Resuturing after penetrating keratoplasty without trauma: Indications and results.

PURPOSE: To determine the indications, frequency, influential factors and clinical outcomes of resuturing in an atraumatic setting after penetrating keratoplasty (PK). METHODS: Medical records of all patients who underwent resuturing in the absence of traumatic wound dehiscences after PK between January 1, 2007 and December 31, 2015 were reviewed. The cases were divided into 2 groups: patients with suture-related problems underwent mandatory resuturing (mandatory group), and patients with post-PK ectasia or a progressive increase in K values and surgically induced astigmatism underwent optional resuturing (Optional group). Patient demographics and surgical indications for PK, reasons for and frequency of resuturing, time between PK and resuturing, and clinical outcomes were evaluated. RESULTS: The frequency of resuturing was 9.03% (59 of 633), and the mean age was 39.15±17.80 years. The most common indication for PK was keratoconus (42.4%) and the interval between PK and resuturing ranged from 0.03 to 32 months. The underlying cause leading to resuturing was suture-related problems in 43 eyes (72.9%), development of ectasia or progressive steepening of the K values and surgically induced astigmatism in 16 eyes (27.1%). The mean visual acuity increased, the K value and astigmatism decreased significantly following resuturing in both the mandatory group and the Optional group (P≤0.2). The decrease in astigmatism and K values was more marked in the Optional group, as expected (P≤0.001). CONCLUSION: While resuturing is essential in order to obtain wound integrity in the setting of dehiscence, it is effective in terms of achieving higher visual acuities and lower astigmatism and K values in high astigmatism and post-PK ectasia cases.

Hybrid contact lenses for visual management of patients after keratoplasty.

AIM: This study aims to report the outcomes of new-generation hybrid contact lenses for visual rehabilitation of postkeratoplasty patients. MATERIALS AND METHODS: Twenty eyes of twenty postkeratoplasty patients were fitted with hybrid lenses. Each patient's keratometric values, ocular surface irregularity indices, central corneal thickness (CCT), uncorrected visual acuity (UCVA), spectacle-corrected visual acuity, contact lens-corrected visual acuity, contact lens fitting data, and contact lens daily wearing time were recorded. Follow-up examinations were performed at 1st week, 1st month, and 3rd month visit after successful fitting of the lenses. RESULTS: The mean age of the patients was 38.42 ± 4.89 years. The mean spherical component of refractive error was -4.46 ± 2.1 D, and the mean astigmatism was -5.31 ± 1.55 D. The median UCVA was 1.00 logarithm of the minimum angle of resolution (logMAR) which improved to 0.40 logMAR after spectacle correction. The median visual acuity with hybrid contact lenses was 0.05 logMAR. The median CCT was 544.4 µm and increased to 549.2 µm at 3 months after contact lens wear. The difference was not statistically significant (P = 0.38). The mean follow-up of patients was 4.32 ± 0.45 months. Eighteen of twenty patients reported a mean of 8.37 ± 1.95 h comfortable wearing time per day during this period. Two patients discontinued contact lens wearing due to conjunctival hyperemia. No graft-related complications such as decompensation, rejection, and infection were documented during the follow-up period. CONCLUSION: The new-generation hybrid contact lenses can be considered helpful in the visual management of postcorneal graft patients, particularly who are unable to achieve an adequate visual outcome with spectacles.

Assessment of conditions affecting surgical success of Ahmed glaucoma valve implants in glaucoma secondary to different uveitis etiologies in adults.

PurposeThere is little known about the long-term efficacy and safety of Ahmed glaucoma valve (AGV) implant and about the conditions affecting surgical success in uveitic glaucoma (UG).Patients and methodsThe charts of adult patients with UG who underwent AGV implantation from 2006 to 2015 were reviewed retrospectively.ResultsData of 46 eyes of 39 patients were evaluated. Mean follow-up was 51.93±23.08 months. Mean preoperative IOP was 37.05±9.62 mm Hg and mean number of preoperative topical anti-glaucomatous medications was 2.98±0.27. One eye (2%) was defined as failure because of implant extraction surgery. In the rest of the eyes, intraocular pressure (IOP) was under control with or without anti-glaucomatous medications during follow-up. The cumulative probability of complete success (IOP control without medications) was 78% at 6 months, 76% at 1 year, 71% at 2 years, 66% at 3 years, and 63% at 4 years (95% confidence interval, 61.24-87.81). The cumulative probability of eyes without complication was 64% at 6 months, 48% at 12 months, 44% at 24 months, 41% at 36 months, and 38% at 48 months (95% confidence interval, 34.64-62.85). Complete success was lower in eyes with previous ocular surgery than the eyes without (P=0.061) and it was lower in eyes with active inflammation at the time of surgery than the eyes without (P=0.011).ConclusionAGV implantation is an effective and safe alternative method in the management of UG, especially when it is performed as a primary surgical option and when no inflammation is present preoperatively.

Subconjunctival amniotic membrane free graft in rabbit eyes: effects on fibrovascular reaction.

PURPOSE: The purpose of our study is to investigate the effect of subconjunctival amniotic membrane free graft on subconjunctival fibrovascular reaction. METHODS: Twelve healthy male white New Zealand rabbits were used for the study. The rabbits were divided randomly into two groups: Study Group (n=6) and Control Group (n=6). In the Study Group, a 4mm limbal incision was made and a 4×4mm subconjunctival pocket was created with blunt dissection. A 4×4mm single layer of free amniotic membrane was placed in the pocket in an epithelium-up fashion without suturing. The limbal opening was secured with 10-0 nylon sutures on both sides. In the Control Group, a 4mm limbal incision was made, a 4×4mm subconjunctival pocket was created with blunt dissection, and the limbal opening was closed with 10-0 nylon sutures on both sides. After the first month, sclero-conjunctival blocks were obtained from the operated area and sections were stained with hematoxylin and eosin, Masson trichrome, and Ki67, SMA and CD34 antibodies. RESULTS: The number of fibroblasts, lymphocytes and macrophages was significantly higher in the Study Group than in the Control Group. The number of Ki67- and SMA-positive cells, and CD34-positive vessels was also significantly higher in the Study Group. Amniotic membrane appeared to form folds in all the specimens. CONCLUSION: The higher fibrovascular reaction shown by our histopathological examination indicates that free human amniotic membrane grafting without suturing is not useful in decreasing the subconjunctival fibrovascular reaction at the first postoperative month in rabbit eyes.

Efecto radioprotector de montelukast sódico en glándulas lagrimales de las ratas después del tratamiento con yodo radioactivo / Radioprotective effect of montelukast sodium in rat lacrimal glands after radioiodine treatment

Objetivo. El objetivo de este estudio fue evaluar los cambios morfológicos de las glándulas lagrimales de las ratas en el tercer mes después del tratamiento con iodo radiactivo (RAI) y el efecto radioprotector de montelukast (ML) sódico contra los daños causados por el RAI en la glándula lagrimal. Métodos. Cincuenta ratas hembra albinas de raza Wistar fueron divididas en 3 grupos. El grupo de control (n = 10) estaba formado por ratas no intervenidas. El grupo de RAI (n = 20) estaba formado por ratas tratadas con 131I orales (111 MBq). El grupo ML estaba formado por ratas tratadas con 10 mg/kg/d de ML sódico intraperitoneal comenzando 3 d antes y continuando durante una semana después de la administración oral del RAI. Las glándulas intraorbitarias (IG), las extraorbitarias (EG) y las de Harder (HG) se eliminaron bilateralmente en 3 meses. Resultados. La existencia de atrofia acinar, fibrosis acinar, líneas celulares anormales, basofilia periférica, la variación de tamaño de las células y la disminución de la cantidad de citoplasma eran significativamente más común en todas las glándulas separadas en el grupo de ratas tratadas con RAI que en el grupo de ratas tratadas con ML. El grupo tratado con ML presentaba menor variación frecuente de la forma celular en las EG (p = 0,001) y las HG (p = 0,027), variación de tamaño de las células en las IG (p < 0,001) y las HG (p = 0,01), enfermedad ductal en las EG (p < 0,001) y las HG (p < 0,001) y menor acumulación de lipofuscina en las EG (p = 0,001) y en las HG (p = 0,01) que el grupo tratado con RAI. Conclusiones. El tratamiento con RAI parece causar daño morfológico en las glándulas lagrimales de las ratas y el ML sódico protege eficazmente a las glándulas lagrimales de ese daño(AU)

Purpose. The aim of this study was to evaluate the morphological changes of rat lacrimal glands at the third month following radioiodine (RAI) treatment and the radioprotective effect of montelukast (ML) sodium against RAI-related lacrimal gland damage. Methods. Fifty female Wistar Albino rats were divided into three groups. The control group (n = 10) consisted of rats with no intervention. RAI group (n = 20) consisted of rats treated with oral 131I (111 MBq). The ML group (n = 20) consisted of rats treated with intraperitoneal 10 mg/kg/day ML sodium, starting three days before and continuing for one week after oral RAI administration. Intraorbital (IG), extraorbital (EG) and Harderian glands (HG) were removed bilaterally after three months. Results. The existence of acinar atrophy, acinar fibrosis, abnormal cell lines, peripheral basophilia, cell size variation and decrease in amount of cytoplasm was significantly more common in the RAI-rat treated group than in the ML group, in each of the glands. The ML-treated group had less-frequent cell shape variation in EG (P = 0.001) and HG (P = 0.027), cell size variation in IG (P < 0.001) and HG (P = 0.01), ductal pathology in EG (P < 0.001) and HG (P < 0.001) and lipofuscin accumulation in EG (P = 0.001) and in HG (P = 0.01) than the RAI-treated group. Conclusions. RAI treatment seems to cause morphological damage to rat lacrimal glands, and ML sodium effectively protects against damage to lacrimal glands(AU)

Radioprotective effect of montelukast sodium in rat lacrimal glands after radioiodine treatment.

PURPOSE: The aim of this study was to evaluate the morphological changes of rat lacrimal glands at the third month following radioiodine (RAI) treatment and the radioprotective effect of montelukast (ML) sodium against RAI-related lacrimal gland damage. METHODS: Fifty female Wistar Albino rats were divided into three groups. The control group (n=10) consisted of rats with no intervention. RAI group (n=20) consisted of rats treated with oral (131)I (111 MBq). The ML group (n=20) consisted of rats treated with intraperitoneal 10mg/kg/day ML sodium, starting three days before and continuing for one week after oral RAI administration. Intraorbital (IG), extraorbital (EG) and Harderian glands (HG) were removed bilaterally after three months. RESULTS: The existence of acinar atrophy, acinar fibrosis, abnormal cell lines, peripheral basophilia, cell size variation and decrease in amount of cytoplasm was significantly more common in the RAI-rat treated group than in the ML group, in each of the glands. The ML-treated group had less-frequent cell shape variation in EG (P=0.001) and HG (P=0.027), cell size variation in IG (P<0.001) and HG (P=0.01), ductal pathology in EG (P<0.001) and HG (P<0.001) and lipofuscin accumulation in EG (P=0.001) and in HG (P=0.01) than the RAI-treated group. CONCLUSIONS: RAI treatment seems to cause morphological damage to rat lacrimal glands, and ML sodium effectively protects against damage to lacrimal glands.

Sexual dysfunction in women with migraine versus tension-type headaches: a comparative study.

The aim of this study was to compare the incidence of sexual dysfunction between patients with tension-type headaches (T), migraines (M) and healthy controls (C) in order to investigate the relationship between sexual dysfunction and the features of headaches. The population comprised of 44 patients with M, 30 with T and 30 with C. They have completed Arizona Sexual Experiences Scale (ASEX), Visual Analog Scale. The number of sexual activities over the past 30 days and the frequency of masturbation behavior in C were considerably higher than those in the headache groups. The averages for ASEX item no. 1, 2, 3 and 4 were significantly higher in those with M versus C; and both the subscales and total scores of ASEX were also higher in those with T than C. The mean score for ASEX item no. 3 and the total ASEX score were significantly higher in T versus M. In both headache groups, no significant relationship was observed between headache features and ASEX. The present study showed that patients with either M or T do experience problems in several aspects of sexuality compared with C. Further research is essential to augment our understanding of the sexual dysfunction in this field.

A new ocular trauma score in pediatric penetrating eye injuries.

PURPOSE: To assess the prognostic value of a new ocular trauma score (OTS) in pediatric penetrating injuries. METHODS: Children ≤ 15 years of age that presented to the emergency room with penetrating eye injuries between April 2007 and August 2008 were evaluated prospectively. All patients were reviewed on the basis of age, gender, time of injury and how it happened, time of admission, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye pathology. Injuries were classified based on a new OTS, and we assessed the relationship with final VA and the new OTS. RESULTS: In total, 30 eyes in 29 patients (41.38% female, 58.62% male) with a mean age of 6.83 ± 4.00 years (range: 1-15 years) were included in the study. Initial VA, which was evaluated in 22 patients, was as follows: no light perception (NLP) in 2 (9.09%) patients, light perception (LP) to hand motion (HM) in 8 (36.36%) patients, counting fingers in 6 (27.27%) patients, 0.1-0.5 in 4 (18.18%) patients, and ≥ 0.6 in 2 (9.09%) patients. Final VA, which was evaluated in 27 patients, was as follows: NLP in 3 (11.11%) patients, LP to HM in 3 (11.11%) patients, counting fingers in 2 (7.41%) patients, 0.1-0.5 in 11 (40.74%) patients, and ≥ 0.6 in 8 (29.63%) patients. The relationship between initial VA and final VA was statistically significant (P < 0.001). CONCLUSIONS: The new OTS calculated at initial examination may be of prognostic value in children with penetrating eye injuries.

A case of retinal detachment in retinitis pigmentosa.

PURPOSE: To report case of retinitis pigmentosa in association with rhegmatogenous retinal detachment. METHODS: An eight year old boy complained of a sudden visual loss. The patient had night blindness, bone spicule-like hyperpigmentation, pale optic disc in both eyes, and the retina was totally detached in the right eye. RESULTS: He was initially treated with conventional scleral buckling surgery, then pars plana vitrectomy with silicone tamponade was performed and retinal reattachment was established. After the phacoemulsification combined with silicone oil removal the final visual acuity of counting fingers was obtained. CONCLUSIONS: The association of retinitis pigmentosa and rhegmatogenous retinal detachment is uncommon in young patients.