and p=0.70). In SFG, one patient had wipe-out phenomenon who had undergone AGV surgery. Conclusion: Although wipe-out phenomenon was a rare complication, it can develop not only after trabeculectomy but also after AGV surgery, and patients with split fixation and severe and end-stage glaucoma were at risk for this phenomenon regardless of the type of surgery. Both trabeculectomy and AGV surgery appear to provide stability of the central 10° VF.

Effect of Diabetes Mellitus and Systemic Hypertension on Macular Hole Surgery.

OBJECTIVE: To evaluate the anatomical and functional results of macular hole surgery in patients with diabetes mellitus (DM) and hypertension (HT) without retinopathy. STUDY DESIGN: Descriptive comparative study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Turkey between January 2016 and December 2020. METHODOLOGY: This study included 141 eyes of 139 patients who underwent pars plana vitrectomy for macular holes. The patients were divided into two groups according to the anatomic closure after surgery. Group 1 (cases) were patients with macular hole closure, and group 2 (controls) were patients whose macular hole was not closed. The patients with and without diabetes mellitus (DM) or hypertension (HT) were compared. All patients did not have retinopathy. After surgery, the anatomical closure rate of the macular hole and the amount of increase in visual acuity were measured. Significance of the difference between the groups was evaluated using chi-square test. RESULTS: The best-corrected visual acuity (BCVA) was 1.30 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). While BCVA was 1.3 logMAR before surgery in the group with DM, it was 0.7 logMAR after surgery (p<0.001). In the group with HT, BCVA was 1.3 logMAR before surgery and 0.7 logMAR after surgery (p<0.001). The anatomic success rate after surgery in patients with DM was similar to the group without DM (p=0.93). The anatomic success rate after surgery in patients with HT was similar to the group without HT (p=0.46). CONCLUSIONS: In the absence of retinopathy there is no difference between the success rates of the macular hole surgery in patients with or without DM and HT. KEY WORDS: Diabetes mellitus, Hypertension, Vitrectomy, Macular hole.

The effect of uneventful cataract surgery in pseudoexfoliation glaucoma with or without previous mitomycin C-augmented trabeculectomy.

PURPOSE: To analyze the effect of uneventful cataract surgery on intraocular pressure (IOP) in pseudoexfoliation glaucoma (PXG) eyes with and without a history of Mitomycin C-augmented trabeculectomy. METHODS: Eyes with PXG that had underwent uneventful cataract surgery were enrolled. The IOP and the medication numbers before cataract surgery, and 1, 3, 6, 12, 18, 24 months after cataract surgery, and at the last visit were recorded in PXG with and without previous trabeculectomy. Failure was defined as IOP > 21 or ≤ 21 mmHg with additional medication or surgery. In the postoperative first 24 h, IOP > 50% above baseline was defined as an IOP spike. RESULTS: In the trabeculectomized eyes (n = 37), the increase in the mean IOP (p = 0.024) and the increase in the mean number of medications (p = 0.007) was significant at the last visit when compared with baseline. In the non-trabeculectomized eyes (n = 42) there was a significant decrease in the mean IOP (p = 0.016) and in the mean number of medications (p = 0.038) at the last visit. Twelve eyes (32.4%) in trabeculectomized group and six (14.3%) in the non-trabeculectomized group experienced failure. An IOP spike was seen in one eye in the trabeculectomized group, in 15 eyes in the non-trabeculectomized group (p < 0.0001). The IOP spike was a significant risk factor for failure (p = 0.027). CONCLUSION: Uneventful cataract surgery may have significant negative effect on the IOP control in the trabeculectomized PXG eyes. After cataract surgery, the non-trabeculectomized PXG eyes had a higher risk of IOP spike and an IOP spike may be a risk factor for failure.

Evaluation of Bruch's membrane opening-minimum rim width and retinal nerve fiber layer thickness in adults with anisometropic amblyopia.

PURPOSE: To investigate the relationship between Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in adult patients anisometropic amblyopia using spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: In this cross-sectional, observational study, 43 anisometropic eyes with corresponding fellow eyes. BMO-MRW (shortest distance from BMO to the internal limiting membrane) and peripapillary RNFLT were obtained with Spectral Domain Optic Coherence Topography (SD-OCT). Global and six sectors values according to the legacy distribution of the SD-OCT (nasal [N], nasal superior [NS], temporal superior [TS], temporal [T], temporal inferior [TI], and nasal inferior [NI]) for both RNFLT and BMO-MRW were evaluated. RESULTS: Mean RNFLT and BMO-MRW measurements comparison showed no significance between anisometropia and fellow eyes. In correlation analyses ; although all sectors showed significant positive correlations; the global, TS and NI BMO-MRW sectors were significantly correlated with their corresponding RNFLT within both anisometropia and fellow eyes. In subgroup caparison analyses RNFLT and BMO-MRW showed no differences between amblyopia and fellow eyes. On subgroups correlation analyses, there were not a consistent correlation sectors between RNFLT and BMO-MRW. CONCLUSIONS: In the analysis of the BMO-MRW and RNFLT measurements obtained by SD-OCT in adult anisometropic amblyopia patients, both parameters were evaluated not significant on showing structural changes. In correlation analysis within amblyopic and fellow eye groups, while there was positive correlation on all sectors, statistically significant relationships were detected in global, NI, TS sectors for both BMO-MRW and RNFLT measurements.

Systemic Inflammatory Biomarkers in Patients with Fuchs' Uveitis Syndrome: Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio.

OBJECTIVE: To evaluate the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in patients with Fuchs' uveitis syndrome (FUS). STUDY DESIGN: A case-control study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Haydarpasa Numune Training and Research Hospital, Turkey, between July 2016 and June 2019. METHODOLOGY: Twenty-eight patients with unilateral FUS and 30 healthy subjects were enrolled in the study. The NLR and PLR were calculated from complete blood counts tests; and compared between the groups. RESULTS: There were 28 patients (14 females, 14 males; median age: 33.5 (30-47.5) in the FUS group; and 30 patients (16 females, 14 males; median age 37.5 (33-41.8) in the healthy group. The NLR (1.7 v.s 1.2, p = 0.036 was found to be significantly higher and PLR was lower (100.27 ±37.13 v.s. 141.68 ±26.50 p <0.001) in the FUS group compared with the healthy controls. The median WBC (p <0.001), neutrophil (p <0.001), lymphocytes (p <0.001), and monocyte (p=0.041) values were found significantly higher in the FUS group compared with controls. The significant correlations were not seen between the number of anterior chamber cells; which are ocular inflammatory parameter and NLRs (r = 0.312, p = 0.106) and PLRs (r = 0.148, p = 0.453). CONCLUSION: The current study suggests that a slowly progressive immune-mediated process can affect peripheral blood inflammatory biomarkers and there is evidence of benign subclinical systemic inflammation in patients with FUS. Key Words: Fuchs uveitis syndrome, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio.